Formative Investigation of Acceptability of Typhoid Vaccine During a Typhoid Fever Outbreak in Neno District, Malawi

Abstract

Abstract. Typhoid fever affects an estimated 22 million people annually and causes 216,000 deaths worldwide. We conducted an investigation in August and September 2010 to examine the acceptability of typhoid vaccine in Neno District, Malawi where a typhoid outbreak was ongoing. We used qualitative methods, including freelisting exercises, key informant and in-depth interviews, and group discussions. Respondents associated illness with exposure to "bad wind," and transmission was believed to be airborne. Typhoid was considered extremely dangerous because of its rapid spread, the debilitating conditions it produced, the number of related fatalities, and the perception that it was highly contagious. Respondents were skeptical about the effectiveness of water, sanitation, and hygiene (WaSH) interventions. The perceived severity of typhoid and fear of exposure, uncertainty about the effectiveness of WaSH measures, and widespread belief in the efficacy of vaccines in preventing disease resulted in an overwhelming interest in receiving typhoid vaccine during an outbreak.

Typhoid fever outbreak investigation in Ofla Woreda, Southern Zone of Tigray Region, Ethiopia, 2016: An unmatched 1:2 case-control

“…Not washing hand after toilet which is consistent with study done in Ethiopia (Getnet, 2014) and poor hygiene of house and compound which is in line with study done in Malawi (Blum et al, 2014), Malaysia (Ramani et al, 2012), Zimbabwe (Muti et al, 2014;Imanishi et al, 2014), Kenya (Akullian, 2015) remains significant factors associated with Typhoid fever contraction. During the investigation of this study, some constraint includes late starting of the investigation leading the cases to take antibiotic therapy which prevented collecting of biological samples for culture confirmation.…”

“…About 10% of untreated typhoid cases can continue to discharge bacilli for three months (Alberta Health, 2014) and between 2-5% of all cases become chronic carriers (WHO, 2011). About 22 million illnesses and 216,000 deaths occurred annually in the worldwide and the majority seen in resource-poor countries like in South Asia and Sub-Saharan Africa (Blum et al, 2014), where clean water and sanitation is inadequate (Buckle, 2012). In Africa, the burden of typhoid fever is largely unknown mainly because diagnosis of typhoid fever like culture is non-existent in many endemic countries (Samuel, 2008).…”

“…Moreover, environmental conditions like lack of access to safe water and sanitation, poor hygiene and poverty, contaminated milk and milk products, poor water and sanitation were associated factors for typhoid fever illness (Blum et al, 2014).…”

Strengthening National Immunization Coverage Capacity and Effectiveness Strategies in Vaccine Preventable Diseases in Rural and Urban Settings in Sub-Saharan Africa

“…Continuous and proper medical supervision and follow up post immunization activities is vital by qualified health professional or trained teachers based on establish mechanisms for enforcement of formal and informal private and public schools or faith based organizations immunization approach. The use of participatory and complementary actions such as monitoring in investigations of disease reports should require community and independent laboratory confirmation to meet clinical case definitions, as well as epidemiological analysis to identify, map and track disease origins, transmission dynamics and high-risk settings [11]. Such investigations commonly involve close and swift data collection and exchange among local, provincial or state and national/federal employees collaboration in educating and alerting health professionals, related science disciplines and communities about important disease patterns and viable information on immunization needs and demand [12].…”

“…Proper care of cold chain equipment and power backup, leading to a loss of vaccine potency, storage and distribution practices, recordkeeping, and stock reconciliation [28]. As local or country cost of acquisition, storage, administration and financial viability complexity in vaccines procurement and delivery, shortages or disruptions of vaccines may lead to parental anxiety and increased demands on the practice setting [1, 7,11,28].…”