Browsing by Author "Heyerdahl LW"

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Factors influencing vaccine acceptance and hesitancy in three informal settlements in Lusaka, Zambia.
(2018-Sep-05) Pugliese-Garcia M; Heyerdahl LW; Mwamba C; Nkwemu S; Chilengi R; Demolis R; Guillermet E; Sharma A; Centre for Infectious Disease Research in Zambia (CIDRZ), Plot # 34620, P.O. Box 34681, Lusaka 10101, Zambia. Electronic address: Miguel.Pugliese-Garcia@lshtm.ac.uk.; Centre for Infectious Disease Research in Zambia (CIDRZ), Plot # 34620, P.O. Box 34681, Lusaka 10101, Zambia.; Agence de Médecine Préventive, Abidjan, Cote d'Ivoire.
INTRODUCTION: Heterogeneous coverage threatens to compromise the effectiveness of immunization programs in Zambia. Demand-creation initiatives are needed to address this; however, there is incomplete understanding of why vaccine coverage is suboptimal. We investigated overarching perceptions on vaccine acceptability, hesitancy, and accessibility at three informal settlements in Lusaka, Zambia. METHODS: Nested within a cholera vaccination uptake study, we sought to understand overarching perceptions on vaccines' hesitancy in three informal settlements in Lusaka, Zambia. We conducted 48 focus group discussions with a convenience sample of laypersons, lay healthcare workers, neighbourhood health committee members and vaccinators. RESULTS: Both laypersons and community-based health actors reported high vaccine acceptance though several sources of hesitancy were reported. Traditional remedies, alcohol use and religious beliefs emerged as drivers of vaccine hesitancy, likely reinforced by a background of distrust towards western medicine. Also mentioned were previous adverse events, fear of injections and low perceived need for immunization. Limited understanding of how vaccines work and overlapping local terms for vaccine and other medical concepts created confusion and inaccurate views and expectations. Some reported refusing injections to avoid pain and perceived risk of infection. Discussants emphasised the importance of education and preferred mobile immunization campaigns, with weekend to reach those with poor access and delivered by a combination of professional and volunteer workers. CONCLUSIONS: Vaccine hesitancy in Zambia is underpinned by many factors including personal experiences with vaccinations, alternative belief models, limited knowledge, deep misunderstanding about how vaccines work, and barriers to access. To overcome these, community-driven models that incorporate factual communication by professionals and operate outside of traditional hours, may help. Better research to understand community preferences for vaccine uptake could inform interventions to improve immunization coverage in Zambia.
"It depends how one understands it:" a qualitative study on differential uptake of oral cholera vaccine in three compounds in Lusaka, Zambia.
(2019-May-14) Heyerdahl LW; Pugliese-Garcia M; Nkwemu S; Tembo T; Mwamba C; Demolis R; Chilengi R; Gessner BD; Guillermet E; Sharma A; École normale supérieure de Lyon, UMR 5206 Triangle, Lyon, France. leonard.heyerdahl@ens-lyon.fr.; Agence de Médecine Préventive, 13 chemin du Levant, 01210, Ferney-Voltaire, France.; Agence de Médecine Préventive, J 87, Deux Plateaux, Abidjan, Côte d'Ivoire. leonard.heyerdahl@ens-lyon.fr.; Centre for Infectious Disease Research in Zambia (CIDRZ), Plot # 34620, P.O. Box 34681, 10101, Lusaka, Zambia.
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.