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Sallam M, Athamneh RY, Alkhazaleh R, Alzayadneh L, Jaradat L, Majali T, Obeidat S, Shhab A, Hallit S, Barakat M, Mahafzah A. Attitude towards cholera vaccination and its related factors in Jordan amid the 2022 Middle East outbreak. BMC Public Health 2024; 24:2237. [PMID: 39152391 PMCID: PMC11330065 DOI: 10.1186/s12889-024-19768-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 08/12/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND An outbreak of cholera was reported in the Middle East by the second half of 2022. Raising public awareness and vaccination against cholera represent critical factors in the preventive efforts. The current study aimed to assess the knowledge of cholera and attitude towards its vaccination among a sample of the general public residing in Jordan. METHODS An online self-administered questionnaire was distributed to the residents in Jordan using a snowball convenience-based sampling approach. The questionnaire based on previously published studies included items to evaluate sociodemographic variables, knowledge about cholera symptoms, transmission, and prevention and the willingness to accept cholera vaccination. Additionally, four items based on the validated 5 C scale in Arabic were included to assess the psychological factors influencing attitude to cholera vaccination. RESULTS The final study sample comprised 1339 respondents, of whom 1216 (90.8%) heard of cholera before the study. Among those who heard of cholera, and on a scale from 0 to 20, the overall mean cholera Knowledge score (K-score) was 12.9 ± 3.8. In multivariate analysis, being over 30 years old and occupation as healthcare workers or students in healthcare-related colleges were significantly associated with a higher K-score compared to younger individuals and students in non-healthcare-related colleges. Overall, the acceptance of cholera vaccination if cases are recorded in Jordan, and if the vaccine is safe, effective, and provided freely was reported among 842 participants (69.2%), while 253 participants were hesitant (20.8%) and 121 participants were resistant (10.0%). In linear regression, the significant predictors of cholera vaccine acceptance were solely the three psychological factors namely high confidence, low constraints, and high collective responsibility. CONCLUSIONS In this study, the identified gaps in cholera knowledge emphasize the need to enhance educational initiatives. Although cholera vaccine acceptance was relatively high, a significant minority of the respondents exhibited vaccination hesitancy or resistance. The evident correlation between the psychological determinants and attitudes toward cholera vaccination emphasizes the need to consider these factors upon designing public health campaigns aimed at cholera prevention. The insights of the current study highlight the importance of addressing both knowledge gaps and psychological barriers to optimize cholera control strategies.
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Affiliation(s)
- Malik Sallam
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman, Jordan.
- Department of Clinical Laboratories and Forensic Medicine, University Hospital, Queen Rania Al-Abdullah Street-Aljubeiha, P.O. Box: 13046, Amman, Jordan.
| | - Rabaa Y Athamneh
- Department of Medical Laboratories Sciences, Faculty of Allied Medical Sciences, Zarqa University, Zarqa, Jordan
| | | | | | - Laila Jaradat
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Tala Majali
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Sarah Obeidat
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Aseel Shhab
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - Muna Barakat
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | - Azmi Mahafzah
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman, Jordan
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Getahun T, Hailu D, Mogeni OD, Mesfin Getachew E, Yeshitela B, Jeon Y, Gedefaw A, Ayele Abebe S, Hundito E, Mukasa D, Jang GH, Pak GD, Kim DR, Worku Demlie Y, Hussen M, Teferi M, Park SE. Healthcare Seeking Behavior and Disease Perception Toward Cholera and Acute Diarrhea Among Populations Living in Cholera High-Priority Hotspots in Shashemene, Ethiopia. Clin Infect Dis 2024; 79:S43-S52. [PMID: 38996036 PMCID: PMC11244153 DOI: 10.1093/cid/ciae232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Healthcare seeking behavior (HSB) and community perception on cholera can influence its management. We conducted a cross-sectional survey to generate evidence on cholera associated HSB and disease perception in populations living in cholera hotspots in Ethiopia. METHODS A total of 870 randomly selected households (HHs) in Shashemene Town (ST) and Shashemene Woreda (SW) participated in our survey in January 2022. RESULTS Predominant HHs (91.0%; 792/870) responded "primary health center" as the nearest healthcare facility (HCF). Around 57.4% (247/430) of ST HHs traveled <30 minutes to the nearest HCF. In SW, 60.2% (265/440) of HHs travelled over 30 minutes and 25.9% (114/440) over 4 km. Two-thirds of all HHs paid CONCLUSIONS Variations in cholera prevention practices between rural and urban residents were shown. Addressing differences in HSB per age groups is needed for community engagement for early case detection and case management; critical in reducing cholera deaths and transmission.
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Affiliation(s)
- Tomas Getahun
- Clinical Trials Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Dejene Hailu
- Clinical, Assessment, Regulatory, Evaluation (CARE) Unit, International Vaccine Institute, Seoul, Republic of Korea
- School of Public Health, Hawassa University, Hawassa, Ethiopia
| | - Ondari D Mogeni
- Clinical, Assessment, Regulatory, Evaluation (CARE) Unit, International Vaccine Institute, Seoul, Republic of Korea
| | | | - Biruk Yeshitela
- Bacterial and Viral Disease Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Yeonji Jeon
- Clinical, Assessment, Regulatory, Evaluation (CARE) Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Abel Gedefaw
- Clinical, Assessment, Regulatory, Evaluation (CARE) Unit, International Vaccine Institute, Seoul, Republic of Korea
- College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Samuyel Ayele Abebe
- Statistics and Data Management Department, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Ermiyas Hundito
- Clinical Trials Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - David Mukasa
- Biostatistics and Data Management (BDM) Department, International Vaccine Institute, Seoul, Republic of Korea
| | - Geun Hyeog Jang
- Biostatistics and Data Management (BDM) Department, International Vaccine Institute, Seoul, Republic of Korea
| | - Gi Deok Pak
- Biostatistics and Data Management (BDM) Department, International Vaccine Institute, Seoul, Republic of Korea
| | - Deok Ryun Kim
- Biostatistics and Data Management (BDM) Department, International Vaccine Institute, Seoul, Republic of Korea
| | - Yeshambel Worku Demlie
- Public Health Emergency Management, Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Mukemil Hussen
- Public Health Emergency Management, Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Mekonnen Teferi
- Clinical Trials Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Se Eun Park
- Clinical, Assessment, Regulatory, Evaluation (CARE) Unit, International Vaccine Institute, Seoul, Republic of Korea
- Department of Global Health and Disease Control, Yonsei University Graduate School of Public Health, Seoul, Republic of Korea
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Baličević SA, Elimian KO, King C, Diaconu K, Akande OW, Ihekweazu V, Trolle H, Gaudenzi G, Forsberg B, Alfven T. Influences of community engagement and health system strengthening for cholera control in cholera reporting countries. BMJ Glob Health 2023; 8:e013788. [PMID: 38084475 PMCID: PMC10711916 DOI: 10.1136/bmjgh-2023-013788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/25/2023] [Indexed: 12/18/2023] Open
Abstract
The 2030 Global Task Force on Cholera Control Roadmap hinges on strengthening the implementation of multistranded cholera interventions, including community engagement and health system strengthening. However, a composite picture of specific facilitators and barriers for these interventions and any overlapping factors existing between the two, is lacking. Therefore, this study aims to address this shortcoming, focusing on cholera-reporting countries, which are disproportionately affected by cholera and may be cholera endemic. A scoping methodology was chosen to allow for iterative mapping, synthesis of the available research and to pinpoint research activity for global and local cholera policy-makers and shareholders. Using the Arksey and O'Malley framework for scoping reviews, we searched PubMed, Web of Science and CINAHL. Inclusion criteria included publication in English between 1990 and 2021 and cholera as the primary document focus in an epidemic or endemic setting. Data charting was completed through narrative descriptive and thematic analysis. Forty-four documents were included, with half relating to sub-Saharan African countries, 68% (30/44) to cholera endemic settings and 21% (9/44) to insecure settings. We identified four themes of facilitators and barriers to health systems strengthening: health system cooperation and agreement with external actors; maintaining functional capacity in the face of change; good governance, focused political will and sociopolitical influences on the cholera response and insecurity and targeted destruction. Community engagement had two themes: trust building in the health system and growing social cohesion. Insecurity and the community; cooperation and agreement; and sociopolitical influences on trust building were themes of factors acting at the interface between community engagement and health system. Given the decisive role of the community-health system interface for both sustained health system strengthening and community engagement, there is a need to advocate for conflict resolution, trust building and good governance for long-term cholera prevention and control in cholera reporting countries.
