Sociocultural determinants of anticipated oral cholera vaccine acceptance in three African settings: a meta-analytic approach

Abstract

BackgroundControlling cholera remains a significant challenge in Sub-Saharan Africa. In areas where access to safe water and sanitation are limited, oral cholera vaccine (OCV) can save lives. Establishment of a global stockpile for OCV reflects increasing priority for use of cholera vaccines in endemic settings. Community acceptance of vaccines, however, is critical and sociocultural features of acceptance require attention for effective implementation. This study identifies and compares sociocultural determinants of anticipated OCV acceptance across populations in Southeastern Democratic Republic of Congo, Western Kenya and Zanzibar.MethodsCross-sectional studies were conducted using similar but locally-adapted semistructured interviews among 1095 respondents in three African settings. Logistic regression models identified sociocultural determinants of OCV acceptance from these studies in endemic areas of Southeastern Democratic Republic of Congo (SE-DRC), Western Kenya (W-Kenya) and Zanzibar. Meta-analytic techniques highlighted common and distinctive determinants in the three settings.ResultsAnticipated OCV acceptance was high in all settings. More than 93 % of community respondents overall indicated interest in a no-cost vaccine. Higher anticipated acceptance was observed in areas with less access to public health facilities. In all settings awareness of cholera prevention methods (safe food consumption and garbage disposal) and relating ingestion to cholera causation were associated with greater acceptance. Higher age, larger households, lack of education, social vulnerability and knowledge of oral rehydration solution for self-treatment were negatively associated with anticipated OCV acceptance. Setting-specific determinants of acceptance included reporting a reliable income (W-Kenya and Zanzibar, not SE-DRC). In SE-DRC, intention to purchase an OCV appeared unrelated to ability to pay. Rural residents were less likely than urban counterparts to accept an OCV in W-Kenya, but more likely in Zanzibar. Prayer as a form of self-treatment was associated with vaccine acceptance in SE-DRC and W-Kenya, but not in Zanzibar.ConclusionsThese cholera-endemic African communities are especially interested in no-cost OCVs. Health education and attention to local social and cultural features of cholera and vaccines would likely increase vaccine coverage. High demand and absence of insurmountable sociocultural barriers to vaccination with OCVs indicate potential for mass vaccination in planning for comprehensive control or elimination.

Identification of cholera hotspots in Zambia: A spatiotemporal analysis of cholera data from 2008 to 2017

“…Since cholera is transmitted by fecal oral route through water, one expects a relationship between cholera and WaSH conditions [21][22][23][24]. It is assumed that a well-managed, improved WaSH infrastructure, as has proven effective in industrialized countries, would be an optimal strategy for the cholera elimination program in Zambia.…”

Sociocultural aspects of health and disease and their pragmatic impact

“…Problems of cultural origin are more prevalent in the female population. This is a fact mainly verified when it comes to sexuality and other intimate aspects, in which there is a discomfort in addressing such issues, which leads to the expression of feelings becoming limited, which ultimately undermines the whole person approach 10,25 .…”

“…The term 'social medicine' used in Europe in the second half of the nineteenth century was a forerunner of the idea of health promotion 10 . A new paradigm emerged: the idea that health is produced socially 11 .…”

Cultural epidemiology: Conceptual framework and current directions of an interdisciplinary field

“…Topics include studies of vaccine acceptance based on awareness, priority and use with a focus on both health care providers and community residents. This work is based on vaccine acceptance and anticipated acceptance studies of oral cholera vaccine in Zanzibar, Kenya and DR Congo (Schaetti et al 2013;Sundaram et al 2016), and a study of influenza vaccine acceptance during the 2009 influenza pandemic in Pune, India (Sundaram et al 2015). More recently, a study of influenza vaccination of pregnant women to protect them and their newborn infants has been developed for WHO.…”