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Hester KA, Sakas Z, Ogutu EA, Dixit S, Ellis AS, Yang C, Chanda C, Freeman MC, Orenstein WA, Sarr M, Bednarczyk RA. Critical interventions for demand generation in Zambia, Nepal, and Senegal with regards to the 5C psychological antecedents of vaccination. Vaccine X 2023; 14:100341. [PMID: 37519776 PMCID: PMC10372309 DOI: 10.1016/j.jvacx.2023.100341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 04/21/2023] [Accepted: 06/28/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Childhood vaccination is an effective intervention for lowering the burden of infectious disease. Vaccine coverage has increased globally, but vaccine hesitancy and refusal threatens these gains. The 5C psychological antecedents of vaccination ("5C") provides a validated measure of "vaccine hesitancy or confidence" to assess individual thoughts and behaviors behind vaccination. We investigated population-level factors that contributed to high and sustained vaccination coverage in Zambia, Nepal, and Senegal, and alignment with the 5Cs. Methods Data was collected in the larger Exemplars in Vaccine Delivery study, from focus group discussions (FDGs) and key informant interviews (KIIs) at the national, regional, district, health facility, and community levels of health systems in Zambia, Nepal, and Senegal. We assessed the demand environment, as relayed by participants, and identified interventions reported as successful for demand generation, then retroactively aligned the interventions with the 5C constructs. Results Demand was positively correlated with high confidence and collective responsibility. Psychological constraints sometimes impacted demand. Physical constraints created barriers in some communities, particularly difficult to access (i.e., mountainous). Occasionally, physical constraints did not affect vaccination behavior - parents believed the benefits of vaccination worth pursuing. Factors negatively correlated with demand and intent, complacency and calculation, had limited impact. Critical interventions were: targeted and tailored health education activities (media partnerships, school outreach); community engagement; community ownership; and community involvement (community health workers, leaders, religious figures). Conclusion We found similar interventions used to generate demand, with strategies aligned with the 5C constructs. Categorizing interventions by drivers of demand may help strategic planning and the division of resources; decision makers may choose to implement our suggested interventions. Assessing the 5Cs allows decision-makers to operationalize demand generation into concrete interventions and policies, and determine the individual impact of these constructs on the population and focus efforts on interventions tailored to a specific need.
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Affiliation(s)
- Kyra A. Hester
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Zoe Sakas
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Sameer Dixit
- Center for Molecular Dynamics Nepal, Katmandu, Nepal
| | - Anna S. Ellis
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Chenmua Yang
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Chama Chanda
- Center for Family Health Research in Zambia, Lusaka, Zambia
| | | | | | - Moussa Sarr
- Institut de Recherche en Santé de Surveillance Epidemiologique et de Formation (IRESSEF), Dakar, Senegal
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Khaliq A, Amreen, Jameel N, Krauth SJ. Knowledge and Practices on the Prevention and Management of Diarrhea in Children Under-2 Years Among Women Dwelling in Urban Slums of Karachi, Pakistan. Matern Child Health J 2022; 26:1442-1452. [PMID: 35247160 PMCID: PMC9174301 DOI: 10.1007/s10995-022-03391-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2022] [Indexed: 11/28/2022]
Abstract
Background Diarrhea is the second leading cause of death especially among children. The age-proportionate mortality of diarrheal disease in infants under 2 years is 72%, among children under 5 years of age. Children living in urban slums are more prone to develop diarrhea. Although the disease can be prevented by many simple cost-effective interventions, i.e. proper sanitation and hygiene, appropriate feeding, and timely vaccination, poverty and lack of basic life amenities often potentiate diarrhea mortality. Gadap town is the largest town of Karachi with a deprived health system. This study aims to assess pediatric diarrhea prevalence and related knowledge-practice gaps in the slums of Gadap Town, Karachi, Pakistan. Method A community-based cross-sectional study was conducted from November 2016 to May 2017 among mothers of children under 2 years, who were residents of Gadap Town, Karachi, Pakistan. The participants were approached by a multistage sampling method. A validated dichotomous questionnaire, piloted on 40 participants, translated into local language Urdu was used for data collection and the data was analyzed by SPSS® version 20.0. Results 51.8% (n = 199) of participants were aged between 25 and 34 years. Among all participants, 68% (n = 261) had primary level education or less, compared to 4.7% (n = 18) of women who had graduate-level education. The mean number of children per woman was 2.52 ± 1.62. Self-reported pediatric diarrhea incidence was 72.1% (n = 277). More than half (55.2% n = 149) of participants reported frequent diarrhea episodes during the 2nd year of their child’s life. In this survey, we found the knowledge of women regarding diarrhea management and how to reduce diarrhea morbidity to be inadequate (p > 0.05). However, many women reported appropriate practices which can significantly reduce diarrhea morbidity (p < 0.05). Conclusion While the knowledge among women on preventive measures for pediatric diarrhea was insufficient, the translation of the right knowledge into appropriate practices showed promising outcomes for reducing diarrhea morbidity. An integrated approach for improving feeding, sanitation, and hygiene practices along with continuous health education could curtail the burden of diarrhea among infants living in urban slums.