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Affiliation(s)
| | - Kelly Osezele Elimian
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Exhale Health Foundation, Abuja, Nigeria
| | - Carina King
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Karin Diaconu
- Institute of Global Health, Queen Margaret University, Edinburgh, UK
| | - Oluwatosin Wuraola Akande
- Department of Epidemiology and Community Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | | | - Hanna Trolle
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Giulia Gaudenzi
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Protein Science, SciLifeLab, Stockholm, Sweden
| | - Birger Forsberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Tobias Alfven
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Sachs' Children and Youth Hospital, Stockholm, Sweden
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Tsagkarliotis I, Rachaniotis NP. A holistic approach in epidemics. Front Public Health 2023; 11:1263293. [PMID: 38026383 PMCID: PMC10679669 DOI: 10.3389/fpubh.2023.1263293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
This paper explores the concept of a holistic approach in preventing and responding to epidemics. Epidemics are defined as the occurrence of an illness or health-related event exceeding normal expectations within a specific community or region. Holism emphasizes viewing systems as a whole rather than a collection of parts. In the context of epidemics, a holistic approach considers not only medical interventions but also social, economic, psychological and environmental factors that influence disease transmission and management. The impact of climate change on epidemic response, the understanding of the significance of animal health and agriculture, the consideration of art, culture and societal factors, the exploration of the use of technology and innovation, the addressing of limitations in resources and the provision of enhanced support for the mental and emotional well-being of individuals and affected communities, are parts of this holistic approach. By integrating them, innovative practices as well as cross-sectoral and interdisciplinary techniques can be employed. Such an approach has the potential to enhance epidemic prevention and response strategies, ultimately contributing to positive public health outcomes.
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Affiliation(s)
- Ioannis Tsagkarliotis
- Department of Industrial Management and Technology, University of Piraeus, Piraeus, Greece
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A scoping review of facilitators and barriers influencing the implementation of surveillance and oral cholera vaccine interventions for cholera control in lower- and middle-income countries. BMC Public Health 2023; 23:455. [PMID: 36890476 PMCID: PMC9994404 DOI: 10.1186/s12889-023-15326-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 02/27/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Cholera still affects millions of people worldwide, especially in lower- and middle-income countries (LMICs). The Global Task Force on Cholera Control (GTFCC) has identified surveillance and oral cholera vaccines as two critical interventions to actualise the global roadmap goals-reduction of cholera-related deaths by 90% and decreasing the number of cholera endemic countries by half by 2030. Therefore, this study aimed to identify facilitators and barriers to implementing these two cholera interventions in LMIC settings. METHODS A scoping review using the methods presented by Arksey and O'Malley. The search strategy involved using key search terms (cholera, surveillance, epidemiology and vaccines) in three databases (PubMed, CINAHL and Web of Science) and reviewing the first ten pages of Google searches. The eligibility criteria of being conducted in LMICs, a timeline of 2011-2021 and documents only in English were applied. Thematic analysis was performed, and the findings were presented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension. RESULTS Thirty-six documents met the predefined inclusion criteria, covering 2011 to 2021. There were two themes identified regarding the implementation of surveillance: timeliness and reporting (1); and resources and laboratory capabilities (2). As for oral cholera vaccines, there were four themes identified: information and awareness (1); community acceptance and trusted community leaders (2); planning and coordination (3); and resources and logistics (4). Additionally, adequate resources, good planning and coordination were identified to be operating at the interface between surveillance and oral cholera vaccines. CONCLUSION Findings suggest that adequate and sustainable resources are crucial for timely and accurate cholera surveillance and that oral cholera vaccine implementation would benefit from increased community awareness and engagement of community leaders.
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Malaeb D, Sallam M, Younes S, Mourad N, Sarray El Dine A, Obeid S, Hallit S, Hallit R. Knowledge, Attitude, and Practice in a Sample of the Lebanese Population Regarding Cholera. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192316243. [PMID: 36498316 PMCID: PMC9735709 DOI: 10.3390/ijerph192316243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 05/12/2023]
Abstract
The evaluation of knowledge, attitude, and practices towards an emerging disease is an essential component of public health preventive measures during an outbreak. In October 2022, an outbreak of cholera was reported in Lebanon, which is the first to be reported in the Middle Eastern country for 30 years. This study aimed to explore the level of knowledge as well as attitude and practice of the general public in Lebanon towards cholera. A self-administered structured questionnaire was distributed via an online link to individuals living in Lebanon during October-November 2022. The survey instrument comprised items to assess the sociodemographic data; questions on knowledge about cholera symptoms, transmission, and prevention; as well as attitude and practice questions. Our study involved 553 participants, with a median age of 24 years and a majority of females (72.5%). The results showed that the majority of respondents correctly identified diarrhea as a symptom of cholera and recognized the spread via contaminated water and food. Having a university level education compared with secondary school or less (adjusted odds ratio (aOR) = 2.09), being married compared with single (aOR = 1.67), and working in the medical field compared with unemployed (aOR = 4.19) were significantly associated with higher odds of having good cholera knowledge. Having good knowledge compared with having a poor level of cholera knowledge (aOR = 1.83) and older age (aOR = 1.03) were significantly associated with higher odds of having a good attitude towards cholera. The current study showed an overall high knowledge score on cholera among the Lebanese population. Nevertheless, gaps in cholera knowledge were identified and should be addressed, particularly among workers in the medical field. Thus, we recommend targeted health education to the general population that aims to strengthen the health resilience in the community.
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Affiliation(s)
- Diana Malaeb
- Department of Pharmacy Practice, College of Pharmacy, Gulf Medical University, Ajman P.O. Box 4184, United Arab Emirates
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Malik Sallam
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 11942, Jordan
- Department of Translational Medicine, Faculty of Medicine, Lund University, 22184 Malmö, Sweden
- Correspondence: (M.S.); (S.H.); Tel.: +962-79-184-5186 (M.S.)
| | - Samar Younes
- Department of Biomedical Sciences, School of Pharmacy, Lebanese International University, Bekaa, Lebanon
| | - Nisreen Mourad
- Pharmaceutical Sciences Department, School of Pharmacy, Lebanese International University, Bekaa, Lebanon
| | - Abir Sarray El Dine
- Department of Biomedical Sciences, School of Arts and Sciences, Lebanese International University, Beirut P.O. Box 146404, Lebanon
| | - Sahar Obeid
- Department of Social and Education Sciences, School of Arts and Sciences, Lebanese American University, Byblos, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh P.O. Box 446, Lebanon
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
- Applied Science Research Center, Applied Science Private University, Amman 11931, Jordan
- Correspondence: (M.S.); (S.H.); Tel.: +962-79-184-5186 (M.S.)
| | - Rabih Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh P.O. Box 446, Lebanon
- Department of Infectious Disease, Bellevue Medical Center, Mansourieh, Lebanon
- Department of Infectious Disease, Notre Dame des Secours, University Hospital Center, Byblos, Lebanon
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Bisimwa L, Williams C, Bisimwa JC, Sanvura P, Endres K, Thomas E, Perin J, Cikomola C, Bengehya J, Maheshe G, Mwishingo A, George CM. Formative Research for the Development of Evidence-Based Targeted Water, Sanitation, and Hygiene Interventions to Reduce Cholera in Hotspots in the Democratic Republic of the Congo: Preventative Intervention for Cholera for 7 Days (PICHA7) Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12243. [PMID: 36231546 PMCID: PMC9566157 DOI: 10.3390/ijerph191912243] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/18/2022] [Accepted: 09/05/2022] [Indexed: 06/16/2023]
Abstract
Compared to the general public, household members of cholera patients are at a 100 times higher risk of contracting cholera during the 7-day high-risk period after a cholera patient has been admitted to a health facility for treatment. The Preventative-Intervention-for-Cholera-for-7-days (PICHA7) program aims to reduce household transmission of cholera during this 7-day high-risk period through a health facility-initiated water, sanitation, and hygiene (WASH) program promoting handwashing with soap, water treatment, and safe water storage. The PICHA7 program is delivered to cholera patient households through: (1) a pictorial flipbook delivered by a health promoter; (2) a cholera prevention package (handwashing station, drinking water vessel with lid and tap, and chlorine tablets); and (3) weekly WASH mobile messages sent to patient households in the Democratic Republic of the Congo (DRC). The objectives of this study were to conduct formative research to identify facilitators and barriers of the promoted WASH behaviors for cholera patient households and to tailor the PICHA7 program to target these facilitators and barriers. Formative research included 93 semi-structured interviews with diarrhea patient households and healthcare workers during exploratory research and a pilot study of 518 participants. Barriers to the promoted WASH behaviors identified during exploratory and pilot study interviews included: (1) low awareness of cholera transmission and prevention; (2) unaffordability of soap for handwashing; and (3) intermittent access to water limiting water for handwashing. For intervention development, narratives of the lived experiences of patient households in our study were presented by health promoters to describe cholera transmission and prevention, and soapy water and ash were promoted in the program flipbook and mobile messages to address the affordability of soap for handwashing. A jerry can was provided to allow for additional water storage, and a tap with a slower flow rate was attached to the handwashing station to reduce the amount of water required for handwashing. The pilot findings indicate that the PICHA7 program has high user acceptability and is feasible to deliver to cholera patients that present at health facilities for treatment in our study setting. Formative research allowed for tailoring this targeted WASH program for cholera patient households in the DRC.
