A rapid qualitative assessment of oral cholera vaccine anticipated acceptability in a context of resistance towards cholera intervention in Nampula, Mozambique

Démolis, Rachel; Botão, Carlos; Heyerdahl, Leonardo W.; Gessner, Bradford D.; Cavailler, Philippe; Sinai, Celestino; Magaço, Amílcar; Gargasson, Jean-Bernard Le; Mengel, Martin; Guillermet, Élise

doi:10.1016/j.vaccine.2017.10.087

Cited by 33 publications

(45 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These findings resonate with various qualitative reports highlighting the role of institutional trust in vaccination hesitancy across Africa. [28][29][30][31][32] They are also in line with a quantitative study from the Democratic Republic of Congo during the Ebola disease epidemic that documented associations between low trust in the government and Ebola vaccine acceptance. 33 We advanced this literature in two ways.…”

Section: Discussionsupporting

confidence: 72%

“…The role of institutional mistrust in explaining vaccine uptake in Africa has received less research attention. 19 27 Qualitative evidence suggests that institutional mistrust is linked to vaccine hesitancy and refusal across the continent, including in Chad, 28 the Democratic Republic of Congo, 29 Mozambique, 30 Nigeria 31 and South Sudan. 32 Apart from an insightful case study from the Democratic Republic of Congo during the Ebola disease epidemic, 33 quantitative evidence on the role of institutional trust in vaccine hesitancy and uptake is rare.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Institutional mistrust and child vaccination coverage in Africa

Stoop

Hirvonen²,

Maystadt

2021

BMJ Glob Health

View full text Add to dashboard Cite

IntroductionDespite considerable improvements in vaccination coverage over the last decade, half of the world’s unvaccinated and undervaccinated children are located in Africa. The role of institutional trust in explaining vaccination gaps has been highlighted in several qualitative reports but so far has only been quantified in a small number of high-income countries.MethodsWe matched information on child vaccination status from the Demographic Health Surveys with information on institutional trust from the Afrobarometer surveys at the subnational level. A total of 166 953 children from 41 surveys administered in 22 African countries covering 216 subnational regions were used. Based on a principal component analysis, we constructed an institutional mistrust index that combined the level of mistrust in the head of state, parliament, electoral system, courts and local government. Associations between institutional mistrust and child vaccination uptake were assessed with multivariable fixed effects logistic regressions that controlled for time-invariant subnational region characteristics and various child, caregiver, household and community characteristics.ResultsA 1 SD increase in the institutional mistrust index was associated with a 10% (95% CI of ORs: 1.03 to 1.18) increase in the likelihood that a child had not received any of eight basic vaccines and with a 6% decrease in the likelihood a child had received all of the basic vaccines (95% CI: 0.92 to 0.97). Institutional mistrust was negatively associated with the likelihood that a child had received each of the eight basic vaccinations (p<0.05).ConclusionsChild vaccination rates in Africa are considerably lower in areas in which the local population displays high levels of mistrust towards local authorities. Institutional mistrust is an important dimension of vaccine hesitancy, considered as one of the most important threats to global health. Empowering local authorities with resources and communication strategies to address institutional mistrust may be needed to close the remaining vaccination gaps in Africa.

show abstract

Section: Discussionsupporting

confidence: 72%

Section: Introductionmentioning

confidence: 99%

Institutional mistrust and child vaccination coverage in Africa

Stoop

Hirvonen²,

Maystadt

2021

BMJ Glob Health

View full text Add to dashboard Cite

show abstract

“…These outbreaks of cholera show the need to intensify actions of hygiene, sanitation, and health education and determining associated factors of the outbreaks in each of the provinces. In order to reduce case fatalities related to cholera, the government introduced cholera vaccine in Nampula in 2016 as priority considering the background of the province, and more than 425.486 doses of vaccine were sent to Nampula to implement the campaign [49].…”

Section: Bacterial Diarrheamentioning

confidence: 99%

The Epidemiology of Diarrhea in Children Under 5 Years of Age in Mozambique

et al. 2018

View full text Add to dashboard Cite

Purpose of the Review Despite the global mortality reduction in the last two decades, diarrhea remains the second major cause of mortality in children less than 5 years of age, particularly in countries like Mozambique. This article aims to review the available data on the burden and etiology of diarrhea in Mozambique. Recent Findings Epidemiological studies defining the burden and etiology of diarrhea (mostly from Southern Mozambique) have demonstrated a high disease burden and an associated case fatality rate of nearly 10%. Rotavirus, Shigella spp., enterotoxigenic, and enteroaggregative Escherichia coli, Vibrio cholerae, and Cryptosporidium spp. have been reported to be associated with infantile diarrhea. Rotavirus vaccine has greatly impacted in the reduction of diarrheal hospitalization cases across the country. Summary Understanding the local epidemiology of diarrhea across the country is critical for defining and prioritizing other enteric vaccines or interventions that can contribute to accelerate the reduction of morbi-mortality of infantile diarrhea in Mozambique.