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Affiliation(s)
- Asif Khaliq
- Department of Community Medicines, Baqai Medical University, Karachi, Pakistan. .,School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia. .,Department of Paediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan.
| | - Amreen
- Department of Psychiatry, Dow University of Health Sciences, Karachi, Pakistan
| | - Nazia Jameel
- Department of Community Medicines, Baqai Medical University, Karachi, Pakistan
| | - Stefanie J Krauth
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK.
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The Need for Health Education and Vaccination-Importance of Teacher Training and Family Involvement. Healthcare (Basel) 2022; 10:healthcare10010110. [PMID: 35052274 PMCID: PMC8775884 DOI: 10.3390/healthcare10010110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/29/2021] [Accepted: 01/05/2022] [Indexed: 02/04/2023] Open
Abstract
The health emergency due to COVID-19 has highlighted the importance of vaccination and its impact on social welfare. Inequalities have surfaced that affect the most vulnerable and those millions of children do not receive the necessary vaccines. Health education becomes a fundamental resource for citizens to access universal rights. One thousand people from 76 countries on five continents participated in this research in 2019–2020, from the health, education, and economic sectors. A descriptive cross-sectional study with a quantitative design was used. The instrument used was a correctly validated questionnaire: VACUNASEDUCA. The objectives were to reflect on the adequacy of teacher training and their awareness for the proper use of vaccines and to analyze the knowledge of parents about the consequences of vaccination. The results demonstrate the importance of teacher training and health education, with positive involvement of the family. The most favorable group is female, under 30 years, from the European continent, with a very high Human Development Index (HDI), and from the education sector. In conclusion, it is noted that, within the framework of the fourth industrial revolution, education must be configured with innovative approaches and tools, making it necessary to intervene in the context considering their cultural characteristics and promoting healthy lifestyle habits.
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Tamysetty S, Babu GR, Sahu B, Shapeti S, Ravi D, Lobo E, Varughese CS, Bhide A, Madhale A, Manyal M, Kamble M, Konar A, Sarkar P, Das DK, Mukherjee PS, Singh K, Chauhan AS, Naskar A, Bhatia R, Khetrapal S. Predictors of COVID-19 Vaccine Confidence: Findings from Slums of Four Major Metro Cities of India. Vaccines (Basel) 2021; 10:60. [PMID: 35062720 PMCID: PMC8781952 DOI: 10.3390/vaccines10010060] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/27/2021] [Accepted: 11/29/2021] [Indexed: 02/08/2023] Open
Abstract
There are limited studies on COVID vaccine confidence at the household level in urban slums, which are at high risk of COVID-19 transmission due to overcrowding and poor living conditions. The objective was to understand the reasons influencing COVID-19 vaccine confidence, in terms of barriers and enablers faced by communities in urban slums and informal settlements in four major metro cities in India. A mixed method approach was adopted, where in field studies were conducted during April-May 2021. First, a survey of at least 50 subjects was conducted among residents of informal urban settlements who had not taken any dose of the COVID-19 vaccine in Mumbai, Bengaluru, Kolkata and Delhi; second, a short interview with five subjects who had taken at least one dose of the vaccine in each of the four cities to understand the factors that contributed to positive behaviour and, finally, an in-depth interview of at least 3 key informants in each city to ascertain the vaccination pattern in the communities. The reasons were grouped under contextual, individual/group and vaccine/vaccination specific issues. The most frequent reason (27.7%) was the uncertainty of getting the vaccine. The findings show the need for increasing effectiveness of awareness campaigns, accessibility and the convenience of vaccination, especially among vulnerable groups, to increase the uptake.