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Affiliation(s)
- Lucien Bisimwa
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205-2103, USA
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo
| | - Camille Williams
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205-2103, USA
| | - Jean-Claude Bisimwa
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205-2103, USA
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo
| | - Presence Sanvura
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205-2103, USA
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo
| | - Kelly Endres
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205-2103, USA
| | - Elizabeth Thomas
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205-2103, USA
| | - Jamie Perin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205-2103, USA
| | - Cirhuza Cikomola
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo
| | - Justin Bengehya
- Bureau de l’Information Sanitaire, Surveillance Epidémiologique et Recherche Scientifique Division Provinciale de la Santé/Sud Kivu, Ministère de la Santé Publique, Hygiène et Prévention, Bukavu B.P 265, Democratic Republic of the Congo
| | - Ghislain Maheshe
- Faculty of Medicine, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo
| | - Alain Mwishingo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205-2103, USA
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo
| | - Christine Marie George
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205-2103, USA
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Bisimwa L, Endres K, Williams C, Thomas ED, Kuhl J, Coglianese N, Bauler S, Masud J, François R, Saxton R, Sanvura P, Bisimwa JC, Mirindi P, Mwishingo A, Perin J, George CM. Diarrheal Disease Awareness Is Associated with Caregiver Handwashing with Soap in the Democratic Republic of the Congo (REDUCE Program). Am J Trop Med Hyg 2022; 106:tpmd210699. [PMID: 35313282 PMCID: PMC9128694 DOI: 10.4269/ajtmh.21-0699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 12/08/2021] [Indexed: 11/07/2022] Open
Abstract
Diarrhea is one of the leading causes of childhood illness and a major cause of infant and child mortality globally. In the Reducing Enteropathy, Undernutrition, and Contamination in the Environment (REDUCE) prospective cohort study, we investigated the association between diarrheal disease awareness and handwashing with soap among caregivers of children under 5 years of age. A total of 259 caregivers of children under 5 years of age in Walungu Territory, South Kivu, Democratic Republic of the Congo (DRC), were administered an open-ended questionnaire assessing awareness of diarrheal disease transmission and prevention, and key times to wash hands with soap. An overall diarrhea awareness score was developed based on the responses to these items. Five-hour structured observation of handwashing behaviors was conducted at the 6-month follow-up. Diarrheal disease awareness among caregivers was low. Only 32% of caregivers were able to correctly identify a method of diarrhea prevention. The median diarrhea awareness score was three out of 10 (SD: 1.7, range: 0-9). During structured observation, 9% of caregivers washed their hands with soap at a food-related event and 9% washed their hands with soap at a stool-related event. Higher diarrheal disease awareness was associated with an increased odds of handwashing with soap at food-related events (odds ratio: 1.40, 95% confidence interval: 1.03, 1.90). Our findings emphasize the need for targeted water, sanitation, and hygiene interventions to increase diarrhea awareness to facilitate handwashing with soap among caregivers of children under 5 years in rural DRC.
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Affiliation(s)
- Lucien Bisimwa
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Food for the Hungry, Washington, District of Columbia
| | - Kelly Endres
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Camille Williams
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Elizabeth D. Thomas
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jennifer Kuhl
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Sarah Bauler
- Food for the Hungry, Washington, District of Columbia
| | - Jahed Masud
- International Center for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Ruthly François
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ronald Saxton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Presence Sanvura
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Food for the Hungry, Washington, District of Columbia
| | - Jean Claude Bisimwa
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Food for the Hungry, Washington, District of Columbia
| | | | - Alain Mwishingo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jamie Perin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Christine Marie George
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Masud J, Islam Bhuyian MS, Kumar Biswas S, Zohura F, Perin J, Papri N, Dil Farzana F, Parvin T, Monira S, Alam M, George CM. Diarrhoeal disease knowledge among diarrhoea patient housholds: findings from the randomised controlled trial of the Cholera-Hospital-Based-Intervention-for-7-days (CHoBI7) mobile health program. Trop Med Int Health 2020; 25:996-1007. [PMID: 32406989 DOI: 10.1111/tmi.13415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the impact of the Cholera-Hospital-Based-Intervention-for-7-days (CHoBI7) handwashing with soap and water treatment mobile health (mHealth) program on diarrhoeal disease knowledge among diarrhoea patients and their household members in urban Dhaka, Bangladesh. METHODS A cluster-randomised controlled trial of the CHoBI7 mHealth program was conducted among diarrhoea patient households in Dhaka, Bangladesh. Patients were randomised to three arms: standard recommendation on oral rehydration solution use; health facility delivery of CHoBI7 plus mHealth (weekly voice and text messages) (no home visits); and health facility delivery of CHoBI7 plus two home visits and mHealth. An open-ended questionnaire was administered to 1468 participants 12 years of age or older on diarrhoeal disease transmission and prevention. These items were combined to form a diarrhoeal disease knowledge score measured at baseline and at a 1 week, 6 month and 12 month follow-up. RESULTS At baseline, when participants were asked to report three ways diarrhoeal diseases were spread 37% (546/1468) of participants reported by water, 13% (187/1468) by lack of handwashing and 4% (53/1468) by food not being covered properly. At baseline when asked to name three ways diarrhoeal diseases could be prevented, 35% (515/1468) of participants reported safe water, and 16% (228/1468) reported handwashing with soap. At the 12-month follow-up, the overall diarrhoeal disease knowledge score was significantly higher in the mHealth with no home visits arm (score coefficient: 0.69, 95% Confidence Interval: 0.36, 1.01, P < 0.0001) and the mHealth with two home visits arm (score coefficient: 1.18, 95% CI: 0.87, 1.49, P < 0.0001) compared with the standard recommendation arm. CONCLUSION The CHoBI7 mHealth program significantly increased knowledge of diarrhoeal disease transmission and prevention among diarrhoea patients and their household members 12 months after in-person visits for program delivery were conducted.
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Affiliation(s)
- Jahed Masud
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Shwapon Kumar Biswas
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Fatema Zohura
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Jamie Perin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nowshin Papri
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Fahmida Dil Farzana
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Tahmina Parvin
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Shirajum Monira
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Munirul Alam
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Christine Marie George
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Liu J, Li Y, Li J, Liu Y, Tao N, Song W, Cui L, Li H. Association between ambient PM 2.5 and children's hospital admissions for respiratory diseases in Jinan, China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:24112-24120. [PMID: 31228058 DOI: 10.1007/s11356-019-05644-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 05/30/2019] [Indexed: 05/12/2023]
Abstract
To determine the association between daily air pollution and the hospital admissions for respiratory diseases in children aged from 0 to 17 years in Jinan, China. Generalized linear models were used to explore the acute effects of ambient fine particulate matter (PM2.5) on the children's hospital admissions for respiratory diseases. We evaluated the lag associations (including lag 0 to lag 3, lag 01, and lag 03) between daily PM2.5 and the number of children's hospital admissions for respiratory diseases, and stratified by gender, age group (baby group: age 0-1 years; child group: age 1-5 years; student group: age 6-17 years), and cause-specific disease (including upper infection, pneumonia, and acute bronchitis) during 2011-2015. PM2.5 had significant positive impacts on the number of children's hospital admissions for respiratory disease. The results showed that per 10 μg/m3 increase of PM2.5 at lag 1 was associated with an increase in total and male hospital admissions of 0.23% (95% CI, 0.02%-0.45%) and 0.32% (95% CI, 0.04%-0.06%). The corresponding risk of the student group (age 6-17 years) hospital admissions was increased 0.90% (95% CI, 0.39%-1.42%) at lag 1 day. The corresponding risk of the upper infection was increased 0.96% (95% CI, 0.37-1.55%) at lag 1 day. Males and student groups (age 6-17 years) were more vulnerable to PM2.5 exposure. Upper infection admission was identified as the sensitive disease for children. It is a better way to reduce children's outdoor activities to avoid health effects when the air pollution increases.
