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Jalloh MF, Sengeh P, Ibrahim N, Kulkarni S, Sesay T, Eboh V, Jalloh MB, Abu Pratt S, Webber N, Thomas H, Kaiser R, Singh T, Prybylski D, Omer SB, Brewer NT, Wallace AS. Association of community engagement with vaccination confidence and uptake: A cross-sectional survey in Sierra Leone, 2019. J Glob Health 2022; 12:04006. [PMID: 35265325 PMCID: PMC8876869 DOI: 10.7189/jogh.12.04006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background The 2014-2016 Ebola epidemic disrupted childhood immunization in Sierra Leone, Liberia, and Guinea. After the epidemic, the Government of Sierra Leone prioritized community engagement to increase vaccination confidence and uptake. To support these efforts, we examined potential drivers of vaccination confidence and uptake in Sierra Leone. Methods We conducted a population-based household survey with primary caregivers of children in a birth cohort of 12 to 23 months in four districts with low vaccination coverage in Sierra Leone in 2019. Modified Poisson regression modeling with robust variance estimation was used to examine if perceived community engagement in planning the immunization program in the community was associated with vaccination confidence and having a fully vaccinated child. Results The sample comprised 621 age-eligible children and their caregivers (91% response rate). Half of the caregivers (52%) reported that it usually takes too long to get to the vaccination site, and 36% perceived that health workers expect money for vaccination services that are supposed to be given at no charge. When mothers were the decision-makers of the children's vaccination, 80% of the children were fully vaccinated versus 69% when fathers were the decision-makers and 56% when other relatives were the decision-makers. Caregivers with high confidence in vaccination were more likely to have fully vaccinated children compared to caregivers with low confidence (78% versus 53%). For example, caregivers who thought vaccines are 'very much' safe were more likely to have fully vaccinated children than those who thought vaccines are 'somewhat' safe (76% versus 48%). Overall, 53% of caregivers perceived high level of community engagement, 41% perceived medium level of engagement, and 6% perceived low level of engagement. Perceiving high community engagement was associated with expressing high vaccination confidence (adjusted prevalence ratio (aPR) = 2.60; 95% confidence interval (CI) = 1.67-4.04) and having a fully vaccinated child (aPR = 1.67; 95% CI = 1.18-2.38). Conclusions In these four low coverage districts in Sierra Leone, the perceived level of community engagement was strongly associated with vaccination confidence among caregivers and vaccination uptake among children. We have provided exploratory cross-sectional evidence to inform future longitudinal assessments to further investigate the potential causal effect of community engagement on vaccination confidence and uptake.
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Affiliation(s)
- Mohamed F Jalloh
- Immunization Systems Branch, Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - Shibani Kulkarni
- Immunization Systems Branch, Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tom Sesay
- Expanded Program on Immunization, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Victor Eboh
- Epidemic Intelligence Service, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | | | - Harold Thomas
- Health Education Division, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Reinhard Kaiser
- Sierra Leone Country Office of U.S. Centers for Disease Control and Prevention, Freetown, Sierra Leone
| | - Tushar Singh
- Sierra Leone Country Office of U.S. Centers for Disease Control and Prevention, Freetown, Sierra Leone
| | - Dimitri Prybylski
- Immunization Systems Branch, Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Saad B Omer
- Yale Institute of Global Health, Yale University, New Haven, Connecticut, USA
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Aaron S Wallace
- Immunization Systems Branch, Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Lukusa LA, Ndze VN, Mbeye NM, Wiysonge CS. A systematic review and meta-analysis of the effects of educating parents on the benefits and schedules of childhood vaccinations in low and middle-income countries. Hum Vaccin Immunother 2018; 14:2058-2068. [PMID: 29580159 PMCID: PMC6149946 DOI: 10.1080/21645515.2018.1457931] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Public health benefits of childhood vaccinations risk being derailed by low vaccination coverage in low and middle-income countries. One reason for the low coverage is poor parental knowledge of the importance of completing vaccination schedules. We therefore assessed the effects on childhood vaccination coverage, of educating parents and other persons assuming the parental role. We prospectively registered the systematic review, published the protocol, and used standard Cochrane methods to collect and synthesise the evidence. We found six eligible randomised trials with 4248 participants. Three trials assessed health-facility based education of mothers on the importance of completing vaccination schedules; immediately after birth and three months later (one study) or during the first vaccination visit (two studies). The other trials assessed community-based education, including information campaigns on the importance of vaccines using audiotaped presentations and leaflet distributions (one study); structured group discussions on benefits and costs of childhood vaccination and local action plans for improving vaccine uptake (one study); and home-based information sessions using graphic cards showing benefits and costs of childhood vaccinations and location of vaccination centres (one study). Combining the data shows that these interventions lead to substantial improvements in childhood vaccination coverage (relative increase 36%, 95% confidence interval 14% to 62%). There was no difference between the effects of community-based and facility-based education. Therefore, education in communities and health facilities on the importance of childhood vaccinations should be integrated into all vaccination programmes in low and middle-income countries; accompanied by robust monitoring of impacts and use of data for action.