show abstract

“…The FGD guide included a set of predetermined questions covering topics on perception of cholera causation, vaccines, and OCV acceptability; practices to prevent and treat cholera; and logistical inputs on space and timeline of vaccine delivery. The FGD Guide was designed on the basis of qualitative assessments of OCV campaigns in Malawi and Mozambique conducted by two authors of this paper [28, 29]. One Research Assistant facilitated the FGD while another recorded and took notes.…”

Section: Methodsmentioning

confidence: 99%

“…Understanding factors influencing participation in the two OCV campaigns in Lusaka can help the MoH better prepare and execute future OCV campaigns. Studies from other countries show that perceptions of cholera, past experience with vaccinations, social disenfranchisement/marginalization, fear of vaccine side effects, and opportunity costs deter participation in OCV campaigns [16–22]. In this paper, we compare the perspectives of those who self-reported 1) not receiving the vaccine (non-vaccinated) and 2) receiving both OCV doses (fully vaccinated) in the three compounds to understand factors that could impact this population’s participation in future campaigns in Zambia.…”

Section: Introductionmentioning

confidence: 99%

“It depends how one understands it:” a qualitative study on differential uptake of oral cholera vaccine in three compounds in Lusaka, Zambia

et al. 2019

Self Cite

View full text Add to dashboard Cite

Background The Zambian Ministry of Health implemented a reactive one-dose Oral Cholera Vaccine (OCV) campaign in April 2016 in three Lusaka compounds, followed by a pre-emptive second-round in December. Understanding uptake of this first-ever two-dose OCV campaign is critical to design effective OCV campaigns and for delivery of oral vaccines in the country and the region. Methods We conducted 12 Focus Group Discussions (FGDs) with men and women who self-reported taking no OCV doses and six with those self-reporting taking both doses. Simple descriptive analysis was conducted on socio-demographic and cholera-related data collected using a short questionnaire. We analyzed transcribed FGDs using the framework of dose, gender and geographic location. Results No differences were found by gender and location. All participants thought cholera to be severe and the reactive OCV campaign as relevant if efficacious. Most reported not receiving information on OCV side-effects and duration of protection. Those who took both doses listed more risk factors (including ‘wind’) and felt personally susceptible to cholera and protected by OCV. Some described OCV side-effects, mostly diarrhoea, vomiting and dizziness, as the expulsion of causative agents. Those who did not take OCV felt protected by their good personal hygiene practices or, thought of themselves and OCV as powerless against the multiple causes of cholera including poor living conditions, water, wind, and curse. Most of those who did not take OCV feared side-effects reported by others. Some interpreted side-effects as ‘western’ malevolence. Though > 80% discussants reported not knowing duration of protection, some who did not vaccinate, suggested that rather than rely on OCV which could lose potency, collective action should be taken to change the physical and economic environment to prevent cholera. Conclusions Due to incomplete information, individual decision-making was complex, rooted in theories of disease causation, perceived susceptibility, circulating narratives, colonial past, and observable outcomes of vaccination. To increase coverage, future OCV campaigns may benefit from better communication on eligibility and susceptibility, expected side effects, mechanism of action, and duration of protection. Governmental improvements in the physical and economic environment may increase confidence in OCV and other public health interventions among residents in Lusaka compounds.

show abstract

A rapid qualitative assessment of oral cholera vaccine anticipated acceptability in a context of resistance towards cholera intervention in Nampula, Mozambique

Abstract: HighlightsPolitical resistance impacts potential OCV acceptability.Perceived vulnerability to cholera overrides rationale for OCV hesitancy.Case-by-case preemptive studies maximize public health intervention acceptability.

Cited by 33 publications

References 19 publications

Institutional mistrust and child vaccination coverage in Africa

Institutional mistrust and child vaccination coverage in Africa

The Epidemiology of Diarrhea in Children Under 5 Years of Age in Mozambique

“It depends how one understands it:” a qualitative study on differential uptake of oral cholera vaccine in three compounds in Lusaka, Zambia

Contact Info

Product

Resources

About