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Affiliation(s)
- Jinyue Liu
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, 250021, China
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, 250062, Shandong, China
| | - Yifan Li
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, 250021, China
| | - Jun Li
- Pediatric Intensive Care Unit, Jinan Children's Hospital, Jinan, 250022, Shandong, China
| | - Yao Liu
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, 250021, China
| | - Ningning Tao
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Wanmei Song
- School of medicine, Shandong University, Jinan, 250000, Shandong, China
| | - Liangliang Cui
- Department of Environmental Health, Jinan Municipal Center for Disease Control and Prevention, Jinan, 250021, Shandong, China.
| | - Huaichen Li
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, 250021, China.
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, 250062, Shandong, China.
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Heyerdahl LW, Pugliese-Garcia M, Nkwemu S, Tembo T, Mwamba C, Demolis R, Chilengi R, Gessner BD, Guillermet E, Sharma A. "It depends how one understands it:" a qualitative study on differential uptake of oral cholera vaccine in three compounds in Lusaka, Zambia. BMC Infect Dis 2019; 19:421. [PMID: 31088376 PMCID: PMC6518637 DOI: 10.1186/s12879-019-4072-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/08/2019] [Indexed: 12/15/2022] Open
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.
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Affiliation(s)
- Leonard W Heyerdahl
- Agence de Médecine Préventive, J 87, Deux Plateaux, Abidjan, Côte d'Ivoire. .,École normale supérieure de Lyon, UMR 5206 Triangle, Lyon, France.
| | - Miguel Pugliese-Garcia
- Centre for Infectious Disease Research in Zambia (CIDRZ), Plot # 34620, P.O. Box 34681, 10101, Lusaka, Zambia
| | - Sharon Nkwemu
- Centre for Infectious Disease Research in Zambia (CIDRZ), Plot # 34620, P.O. Box 34681, 10101, Lusaka, Zambia
| | - Taniya Tembo
- Centre for Infectious Disease Research in Zambia (CIDRZ), Plot # 34620, P.O. Box 34681, 10101, Lusaka, Zambia
| | - Chanda Mwamba
- Centre for Infectious Disease Research in Zambia (CIDRZ), Plot # 34620, P.O. Box 34681, 10101, Lusaka, Zambia
| | - Rachel Demolis
- Agence de Médecine Préventive, 13 chemin du Levant, 01210, Ferney-Voltaire, France
| | - Roma Chilengi
- Centre for Infectious Disease Research in Zambia (CIDRZ), Plot # 34620, P.O. Box 34681, 10101, Lusaka, Zambia
| | - Bradford D Gessner
- Agence de Médecine Préventive, 13 chemin du Levant, 01210, Ferney-Voltaire, France
| | - Elise Guillermet
- Agence de Médecine Préventive, 13 chemin du Levant, 01210, Ferney-Voltaire, France
| | - Anjali Sharma
- Centre for Infectious Disease Research in Zambia (CIDRZ), Plot # 34620, P.O. Box 34681, 10101, Lusaka, Zambia
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Mhalu G, Weiss MG, Hella J, Mhimbira F, Mahongo E, Schindler C, Reither K, Fenner L, Zemp E, Merten S. Explaining patient delay in healthcare seeking and loss to diagnostic follow-up among patients with presumptive tuberculosis in Tanzania: a mixed-methods study. BMC Health Serv Res 2019; 19:217. [PMID: 30953502 PMCID: PMC6451234 DOI: 10.1186/s12913-019-4030-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 03/22/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Delay in healthcare seeking and loss to diagnostic follow-up (LDFU) contribute to substantial increase in tuberculosis (TB) morbidity and mortality. We examined factors, including perceived causes and prior help seeking, contributing to delay and LDFU during referral to a TB clinic among patients with presumptive TB initially seeking help at the pharmacies in Dar es Salaam Tanzania. METHODS In a TB clinic, a semi-structured interview based on the explanatory model interview catalogue (EMIC) framework for cultural epidemiology was administered to presumptive TB patients enrolled at pharmacies during an intervention study. We assessed delay in seeking care at any medical care provider for a period of ≥3 weeks after the onset of symptoms, LDFU during referral (not reaching the TB clinic), and LDFU for three required TB clinic visits among the presumptive and confirmed TB patients. Logistic regression models were used to assess factors associated with delay and LDFU. RESULTS Among 136 interviewed patients, 86 (63.2%) were LDFU from pharmacies and TB clinic while 50 (36.8%) were non-LDFU. Out of 136 patients 88 (64.7%) delayed seeking care, of whom 59 (67%) were females. Among the 86 (63.2%) patients in LDFU group, 62 (72.1%) delayed seeking care, while among the 50 (36.8%) non-LDFU, 26 (52.0%) had also delayed seeking care. Prior consultation with a traditional healer (aOR 2.84, 95% CI 1.08-7.40), perceived causes as ingestion (water and food) (aOR 0.38 CI 0.16-0.89), and substance use (smoking and alcohol) (aOR 1.45 CI 0.98-2.14) were all associated with patient delay. Female gender was associated with LDFU (aOR 3.80, 95% CI 1.62-8.87) but not with delay. Other conditions as prior illness and heredity were also associated with LDFU but not delay (aOR 1.48 CI 1.01-2.17). CONCLUSION Delay and LDFU after referral from the pharmacies were substantial. Notable effects of diagnosis and female gender indicate a need for more attention to women's health to promote timely and sustained TB treatment. Public awareness to counter misconceptions about the causes of TB is needed.
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Affiliation(s)
- Grace Mhalu
- Ifakara Health Institute, Dar es Salaam and Bagamoyo, Tanzania
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Mitchell G. Weiss
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Jerry Hella
- Ifakara Health Institute, Dar es Salaam and Bagamoyo, Tanzania
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Francis Mhimbira
- Ifakara Health Institute, Dar es Salaam and Bagamoyo, Tanzania
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Enos Mahongo
- Ifakara Health Institute, Dar es Salaam and Bagamoyo, Tanzania
| | - Christian Schindler
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Klaus Reither
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Lukas Fenner
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Elisabeth Zemp
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Sonja Merten
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Vinck P, Pham PN, Bindu KK, Bedford J, Nilles EJ. Institutional trust and misinformation in the response to the 2018-19 Ebola outbreak in North Kivu, DR Congo: a population-based survey. THE LANCET. INFECTIOUS DISEASES 2019; 19:529-536. [PMID: 30928435 DOI: 10.1016/s1473-3099(19)30063-5] [Citation(s) in RCA: 260] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 12/21/2018] [Accepted: 01/15/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The current outbreak of Ebola in eastern DR Congo, beginning in 2018, emerged in a complex and violent political and security environment. Community-level prevention and outbreak control measures appear to be dependent on public trust in relevant authorities and information, but little scholarship has explored these issues. We aimed to investigate the role of trust and misinformation on individual preventive behaviours during an outbreak of Ebola virus disease (EVD). METHODS We surveyed 961 adults between Sept 1 and Sept 16, 2018. We used a multistage sampling design in Beni and Butembo in North Kivu, DR Congo. Of 412 avenues and cells (the lowest administrative structures; 99 in Beni and 313 in Butembo), we randomly selected 30 in each city. In each avenue or cell, 16 households were selected using the WHO Expanded Programme on Immunization's random walk approach. In each household, one adult (aged ≥18 years) was randomly selected for interview. Standardised questionnaires were administered by experienced interviewers. We used multivariate models to examine the intermediate variables of interest, including institutional trust and belief in selected misinformation, with outcomes of interest related to EVD prevention behaviours. FINDINGS Among 961 respondents, 349 (31·9%, 95% CI 27·4-36·9) trusted that local authorities represent their interest. Belief in misinformation was widespread, with 230 (25·5%, 21·7-29·6) respondents believing that the Ebola outbreak was not real. Low institutional trust and belief in misinformation were associated with a decreased likelihood of adopting preventive behaviours, including acceptance of Ebola vaccines (odds ratio 0·22, 95% CI 0·21-0·22, and 1·40, 1·39-1·42) and seeking formal health care (0·06, 0·05-0·06, and 1·16, 1·15-1·17). INTERPRETATION The findings underscore the practical implications of mistrust and misinformation for outbreak control. These factors are associated with low compliance with messages of social and behavioural change and refusal to seek formal medical care or accept vaccines, which in turn increases the risk of spread of EVD. FUNDING The Harvard Humanitarian Initiative Innovation Fund.