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Affiliation(s)
- Sathyanarayana Tamysetty
- Indian Institute of Public Health, Bangalore 560023, India; (G.R.B.); (B.S.); (S.S.); (D.R.); (E.L.)
| | - Giridhara R. Babu
- Indian Institute of Public Health, Bangalore 560023, India; (G.R.B.); (B.S.); (S.S.); (D.R.); (E.L.)
| | - Biswamitra Sahu
- Indian Institute of Public Health, Bangalore 560023, India; (G.R.B.); (B.S.); (S.S.); (D.R.); (E.L.)
| | - Suresh Shapeti
- Indian Institute of Public Health, Bangalore 560023, India; (G.R.B.); (B.S.); (S.S.); (D.R.); (E.L.)
| | - Deepa Ravi
- Indian Institute of Public Health, Bangalore 560023, India; (G.R.B.); (B.S.); (S.S.); (D.R.); (E.L.)
| | - Eunice Lobo
- Indian Institute of Public Health, Bangalore 560023, India; (G.R.B.); (B.S.); (S.S.); (D.R.); (E.L.)
| | | | - Amita Bhide
- Tata Institute of Social Science, Mumbai 400088, India; (A.B.); (A.M.); (M.M.); (M.K.)
| | - Avinash Madhale
- Tata Institute of Social Science, Mumbai 400088, India; (A.B.); (A.M.); (M.M.); (M.K.)
| | - Mukta Manyal
- Tata Institute of Social Science, Mumbai 400088, India; (A.B.); (A.M.); (M.M.); (M.K.)
| | - Mahesh Kamble
- Tata Institute of Social Science, Mumbai 400088, India; (A.B.); (A.M.); (M.M.); (M.K.)
| | - Asokananda Konar
- Liver Foundation, Kolkata 700150, India; (A.K.); (P.S.); (D.K.D.); (P.S.M.)
| | - Pabak Sarkar
- Liver Foundation, Kolkata 700150, India; (A.K.); (P.S.); (D.K.D.); (P.S.M.)
| | - Dipesh Kumar Das
- Liver Foundation, Kolkata 700150, India; (A.K.); (P.S.); (D.K.D.); (P.S.M.)
| | | | - Kultar Singh
- Sambodhi Research and Communication, Pvt Ltd., Noida 201301, India; (K.S.); (A.S.C.); (A.N.)
| | - Ankur Singh Chauhan
- Sambodhi Research and Communication, Pvt Ltd., Noida 201301, India; (K.S.); (A.S.C.); (A.N.)
| | - Aditya Naskar
- Sambodhi Research and Communication, Pvt Ltd., Noida 201301, India; (K.S.); (A.S.C.); (A.N.)
| | - Rajesh Bhatia
- Asian Development Bank, New Delhi 110021, India; (R.B.); (S.K.)
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Tahir MJ, Saqlain M, Tariq W, Waheed S, Tan SHS, Nasir SI, Ullah I, Ahmed A. Population preferences and attitudes towards COVID-19 vaccination: a cross-sectional study from Pakistan. BMC Public Health 2021; 21:1759. [PMID: 34565351 PMCID: PMC8474768 DOI: 10.1186/s12889-021-11814-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 09/17/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND While vaccine development is itself a challenge; ensuring optimal vaccine uptake at population level can present an even more significant challenge. Therefore, this study aimed to assess the Pakistani population's attitude and preferences towards the Coronavirus disease 2019 (COVID-19) vaccine. METHOD A cross-sectional study was carried out through an online self-administered questionnaire from 27 September 2020 to 11 October 2020. A total of 883 people responded to the survey. The questionnaire included the participants' socio-demographic variables, attitudes, beliefs towards the COVID-19 vaccine and acceptance and rejection of vaccination, and reasons for them. Logistic regression analysis was used to analyze the predictors for vaccine acceptance and willingness to pay for the vaccine. RESULTS A majority (70.8%) of respondents will accept the COVID-19vaccine if available, and 66.8% showed a positive attitude towards vaccination. Monthly family income, education level, self-diagnosis of COVID-19 or a friend, family member, or colleague are significant factors influencing the acceptance of COVID-19 vaccination. The dogma of being naturally immune to COVID-19 was a key reason for the refusal of the vaccine. Less than half (48%) of those who refuse will vaccinate themselves if government officials have made it compulsory. A third (33.9%) of participants were willing to pay up to (7 USD) 1000 Pkr (Pakistani Rupees) for the vaccine. CONCLUSION The population's positive attitude should be improved by increasing awareness and eradicating false myths about vaccines through large-scale campaigns.
