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

Abstract

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.

Incorporating qualitative research methods into the monitoring and evaluation of neglected tropical disease programmes: a scoping literature review

“…Rationale for selection of qualitative method : The selected articles provided a broad range of reasons for the use of qualitative methods. These included the need to generate formative insights to influence the design of programmes, such as vaccinations, childhood feeding, Ebola and malaria control, 52–54 , 66 , 68 , 71 , 76 to increase community and stakeholder participation, including with racial and ethnic minority communities in HIV/AIDS prevention, 70 injecting drug users 73 and those undergoing aortic valve implants, 56 and to understand specific operational shortcomings or failures of accepted approaches and policies, many of which were comparative studies reflecting on implementation across multiple countries. 58,60 , 61 , 75 …”

Knowledge, Attitude, and Practice in a Sample of the Lebanese Population Regarding Cholera

“…A previous qualitative study from Mozambique displayed hesitancy towards oral cholera vaccination and recommended the promotion of community engagement in the trust building efforts aiming to address cholera epidemic [ 59 ]. Another study from Zambia recommended the provision of transparency about cholera vaccine effectiveness and possible side effects to promote vaccine uptake and to tackle the possible conspiratorial beliefs regarding the vaccine [ 60 ]. Furthermore, two studies from Tanzania showed the importance of trust in health systems, optimal vaccine campaign implementation, and providing vaccination for free as cholera vaccine acceptance declined if payment was needed as determinants for cholera vaccine uptake [ 61 , 62 ].…”

COVID-19 and the View from Africa

“…Tanzania also has low compliance with HPV screening as part of the battle against cervical cancer, mainly because of a lack of confidence in provision for diagnosis and treatment (Urasa and Darj 2011). As Heyerdahl and Pugliese-Garcia note: Despite universal provision, evidence suggests relatively low vaccination coverage in Zambia' (Babaniyi et al 2013;Heyerdahl et al 2019), with the result that, despite there being provision for universal coverage of vaccinations in Zambia since the 1970s, during 2013-2014 there was only a 60% vaccination take-up rate. A systematic study showed that the principal obstacles to full vaccine coverage in Zambia were a belief in traditional remedies, general aversion to injections and distance from medical centres.…”