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Affiliation(s)
- Patrick Vinck
- Harvard Medical School, Harvard University, Cambridge, MA, USA.
| | - Phuong N Pham
- Harvard Medical School, Harvard University, Cambridge, MA, USA
| | - Kenedy K Bindu
- Center for Research on Democracy and Development in Arica, Free University of the Great Lakes Countries in the Democratic Republic of the Congo, Goma, DR Congo
| | | | - Eric J Nilles
- Harvard Medical School, Harvard University, Cambridge, MA, USA
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Recurrent cholera epidemics in Africa: which way forward? A literature review. Infection 2018; 47:341-349. [DOI: 10.1007/s15010-018-1186-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 07/27/2018] [Indexed: 02/03/2023]
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15
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Partizipative Forschungsansätze in der Epidemiologie. PRAVENTION UND GESUNDHEITSFORDERUNG 2018. [DOI: 10.1007/s11553-018-0639-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Démolis R, Botão C, Heyerdahl LW, Gessner BD, Cavailler P, Sinai C, Magaço A, Le Gargasson JB, Mengel M, Guillermet E. A rapid qualitative assessment of oral cholera vaccine anticipated acceptability in a context of resistance towards cholera intervention in Nampula, Mozambique. Vaccine 2017; 36:6497-6505. [PMID: 29174106 PMCID: PMC6190029 DOI: 10.1016/j.vaccine.2017.10.087] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 09/27/2017] [Accepted: 10/30/2017] [Indexed: 11/29/2022]
Abstract
Political resistance impacts potential OCV acceptability. Perceived vulnerability to cholera overrides rationale for OCV hesitancy. Case-by-case preemptive studies maximize public health intervention acceptability.
Introduction While planning an immunization campaign in settings where public health interventions are subject to politically motivated resistance, designing context-based social mobilization strategies is critical to ensure community acceptability. In preparation for an Oral Cholera Vaccine campaign implemented in Nampula, Mozambique, in November 2016, we assessed potential barriers and levers for vaccine acceptability. Methods Questionnaires, in-depth interviews, and focus group discussions, as well as observations, were conducted before the campaign. The participants included central and district level government informants (national immunization program, logistics officers, public health directors, and others), community leaders and representatives, and community members. Results During previous well chlorination interventions, some government representatives and health agents were attacked, because they were believed to be responsible for spreading cholera instead of purifying the wells. Politically motivated resistance to cholera interventions resurfaced when an OCV campaign was considered. Respondents also reported vaccine hesitancy related to experiences of problems during school-based vaccine introduction, rumors related to vaccine safety, and negative experiences following routine childhood immunization. Despite major suspicions associated with the OCV campaign, respondents’ perceived vulnerability to cholera and its perceived severity seem to override potential anticipated OCV vaccine hesitancy. Discussion Potential hesitancy towards the OCV campaign is grounded in global insecurity, social disequilibrium, and perceived institutional negligence, which reinforces a representation of estrangement from the central government, triggering suspicions on its intentions in implementing the OCV campaign. Recommendations include a strong involvement of community leaders, which is important for successful social mobilization; representatives of different political parties should be equally involved in social mobilization efforts, before and during campaigns; and public health officials should promote other planned interventions to mitigate the lack of trust associated with perceived institutional negligence. Successful past initiatives include public intake of purified water or newly introduced medication by social mobilizers, teachers or credible leaders.
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Affiliation(s)
- Rachel Démolis
- Agence de Médecine Préventive, Bât. JB Say, 4e étage, aile A, 13 chemin du Levant, 01210 Ferney-Voltaire, France.
| | - Carlos Botão
- Instituto Nacional de Saúde, Avenido Eduardo Mundlane/Salvador Allende, Maputo, Mozambique
| | | | - Bradford D Gessner
- Agence de Médecine Préventive, Bât. JB Say, 4e étage, aile A, 13 chemin du Levant, 01210 Ferney-Voltaire, France
| | - Philippe Cavailler
- Agence de Médecine Préventive, Bât. JB Say, 4e étage, aile A, 13 chemin du Levant, 01210 Ferney-Voltaire, France
| | - Celestino Sinai
- Instituto Nacional de Saúde, Avenido Eduardo Mundlane/Salvador Allende, Maputo, Mozambique
| | - Amílcar Magaço
- Instituto Nacional de Saúde, Avenido Eduardo Mundlane/Salvador Allende, Maputo, Mozambique
| | - Jean-Bernard Le Gargasson
- Agence de Médecine Préventive, Bât. JB Say, 4e étage, aile A, 13 chemin du Levant, 01210 Ferney-Voltaire, France
| | - Martin Mengel
- Agence de Médecine Préventive, Bât. JB Say, 4e étage, aile A, 13 chemin du Levant, 01210 Ferney-Voltaire, France
| | - Elise Guillermet
- Agence de Médecine Préventive, Bât. JB Say, 4e étage, aile A, 13 chemin du Levant, 01210 Ferney-Voltaire, France
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Heyerdahl LW, Ngwira B, Demolis R, Nyirenda G, Mwesawina M, Rafael F, Cavailler P, Bernard Le Gargasson J, Mengel MA, Gessner BD, Guillermet E. Innovative vaccine delivery strategies in response to a cholera outbreak in the challenging context of Lake Chilwa. A rapid qualitative assessment. Vaccine 2017; 36:6491-6496. [PMID: 29126808 PMCID: PMC6189868 DOI: 10.1016/j.vaccine.2017.10.108] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 08/09/2017] [Accepted: 10/31/2017] [Indexed: 10/25/2022]
Abstract
A reactive campaign using two doses of Shanchol Oral Cholera Vaccine (OCV) was implemented in 2016 in the Lake Chilwa Region (Malawi) targeting fish dependent communities. Three strategies for the second vaccine dose delivery (including delivery by a community leader and self-administration) were used to facilitate vaccine access. This assessment collected vaccine perceptions and opinions about the OCV campaign of 313 study participants, including: fishermen, fish traders, farmers, community leaders, and one health and one NGO officer. Socio-demographic surveys were conducted, In Depth Interviews and Focus Group Discussions were conducted before and during the campaign. Some fishermen perceived the traditional delivery strategy as reliable but less practical. Delivery by traditional leaders was acceptable for some participants while others worried about traditional leaders not being trained to deliver vaccines or beneficiaries taking doses on their own. A slight majority of beneficiaries considered the self-administration strategy practical while some beneficiaries worried about storing vials outside of the cold chain or losing vials. During the campaign, a majority of participants preferred receiving oral vaccines instead of injections given ease of intake and lack of pain. OCV was perceived as efficacious and safe. However, a lack of information on how sero-protection may be delayed and the degree of sero-protection led to loss of trust in vaccine potency among some participants who witnessed cholera cases among vaccinated individuals. OCV campaign implementation requires accompanying communication on protective levels, less than 100% vaccine efficacy, delays in onset of sero-protection, and out of cold chain storage.
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Affiliation(s)
| | - Bagrey Ngwira
- University of Malawi, College of Medicine, Community Health Department, Blantyre, Malawi
| | | | - Gabriel Nyirenda
- University of Malawi, College of Medicine, Community Health Department, Blantyre, Malawi
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Socioeconomic and Attitudinal Variables Associated with Acceptance and Willingness to Pay Towards Dengue Vaccine: A Systematic Review. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2017. [DOI: 10.5812/archcid.13914] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Bach M, Jordan S, Hartung S, Santos-Hövener C, Wright MT. Participatory epidemiology: the contribution of participatory research to epidemiology. Emerg Themes Epidemiol 2017; 14:2. [PMID: 28203262 PMCID: PMC5301332 DOI: 10.1186/s12982-017-0056-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 01/21/2017] [Indexed: 11/26/2022] Open
Abstract
Background Epidemiology has contributed in many ways to identifying various risk factors for disease and to promoting population health. However, there is a continuing debate about the ability of epidemiology not only to describe, but also to provide results which can be better translated into public health practice. It has been proposed that participatory research approaches be applied to epidemiology as a way to bridge this gap between description and action. A systematic account of what constitutes participatory epidemiology practice has, however, been lacking. Methods A scoping review was carried out focused on the question of what constitutes participatory approaches to epidemiology for the purpose of demonstrating their potential for advancing epidemiologic research. Relevant databases were searched, including both the published and non-published (grey) literature. The 102 identified sources were analyzed in terms of comparing common epidemiologic approaches to participatory counterparts regarding central aspects of the research process. Exemplary studies applying participatory approaches were examined more closely. Results A highly diverse, interdisciplinary body of literature was synthesized, resulting in a framework comprised of seven aspects of the research process: research goal, research question, population, context, data synthesis, research management, and dissemination of findings. The framework specifies how participatory approaches not only differ from, but also how they can enhance common approaches in epidemiology. Finally, recommendations for the further development of participatory approaches are given. These include: enhancing data collection, data analysis, and data validation; advancing capacity building for research at the local level; and developing data synthesis. Conclusion The proposed framework provides a basis for systematically developing the emergent science of participatory epidemiology.
