Social and cultural determinants of anticipated acceptance of an oral cholera vaccine prior to a mass vaccination campaign in Zanzibar

Scheffold, Christian; Chaignat, Claire-Lise; Hutubessy, Raymond; Khatib, Ahmed; Ali, Said M.; Schindler, Christian; Weiss, Mitchell G.

doi:10.4161/hv.7.12.18012

Cited by 18 publications

(18 citation statements)

References 27 publications

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“…Rural villagers feared that the local healthcare system would be overburdened with cholera cases; this might explain their preference for vaccination, although supplementary WASH activities were also frequently demanded. 25 This finding and the previously reported higher rural than peri-urban willingness to buy the OCV at a price of almost USD 10 25 suggest a higher priority for using OCV in rural Zanzibar.…”

Section: Discussionsupporting

confidence: 72%

“…25 Findings from that study showed that 93.5% of the interviewed adults intended to take a vaccine if offered without charge. However, when offered at three different prices levels-approximately USD 0.9, USD 4.5 and USD 9-acceptance rates dropped to 60.7, 19.4 and 15.2%, respectively.…”

Section: Introductionmentioning

confidence: 97%

“…This approach to analysis followed exactly the one laid out in the study of anticipated OCV acceptance to ensure full technical comparability. 25 Anticipated acceptance if the OCV was offered without charge, and at low, medium and high price, respectively, were also considered as potential explanatory variables; however, only anticipated acceptance of a free OCV was included in an additional focal model because crude analysis showed no associations between intention to buy an OCV and uptake in the campaign (p > 0.2). Because 15.5% of the sample had reported a personal or household episode of cholera, 25 previous illness experience was also considered as potential explanatory variable, but not included in further analyses since crude analysis showed no suggestive association (p = 0.44).…”

Section: Acknowledgmentsmentioning

confidence: 99%

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Social and cultural determinants of oral cholera vaccine uptake in Zanzibar

Scheffold

Ali

Hutubessy

et al. 2012

Human Vaccines & Immunotherapeutics

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Section: Discussionsupporting

confidence: 72%

Section: Introductionmentioning

confidence: 97%

Section: Acknowledgmentsmentioning

confidence: 99%

See 1 more Smart Citation

Social and cultural determinants of oral cholera vaccine uptake in Zanzibar

Scheffold

Ali

Hutubessy

et al. 2012

Human Vaccines & Immunotherapeutics

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“…Recent research in two cholera-endemic communities of Zanzibar, conducted within the framework of a WHO study to evaluate the use of OCV in endemic settings, has shown that a vast majority (∼94%) of the population targeted for the campaign was in principle willing to receive free vaccines against cholera [23]. Since actual OCV acceptance (or uptake) reached only ∼50% in this pre-vaccination sample, an evaluation of social and cultural factors and of barriers to OCV uptake was needed to understand this difference for future cholera control planning in Zanzibar.…”

Section: Introductionmentioning

confidence: 99%

“…Findings reported here are based on the research approach of cultural epidemiology, which was used in pre-vaccination studies to examine social and cultural determinants of anticipated and actual OCV acceptance [23], [24]. Cultural epidemiology [25] is a research approach in health social sciences based on Arthur Kleinman's framework of illness explanatory models [26].…”

Section: Introductionmentioning

confidence: 99%

Improving Community Coverage of Oral Cholera Mass Vaccination Campaigns: Lessons Learned in Zanzibar

et al. 2012

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BackgroundRecent research in two cholera-endemic communities of Zanzibar has shown that a majority (∼94%) of the adult population was willing to receive free oral cholera vaccines (OCVs). Since OCV uptake in the 2009 campaign reached only ∼50% in these communities, an evaluation of social and cultural factors and of barriers was conducted to understand this difference for future cholera control planning.Methodology/Principal FindingsA random sample of 367 adult peri-urban and rural community residents (46.6% immunized vs. 53.4% unimmunized) was studied with a semi-structured interview that inquired about social and cultural features of cholera depicted in a vignette and barriers to OCV uptake. Symptoms (rectal pain, loose skin only in rural community) and perceived causes (uncovered food, contact with contaminated water) specific for severe diarrhea were associated with uptake. Purchasing drugs from pharmacies to stop diarrhea and vomiting was negatively associated with uptake. Increasing household size, age and previous enteric illness episode were positively related to uptake, the latter only at the rural site. The most prominent barrier to uptake was competing obligations or priorities (reported by 74.5%, identified as most important barrier by 49.5%). Next most prominent barriers were lacking information about the campaign (29.6%, 12.2%), sickness (14.3%, 13.3%) and fear of possible vaccine side effects (15.3%, 5.6%). The majority of unvaccinated respondents requested repetition of the vaccination with free OCVs.Conclusions/SignificanceFactors associated with uptake indicated a positive impact of the vaccination campaign and of sensitization activities on vaccine acceptance behavior. Unlike communities opposed to cholera control or settings where public confidence in vaccines is lacking, identified barriers to uptake indicated a good campaign implementation and trust in the health system. Despite prospects and demand for repeating the vaccination, local decision-makers should reconsider how careful logistical arrangements may improve community coverage and thus effectiveness of vaccination campaigns.

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