IntroductionVaccine acceptance is a critical component of sustainable immunization programs, yet rates of vaccine hesitancy are rising. Increased access to misinformation through media and anti-vaccine advocacy is an important contributor to hesitancy in the United States and other high-income nations with robust immunization programs. Little is known about the content and effect of information sources on attitudes toward vaccination in settings with rapidly changing or unstable immunization programs.ObjectiveThe objective of this study was to explore knowledge and attitudes regarding vaccines and vaccine-preventable diseases among caregivers and immunization providers in Botswana, the Dominican Republic, and Greece and examine how access to information impacts reported vaccine acceptance.MethodsWe conducted 37 focus groups and 14 semi-structured interviews with 96 providers and 153 caregivers in Botswana, the Dominican Republic, and Greece. Focus groups were conducted in Setswana, English, Spanish, or Greek; digitally recorded; and transcribed. Transcripts were translated into English, coded in qualitative data analysis software (NVivo 10, QSR International, Melbourne, Australia), and analyzed for common themes.ResultsDominant themes in all three countries included identification of health care providers or medical literature as the primary source of vaccine information, yet participants reported insufficient communication about vaccines was available. Comments about level of trust in the health care system and government contrasted between sites, with the highest level of trust reported in Botswana but lower levels of trust in Greece.ConclusionsIn Botswana, the Dominican Republic, and Greece, participants expressed reliance on health care providers for information and demonstrated a need for more communication about vaccines. Trust in the government and health care system influenced vaccine acceptance differently in each country, demonstrating the need for country-specific data that focus on vaccine acceptance to fully understand which drivers can be leveraged to improve implementation of immunization programs.

Background Despite growing interest in the use of technology to improve health outcomes in low- and middle-income countries (LMICs), local attitudes toward mobile health (mHealth) use in these settings are minimally understood. This is especially true in the Dominican Republic, where mHealth interventions are starting to emerge. This information is critical for developing effective mHealth interventions to address public health issues, such as low exclusive breastfeeding (EBF) rates, which can lead to poor outcomes. With an EBF rate of 5% in the first 6 months of life, the Dominican Republic has one of the lowest EBF rates worldwide. Objective This study aims to describe the current use of information and communication technology (ICT) and to analyze the attitudes and perceptions related to using mHealth interventions among caregivers of children aged ≤5 years and health promoters in the Dominican Republic. Findings can inform mHealth strategies aimed at improving EBF in this, and other, LMICs. Methods Participants were recruited from 3 outpatient sites: the Niños Primeros en Salud program at Centro de Salud Divina Providencia in Consuelo (rural setting) and Clínica de Familia La Romana and its program Módulo de Adolescentes Materno Infantil in La Romana (urban setting). Focus groups were conducted with caregivers and community health promoters to identify the use, attitudes, perceptions, and acceptability of mHealth as well as barriers to EBF. Discussions were conducted in Spanish, guided by semistructured interview guides. All sessions were audio-recorded and later transcribed. Thematic content analysis was conducted in Spanish by two bilingual researchers and was structured around a hybrid behavioral theory framework to identify salient themes. Results All participants (N=35) reported having a mobile phone, and 29 (83%) participants had a smartphone. Sources for obtaining health information included the internet, physicians and clinic, family and friends, health promoters, and television. Barriers to mHealth use included the cost of internet service, privacy concerns, and perceived credibility of information sources. Participants indicated the desire for, and willingness to use, an mHealth intervention to support breastfeeding. The desired features of a possible mHealth intervention included offering diverse methods of information delivery such as images and video content, text messages, and person-to-person interaction as well as notifications for appointments, vaccines, and feeding schedules. Other important considerations were internet-free access and content that included maternal and child health self-management topics beyond breastfeeding. Conclusions There is a high level of acceptance of ICT tools for breastfeeding promotion among caregivers in urban and rural areas of the Dominican Republic. As mHealth tools can contribute to increased breastfeeding self-efficacy, identifying desirable features of such a tool is necessary to create an effective intervention. Participants wanted to receive trusted and reliable information through various formats and were interested in information beyond breastfeeding.

Background Iron deficiency anemia affects millions of children worldwide. Iron intake assessments can inform targeted interventions. Methods This cross-sectional study describes diet and hemoglobin levels of children 1–5 y of age in a resource-limited setting in the Dominican Republic. The study team performed meal observations and measurements, dietary questionnaires, and point-of-care hemoglobin testing. Results Iron intake and bioavailability were low, with liberal estimates indicating that not more than 40% of subjects consumed the recommended daily allowance for iron. Forty of 80 children had anemia, with 23% demonstrating moderate or severe anemia. Conclusions Poor observed iron intake likely contributes to the high prevalence of anemia in this population.

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BACKGROUND Despite growing interest in the use of technology to improve health outcomes and health care delivery in low- and middle-income countries (LMIC), local attitudes towards mHealth use in these settings are minimally understood. This is especially true in the Dominican Republic, where attitudes toward mHealth have not been fully assessed. Yet, this information is critical for developing effective mHealth interventions to address public health problems, such as low rates of exclusive breastfeeding (EBF), which can lead to poor infant outcomes. With an EBF rate of 5% in the first 6 months of life, the Dominican Republic (DR) has one of the lowest EBF rates worldwide. OBJECTIVE This study aimed to describe the current use of information and communication technologies (ICT) and to analyze the attitudes and perceptions related to using cellular phones for mobile health (mHealth) interventions among caregivers of children ≤5 years old and health promoters in the DR. Findings can inform mHealth strategies aiming to improve EBF in this, and other, LMICs. METHODS Participants were recruited from three outpatient sites: the Niños Primeros en Salud program based at Centro de Salud Divina Providencia in Consuelo (rural setting), Clínica de Familia La Romana and its program Módulo de Adolescentes Materno Infantil in La Romana (urban setting). Focus groups were conducted with caregivers of infants and community health promoters to identify use, attitudes, perceptions, and acceptability of mHealth as well as barriers to EBF. Discussions were conducted in Spanish, guided by a semi-structured interview guide. All sessions were audio recorded and later transcribed. Thematic content analysis was conducted in Spanish by two bilingual researchers and was structured around a hybrid behavioral theory framework to identify salient themes. RESULTS All participants (n=35) reported having a cellular phone and 29 (83%) had smartphone technology. Sources for obtaining health information included internet, physician/clinic, family/friends, health promoters, and television. Barriers to mHealth use included cost of internet service, privacy concerns, and perceived credibility of sources. Participants indicated desire for, and willingness to use, a mHealth intervention to support breastfeeding. Desired features of a possible mHealth intervention included offering diverse methods of information delivery such as images/video content, text messages and person-to-person interaction, as well as notifications for appointments/vaccines/feeding schedule. Other important considerations were internet-free access and content that included maternal and child health self-management topics beyond breastfeeding. CONCLUSIONS There is a high level of acceptance for ICT tools for breastfeeding promotion among caregivers in urban and rural areas of the Dominican Republic. As mHealth tools can contribute to increased breastfeeding self-efficacy, identifying desirable features of such a tool is necessary to create a meaningful and useful intervention. Participants wanted to receive trusted, reliable information through various formats and were interested in information beyond breastfeeding.