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Affiliation(s)
| | | | - Susanne Hartung
- Catholic University of Applied Sciences Berlin, Berlin, Germany
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Scobie HM, Phares CR, Wannemuehler KA, Nyangoma E, Taylor EM, Fulton A, Wongjindanon N, Aung NR, Travers P, Date K. Use of Oral Cholera Vaccine and Knowledge, Attitudes, and Practices Regarding Safe Water, Sanitation and Hygiene in a Long-Standing Refugee Camp, Thailand, 2012-2014. PLoS Negl Trop Dis 2016; 10:e0005210. [PMID: 27992609 PMCID: PMC5167226 DOI: 10.1371/journal.pntd.0005210] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 11/25/2016] [Indexed: 12/05/2022] Open
Abstract
Oral cholera vaccines (OCVs) are relatively new public health interventions, and limited data exist on the potential impact of OCV use on traditional cholera prevention and control measures—safe water, sanitation and hygiene (WaSH). To assess OCV acceptability and knowledge, attitudes, and practices (KAPs) regarding cholera and WaSH, we conducted cross-sectional surveys, 1 month before (baseline) and 3 and 12 months after (first and second follow-up) a preemptive OCV campaign in Maela, a long-standing refugee camp on the Thailand-Burma border. We randomly selected households for the surveys, and administered questionnaires to female heads of households. In total, 271 (77%), 187 (81%), and 199 (85%) households were included in the baseline, first and second follow-up surveys, respectively. Anticipated OCV acceptability was 97% at baseline, and 91% and 85% of household members were reported to have received 1 and 2 OCV doses at first follow-up. Compared with baseline, statistically significant differences (95% Wald confidence interval not overlapping zero) were noted at first and second follow-up among the proportions of respondents who correctly identified two or more means of cholera prevention (62% versus 78% and 80%), reported boiling or treating drinking water (19% versus 44% and 69%), and washing hands with soap (66% versus 77% and 85%); a significant difference was also observed in the proportion of households with soap available at handwashing areas (84% versus 90% and 95%), consistent with reported behaviors. No significant difference was noted in the proportion of households testing positive for Escherichia coli in stored household drinking water at second follow-up (39% versus 49% and 34%). Overall, we observed some positive, and no negative changes in cholera- and WaSH-related KAPs after an OCV campaign in Maela refugee camp. OCV campaigns may provide opportunities to reinforce beneficial WaSH-related KAPs for comprehensive cholera prevention and control. Safe water, sanitation, and hygiene (WaSH) are the primary measures for cholera prevention and control. Since 2010, oral cholera vaccines (OCVs) have been recommended as an additional tool for endemic and epidemic cholera prevention and control. Given the relatively new use of OCVs in public health programs, there is limited information on the impact of OCV use on traditional WaSH activities, i.e., can they serve as complementary tools, or will OCV use have a negative impact on WaSH-related behaviors? This study reports the findings of knowledge, attitudes and practices (KAP) surveys conducted before and after a preventive OCV campaign (2013) in a long-standing refugee camp in Thailand, where frequent cholera outbreaks had occurred in recent years. The surveys demonstrated high acceptability of the OCV campaign and several modest improvements in cholera and WaSH KAPs among the camp population. OCV campaigns may be used as opportunities to reinforce cholera and WaSH-related messaging towards strengthening comprehensive cholera prevention and control.
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Affiliation(s)
- Heather M. Scobie
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Christina R. Phares
- Thailand Ministry of Public Health – U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kathleen A. Wannemuehler
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Edith Nyangoma
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Eboni M. Taylor
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Anna Fulton
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Nuttapong Wongjindanon
- Thailand Ministry of Public Health – U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Naw Rody Aung
- Première Urgence-Aide Médicale Internationale, Mae Sot, Thailand
| | - Phillipe Travers
- Première Urgence-Aide Médicale Internationale, Mae Sot, Thailand
| | - Kashmira Date
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Harapan H, Fajar JK, Sasmono RT, Kuch U. Dengue vaccine acceptance and willingness to pay. Hum Vaccin Immunother 2016; 13:786-790. [PMID: 27905832 DOI: 10.1080/21645515.2016.1259045] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The introduction of new vaccines is accompanied by a variety of challenges. Among these, very important ones concern the questions whether the public is willing to accept and willing to purchase the vaccine. Here we discuss factors associated with these questions in the context of vaccines that are becoming available against dengue virus infection. We reviewed published studies available from PubMed and Embase, conducting a meta-analysis when possible and narrative review when the data did not qualify for meta-analysis. We found that attitude toward vaccination and socioeconomic level had significant associations with dengue vaccine acceptance. In addition, socioeconomic level, knowledge, attitude and practice regarding dengue fever, having personally experienced dengue fever and vaccine price were associated with willingness to pay for dengue vaccine. To improve acceptance and willingness to pay for dengue vaccine, well-designed introduction programs that address the associated factors in a context-specific manner are essential.
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Affiliation(s)
- Harapan Harapan
- a Medical Research Unit , School of Medicine, Syiah Kuala University , Banda Aceh , Indonesia.,b Tropical Disease Centre, School of Medicine, Syiah Kuala University , Banda Aceh , Indonesia.,c Department of Microbiology , School of Medicine, Syiah Kuala University , Banda Aceh , Indonesia
| | - Jonny K Fajar
- a Medical Research Unit , School of Medicine, Syiah Kuala University , Banda Aceh , Indonesia
| | - R Tedjo Sasmono
- d Eijkman Institute for Molecular Biology , Jakarta , Indonesia
| | - Ulrich Kuch
- e Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University , Frankfurt am Main , Germany
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22
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Saif-Ur-Rahman KM, Parvin T, Bhuyian SI, Zohura F, Begum F, Rashid MU, Biswas SK, Sack D, Sack RB, Monira S, Alam M, Shaly NJ, George CM. Promotion of Cholera Awareness Among Households of Cholera Patients: A Randomized Controlled Trial of the Cholera-Hospital-Based-Intervention-for-7 Days (CHoBI7) Intervention. Am J Trop Med Hyg 2016; 95:1292-1298. [PMID: 27799644 DOI: 10.4269/ajtmh.16-0378] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 09/06/2016] [Indexed: 11/07/2022] Open
Abstract
Previous studies have demonstrated that household contacts of cholera patients are highly susceptible to cholera infections for a 7-day period after the presentation of the index patient in the hospital. However, there is no standard of care to prevent cholera transmission in this high-risk population. Furthermore, there is limited information available on awareness of cholera transmission and prevention among cholera patients and their household contacts. To initiate a standard of care for this high-risk population, we developed the Cholera-Hospital-Based-Intervention-for-7-Days (CHoBI7), which delivers a handwashing with soap and water treatment intervention to household contacts during the time they spend with the admitted cholera patient in the hospital and reinforces these messages through home visits. To test CHoBI7, we conducted a randomized controlled trial among 302 intervention cholera patient household members and 302 control cholera patient household members in Dhaka, Bangladesh. In this study, we evaluated the effectiveness of the CHoBI7 intervention in increasing awareness of cholera transmission and prevention, and the key times for handwashing with soap. We observed a significant increase in cholera knowledge score in the intervention arm compared with the control arm at both the 1-week follow-up {score coefficient = 2.34 (95% confidence interval [CI] = 1.96, 2.71)} and 6 to 12-month follow-up period (score coefficient = 1.59 [95% CI = 1.05, 2.13]). This 1-week hospital- and home-based intervention led to a significant increase in knowledge of cholera transmission and prevention which was sustained 6 to 12 months post-intervention. These findings suggest that the CHoBI7 intervention presents a promising approach to increase cholera awareness among this high-risk population.