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Affiliation(s)
- Lungeni Auguy Lukusa
- a Division of Epidemiology and Biostatistics, Department of Global Health , Faculty of Medicine and Health Sciences, Stellenbosch University , Cape Town , South Africa
| | - Valantine Ngum Ndze
- b Department of Microbiology, Haematology, Parasitology and Infectious Disease , Faculty of Medicine and Biomedical Sciences, University of Yaoundé I , Yaoundé , Cameroon
| | - Nyanyiwe Masingi Mbeye
- a Division of Epidemiology and Biostatistics, Department of Global Health , Faculty of Medicine and Health Sciences, Stellenbosch University , Cape Town , South Africa.,c Cochrane South Africa, South African Medical Research Council , Cape Town , South Africa.,d School of Public Health and Family Medicine , College of Medicine, University of Malawi , Blantyre , Malawi
| | - Charles Shey Wiysonge
- a Division of Epidemiology and Biostatistics, Department of Global Health , Faculty of Medicine and Health Sciences, Stellenbosch University , Cape Town , South Africa.,c Cochrane South Africa, South African Medical Research Council , Cape Town , South Africa.,e Division of Epidemiology and Biostatistics , School of Public Health and Family Medicine, University of Cape Town , Cape Town , South Africa
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Lukusa LA, Mbeye NN, Adeniyi FB, Wiysonge CS. Protocol for a systematic review of the effects of interventions to inform or educate caregivers about childhood vaccination in low and middle-income countries. BMJ Open 2015; 5:e008113. [PMID: 26169807 PMCID: PMC4513514 DOI: 10.1136/bmjopen-2015-008113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Despite their proven effectiveness in reducing childhood infectious diseases, the uptake of vaccines remains suboptimal in low and middle-income countries. Identifying strategies for transmitting accurate vaccine information to caregivers would boost childhood vaccination coverage in these countries. The purpose of this review is to assess the effects on childhood vaccination coverage of interventions for informing or educating caregivers about the importance of vaccines in low and middle-income countries, as defined by the World Bank. METHODS AND ANALYSIS Eligible study designs include randomised controlled trials (RCTs) as well as non-randomised controlled trials (non-RCTs). We will conduct a comprehensive search of both peer-reviewed and grey literature available up to 31 May 2015. We will search PubMed, Scopus, Cochrane Central Register of Controlled Trials, Web of Science, Cumulative Index of Nursing and Allied Health, prospective trial registries and reference lists of relevant publications. Two authors will independently screen the search output, retrieve full texts of potentially eligible studies and assess the latter against predefined inclusion criteria. Disagreements between the two authors will be resolved through consensus and arbitration by a third author. We will pool data from studies with homogenous interventions and outcomes, using random-effects meta-analysis. We will assess statistical heterogeneity using the χ(2) test of homogeneity (with significance defined at the 10% α-level) and quantify it using Higgins' inconsistency index. We will explore the cause of any observed statistical heterogeneity using subgroup analysis, with subgroups defined by study design (RCTs vs non-RCTs) and type of intervention (information vs educational interventions). ETHICS AND DISSEMINATION The proposed systematic review will collect and analyse secondary data that are not associated with individuals. The review will make a significant contribution to the knowledge base of interventions for improving childhood vaccination coverage in low and middle-income countries. PROTOCOL REGISTRATION NUMBER PROSPERO, CRD42014010141.
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Affiliation(s)
- Lungeni A Lukusa
- Division of Community Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Nyanyiwe N Mbeye
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Folasade B Adeniyi
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Charles S Wiysonge
- Division of Community Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
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