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Affiliation(s)
- Muhammad Junaid Tahir
- Ameer-ud-Din Medical College Affiliated with University of Health Sciences, Lahore, 54000 Pakistan
- Lahore General Hospital, Lahore, 54000 Pakistan
| | - Muhammad Saqlain
- Department of Pharmacy, Quaid-I-Azam University, Islamabad, 45320 Pakistan
| | - Waleed Tariq
- Ameer-ud-Din Medical College Affiliated with University of Health Sciences, Lahore, 54000 Pakistan
- Lahore General Hospital, Lahore, 54000 Pakistan
| | - Summaiya Waheed
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | | | | | - Irfan Ullah
- Kabir Medical College, Gandhara University, Peshawar, Pakistan
| | - Ali Ahmed
- Department of Pharmacy, Quaid-I-Azam University, Islamabad, 45320 Pakistan
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Subang Jaya, Selangor Malaysia
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Rahman R, Ross A, Pinto R. The critical importance of community health workers as first responders to COVID-19 in USA. Health Promot Int 2021; 36:1498-1507. [PMID: 33569593 PMCID: PMC7928891 DOI: 10.1093/heapro/daab008] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
COVID-19 has served to exacerbate existing health disparities and inequities, most—if not all—of which can be traced to the social determinants of health (SDOH) that affect specific populations and communities. Essential to health and health systems long before, community health workers are experts in addressing SDOH in community-based settings; however, they have yet to be mobilized as part of the COVID-19 response both in the US and internationally. We use data from our mixed-methods study with supervisors (n=6), Executive Directors (EDs) (n=7), and CHWs (n=90) to describe the critical role that CHWs can play to assist in response to COVID-19 using New York State's (NYS) as a case example. Building on these findings, we raise specific CHW workforce issues and propose recommendations for how to mobilize this workforce in national pandemic response efforts.
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Affiliation(s)
- Rahbel Rahman
- Graduate School of Social Service, Fordham University, New York, NY 10023, USA
| | - Abigail Ross
- Graduate School of Social Service, Fordham University, New York, NY 10023, USA
| | - Rogério Pinto
- University of Michigan School of Social Work, Ann Arbor, Michigan 48109, USA
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Rauh LD, Lathan HS, Masiello MM, Ratzan SC, Parker RM. A Select Bibliography of Actions to Promote Vaccine Literacy: A Resource for Health Communication. JOURNAL OF HEALTH COMMUNICATION 2020; 25:843-858. [PMID: 33719890 DOI: 10.1080/10810730.2021.1878312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In this bibliography, the researchers provide an introduction to the available evidence base of actions to promote vaccine literacy. The research team organized interventions to create a tool that can inform health communicators and practitioners seeking a resource focused on strategy and implementation design for actions that support vaccine literacy. This scoping bibliography is honed specifically to respond to the urgency of the current pandemic, when supporting and increasing vaccine literacy offers promise for achieving the critically needed high levels of vaccination. Over the course of the coming months and year, this bibliography will be a dynamic and "living" document hosted and maintained on vaccineliteracy.com.
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Affiliation(s)
- Lauren D Rauh
- Department of Community Health and Social Sciences, City University of New York Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Hannah S Lathan
- Department of Community Health and Social Sciences, City University of New York Graduate School of Public Health and Health Policy, New York, NY, USA
| | | | - Scott C Ratzan
- Department of Community Health and Social Sciences, City University of New York Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Ruth M Parker
- Division of General Medicine, Emory University School of Medicine, Atlanta, GA, USA
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