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Affiliation(s)
- K M Saif-Ur-Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tahmina Parvin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sazzadul Islam Bhuyian
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Fatema Zohura
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Farzana Begum
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mahamud-Ur Rashid
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shwapon Kumar Biswas
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - David Sack
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - R Bradley Sack
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Shirajum Monira
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Munirul Alam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Nusrat Jahan Shaly
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Christine Marie George
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
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23
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Weiss C, Schröpfer D, Merten S. Parental attitudes towards measles vaccination in the canton of Aargau, Switzerland: a latent class analysis. BMC Infect Dis 2016; 16:400. [PMID: 27514620 PMCID: PMC4982412 DOI: 10.1186/s12879-016-1747-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 08/03/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the successes of routine national childhood vaccination programmes, measles remains a public health concern. The purpose of this paper is to investigate how patterns of parental attitudes are linked to the decision-making process for or against MMR vaccination. This exploratory study was designed to identify distinct patterns of attitudes towards or against measles vaccination through Latent Class Analysis (LCA) in a sub-sample of mothers living in the canton of Aargau in Switzerland. METHODS Parents of young children below 36 months of age were randomly selected through parents' counsellors' registries. Among other questions, respondents were asked to state their agreement in response to 14 belief statements regarding measles vaccination on a 5-point Likert scale. To identify groups of parents showing distinct patterns of attitudes and beliefs regarding measles vaccination, we used Latent Class Analysis (LCA). RESULTS The LCA showed three classes of parents with different attitudes and believes towards measles vaccination: The biggest group (class 1) are those having positive attitudes towards immunisation, followed by the second biggest group (class 2) which is characterised by having fearful attitudes and by showing uncertainty about immunisation. The third group (class 3) shows distinct patterns of critical attitudes against immunisation. Within this group over 90 % agree or totally agree that immunisation is an artificial intrusion into the natural immune system and therefore want to vaccinate their children only if necessary. CONCLUSION We find that parents in the Canton Aargau who hesitate to vaccinate their children against measles, mumps and rubella show distinct opinions and attitudes. Health professionals should be aware of these perceptions to tailor their messages accordingly and positively influence these parents to vaccinate their children. Special attention needs to be given to those parents who are planning to vaccinate their children but are not following the national guidelines.
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Affiliation(s)
- Carine Weiss
- Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Daniel Schröpfer
- Stadtärztlicher Dienst Zürich/Ambulatorium Kanonengasse, Zürich, Switzerland
| | - Sonja Merten
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
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Sundaram N, Purohit V, Schaetti C, Kudale A, Joseph S, Weiss MG. Community awareness, use and preference for pandemic influenza vaccines in Pune, India. Hum Vaccin Immunother 2016; 11:2376-88. [PMID: 26110454 PMCID: PMC4635903 DOI: 10.1080/21645515.2015.1062956] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Vaccination is a cornerstone of influenza prevention, but limited vaccine uptake was a problem worldwide during the 2009–2010 pandemic. Community acceptance of a vaccine is a critical determinant of its effectiveness, but studies have been confined to high-income countries. We conducted a cross-sectional, mixed-method study in urban and rural Pune, India in 2012–2013. Semi-structured explanatory model interviews were administered to community residents (n = 436) to study awareness, experience and preference between available vaccines for pandemic influenza. Focus group discussions and in-depth interviews complemented the survey. Awareness of pandemic influenza vaccines was low (25%). Some respondents did not consider vaccines relevant for adults, but nearly all (94.7%), when asked, believed that a vaccine would prevent swine flu. Reported vaccine uptake however was 8.3%. Main themes identified as reasons for uptake were having heard of a death from swine flu, health care provider recommendation or affiliation with the health system, influence of peers and information from media. Reasons for non-use were low perceived personal risk, problems with access and cost, inadequate information and a perceived lack of a government mandate endorsing influenza vaccines. A majority indicated a preference for injectable over nasal vaccines, especially in remote rural areas. Hesitancy from a lack of confidence in pandemic influenza vaccines appears to have been less of an issue than access, complacency and other sociocultural considerations. Recent influenza outbreaks in 2015 highlight a need to reconsider policy for routine influenza vaccination while paying attention to sociocultural factors and community preferences for effective vaccine action.
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Affiliation(s)
- Neisha Sundaram
- a Department of Epidemiology and Public Health ; Swiss Tropical and Public Health Institute ; Basel , Switzerland.,b University of Basel ; Basel , Switzerland.,c Saw Swee Hock School of Public Health; National University of Singapore; National University Health System ; Singapore , Singapore
| | - Vidula Purohit
- d Centre for Health Research and Development; The Maharashtra Association of Anthropological Sciences ; Pune , Maharashtra , India.,e Savitribai Phule Pune University ; Pune , Maharashtra , India
| | - Christian Schaetti
- a Department of Epidemiology and Public Health ; Swiss Tropical and Public Health Institute ; Basel , Switzerland.,b University of Basel ; Basel , Switzerland
| | - Abhay Kudale
- d Centre for Health Research and Development; The Maharashtra Association of Anthropological Sciences ; Pune , Maharashtra , India.,e Savitribai Phule Pune University ; Pune , Maharashtra , India
| | - Saju Joseph
- d Centre for Health Research and Development; The Maharashtra Association of Anthropological Sciences ; Pune , Maharashtra , India.,e Savitribai Phule Pune University ; Pune , Maharashtra , India
| | - Mitchell G Weiss
- a Department of Epidemiology and Public Health ; Swiss Tropical and Public Health Institute ; Basel , Switzerland.,b University of Basel ; Basel , Switzerland
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25
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Tamason CC, Tulsiani SM, Siddique AK, Hoque BA, Mackie Jensen PK. What is cholera? A preliminary study on caretakers' knowledge in Bangladesh. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2016; 35:3. [PMID: 26858019 PMCID: PMC5025963 DOI: 10.1186/s41043-016-0040-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 01/29/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Cholera has afflicted the Indian sub-continent for centuries, predominantly in West Bengal and modern-day Bangladesh. This preliminary study aims to understand the current level of knowledge of cholera in female Bangladeshi caretakers, which is important in the outcome of the disease and its spread. A pilot study was conducted among 85 women in Bangladesh using qualitative questionnaires to explore the ability of female caretakers in identifying cholera and its transmission. FINDINGS The survey revealed that though all the female caretakers were aware of the term "cholera," nearly a third of the respondents did not associate diarrhea with cholera or mentioned symptoms that could not be caused by cholera (29 %). Approximately half of the respondents associated water with the cause of cholera (56 %) and only 8 % associated cholera with sanitation or hygiene. Shame and stigma (54 %) were more commonly described than death (47 %) as negative effects of cholera. CONCLUSIONS The results from this study are suggestive of a need for reformulation of cholera and diarrhea communication. Messaging should be based on signs of dehydration, foregoing the use of medical terminology.
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Affiliation(s)
- Charlotte C Tamason
- Department of Public Health, Global Health Section, University of Copenhagen, Øster Farimagsgade 5, Building 9, 1353, Copenhagen, Denmark.
- Copenhagen Centre for Disaster Research, University of Copenhagen, Øster Farimagsgade 5, Building, 1353, Copenhagen, Denmark.
| | - Suhella M Tulsiani
- Department of Public Health, Global Health Section, University of Copenhagen, Øster Farimagsgade 5, Building 9, 1353, Copenhagen, Denmark.
- Copenhagen Centre for Disaster Research, University of Copenhagen, Øster Farimagsgade 5, Building, 1353, Copenhagen, Denmark.
| | - A K Siddique
- International Centre for Diarrhoeal Disease Research, GPO Box 128, Mohakhali, Dhaka, 1000, Bangladesh.
| | - Bilqis A Hoque
- Environment and Population Research Centre, House# 292, Road# 19/B, New DOHS Mohakhali, Dhaka, 1206, Bangladesh.
- Department of Civil and Environmental Engineering, Uttara University, House# 4, Road# 15, Uttara, Dhaka, 1230, Bangladesh.
| | - Peter K Mackie Jensen
- Department of Public Health, Global Health Section, University of Copenhagen, Øster Farimagsgade 5, Building 9, 1353, Copenhagen, Denmark.
- Copenhagen Centre for Disaster Research, University of Copenhagen, Øster Farimagsgade 5, Building, 1353, Copenhagen, Denmark.
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Sundaram N, Schaetti C, Merten S, Schindler C, Ali SM, Nyambedha EO, Lapika B, Chaignat CL, Hutubessy R, Weiss MG. Sociocultural determinants of anticipated oral cholera vaccine acceptance in three African settings: a meta-analytic approach. BMC Public Health 2016; 16:36. [PMID: 26762151 PMCID: PMC4712562 DOI: 10.1186/s12889-016-2710-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 01/08/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Controlling 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. METHODS Cross-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. RESULTS Anticipated 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. CONCLUSIONS These 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.
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Affiliation(s)
- Neisha Sundaram
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002 Basel, Switzerland
- University of Basel, Petersplatz 1, 4003 Basel, Switzerland
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Singapore, 117549 Singapore
| | - Christian Schaetti
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002 Basel, Switzerland
- University of Basel, Petersplatz 1, 4003 Basel, Switzerland
| | - Sonja Merten
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002 Basel, Switzerland
- University of Basel, Petersplatz 1, 4003 Basel, Switzerland
| | - Christian Schindler
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002 Basel, Switzerland
- University of Basel, Petersplatz 1, 4003 Basel, Switzerland
| | - Said M. Ali
- Public Health Laboratory Ivo de Carneri, Chake-Chake, Pemba, Zanzibar United Republic of Tanzania
| | - Erick O. Nyambedha
- Department of Sociology and Anthropology, Maseno University, Private Bag, Maseno, Kenya
| | - Bruno Lapika
- Department of Anthropology, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Claire-Lise Chaignat
- Global Task Force on Cholera Control, World Health Organization, 20, Avenue Appia, 1211 Geneva 27, Switzerland
| | - Raymond Hutubessy
- Initiative for Vaccine Research, World Health Organization, 20, Avenue Appia, 1211 Geneva 27, Switzerland
| | - Mitchell G. Weiss
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002 Basel, Switzerland
- University of Basel, Petersplatz 1, 4003 Basel, Switzerland
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Chung AH, Rimal RN. Applying Choice Architecture Principles to Understand HIV Testing: Findings From Malawi and Zimbabwe. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2015; 27:362-372. [PMID: 26241385 DOI: 10.1521/aeap.2015.27.4.362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Improvements spearheaded by the World Health Organization in antenatal HIV counseling in sub-Saharan Africa from 2004 to 2011 have seen a parallel increase in HIV testing. We sought to determine the extent to which the use of choice architecture principles (one that introduces an opt-out option as the default) affect uptake of HIV testing, above and beyond individual-level attitudes and cognitions. Demographic and Health Survey data collected between 2004 and 2011 from Zimbabwe (N = 1,330) and Malawi (N = 4,043)--countries where over 10% of adults have HIV--were analyzed. We explored the influence of demographic variables, modes of knowledge about HIV, stigma against people living with HIV, attitudes about spousal abuse, and whether or not HIV testing had been offered during antenatal visits. Results demonstrated that, taking into account secular trends in higher testing rates, structural-level support was the strongest predictor of HIV testing above and beyond individual-level attitudes and cognitions.
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Innocent AOU, Francisca N, Adeniyi A, David O, Tajudeen B, Sola M, Kehinde A, Jerry I, Mike O, Stella S, Innocent AOU, Francisca N, Adeniyi A, David O, Tajudeen B, Sola M, Kehinde A, Jerry I, Mike O, Stella S. A review of perception and myth on causes of cholera infection in endemic areas of Nigeria. ACTA ACUST UNITED AC 2015. [DOI: 10.5897/ajmr2015.7362] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Kochhar S, Rath B, Seeber LD, Rundblad G, Khamesipour A, Ali M. Introducing new vaccines in developing countries. Expert Rev Vaccines 2014; 12:1465-78. [DOI: 10.1586/14760584.2013.855612] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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30
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Schaetti C, Sundaram N, Merten S, Ali SM, Nyambedha EO, Lapika B, Chaignat CL, Hutubessy R, Weiss MG. Comparing sociocultural features of cholera in three endemic African settings. BMC Med 2013; 11:206. [PMID: 24047241 PMCID: PMC4016292 DOI: 10.1186/1741-7015-11-206] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 08/15/2013] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Cholera mainly affects developing countries where safe water supply and sanitation infrastructure are often rudimentary. Sub-Saharan Africa is a cholera hotspot. Effective cholera control requires not only a professional assessment, but also consideration of community-based priorities. The present work compares local sociocultural features of endemic cholera in urban and rural sites from three field studies in southeastern Democratic Republic of Congo (SE-DRC), western Kenya and Zanzibar. METHODS A vignette-based semistructured interview was used in 2008 in Zanzibar to study sociocultural features of cholera-related illness among 356 men and women from urban and rural communities. Similar cross-sectional surveys were performed in western Kenya (n = 379) and in SE-DRC (n = 360) in 2010. Systematic comparison across all settings considered the following domains: illness identification; perceived seriousness, potential fatality and past household episodes; illness-related experience; meaning; knowledge of prevention; help-seeking behavior; and perceived vulnerability. RESULTS Cholera is well known in all three settings and is understood to have a significant impact on people's lives. Its social impact was mainly characterized by financial concerns. Problems with unsafe water, sanitation and dirty environments were the most common perceived causes across settings; nonetheless, non-biomedical explanations were widespread in rural areas of SE-DRC and Zanzibar. Safe food and water and vaccines were prioritized for prevention in SE-DRC. Safe water was prioritized in western Kenya along with sanitation and health education. The latter two were also prioritized in Zanzibar. Use of oral rehydration solutions and rehydration was a top priority everywhere; healthcare facilities were universally reported as a primary source of help. Respondents in SE-DRC and Zanzibar reported cholera as affecting almost everybody without differentiating much for gender, age and class. In contrast, in western Kenya, gender differentiation was pronounced, and children and the poor were regarded as most vulnerable to cholera. CONCLUSIONS This comprehensive review identified common and distinctive features of local understandings of cholera. Classical treatment (that is, rehydration) was highlighted as a priority for control in the three African study settings and is likely to be identified in the region beyond. Findings indicate the value of insight from community studies to guide local program planning for cholera control and elimination.
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Affiliation(s)
- Christian Schaetti
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, PO Box, 4002, Basel, Switzerland
- University of Basel, Petersplatz 1, 4003 Basel, Switzerland
| | - Neisha Sundaram
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, PO Box, 4002, Basel, Switzerland
- University of Basel, Petersplatz 1, 4003 Basel, Switzerland
| | - Sonja Merten
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, PO Box, 4002, Basel, Switzerland
- University of Basel, Petersplatz 1, 4003 Basel, Switzerland
| | - Said M Ali
- Public Health Laboratory Ivo de Carneri, PO Box 122, Wawi, Chake-Chake, Pemba, Zanzibar, United Republic of Tanzania
| | - Erick O Nyambedha
- Department of Sociology and Anthropology, Maseno University, Private Bag, Maseno, Kenya
| | - Bruno Lapika
- Department of Anthropology, University of Kinshasa, PO Box 127, Kinshasa XI, Democratic Republic of Congo
| | - Claire-Lise Chaignat
- Global Task Force on Cholera Control, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Raymond Hutubessy
- Initiative for Vaccine Research, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Mitchell G Weiss
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, PO Box, 4002, Basel, Switzerland
- University of Basel, Petersplatz 1, 4003 Basel, Switzerland
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31
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Merten S, Schaetti C, Manianga C, Lapika B, Hutubessy R, Chaignat CL, Weiss M. Sociocultural determinants of anticipated vaccine acceptance for acute watery diarrhea in early childhood in Katanga Province, Democratic Republic of Congo. Am J Trop Med Hyg 2013; 89:419-25. [PMID: 23878187 DOI: 10.4269/ajtmh.12-0643] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Rotavirus and oral cholera vaccines have the potential to reduce diarrhea-related child mortality in low-income settings and are recommended by the World Health Organization. Uptake of vaccination depends on community support, and is based on local priorities. This study investigates local perceptions of acute watery diarrhea in childhood and anticipated vaccine acceptance in two sites in the Democratic Republic of Congo. In 2010, 360 randomly selected non-affected adults were interviewed by using a semi-structured questionnaire. Witchcraft and breastfeeding were perceived as potential cause of acute watery diarrhea by 51% and 48% of respondents. Despite misperceptions, anticipated vaccine acceptance at no cost was 99%. The strongest predictor of anticipated vaccine acceptance if costs were assumed was the educational level of the respondents. Results suggest that the introduction of vaccines is a local priority and local (mis)perceptions of illness do not compromise vaccine acceptability if the vaccine is affordable.
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Affiliation(s)
- Sonja Merten
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.
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32
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Kaljee LM, Pach A, Thriemer K, Ley B, Jiddawi M, Puri M, Ochiai L, Wierzba T, Clemens J, Ali SM. Desirability for a typhoid fever vaccine among rural residents, Pemba Island, Tanzania. Vaccine 2013; 31:2994-9. [DOI: 10.1016/j.vaccine.2013.04.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 03/28/2013] [Accepted: 04/24/2013] [Indexed: 10/26/2022]
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