Factors influencing vaccine acceptance and hesitancy in three informal settlements in Lusaka, Zambia

Pugliese-Garcia, Miguel; Heyerdahl, Leonardo W.; Mwamba, Chanda; Nkwemu, Sharon; Chilengi, Roma; Démolis, Rachel; Guillermet, Élise; Sharma, Anjali

doi:10.1016/j.vaccine.2018.07.042

Cited by 102 publications

(123 citation statements)

References 31 publications

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“…21 Further research in Zambia explored vaccine attitudes and hesitancy and found that lack of knowledge, along with other factors such as traditional religious practices, created misgivings toward western medicine amongst some participants. 22 In other studies conducted in low-resource settings, researchers found that acceptability of maternal tetanus toxoid (Ivory Coast) and maternal Tdap vaccine (Pakistan) was good, but similarly noted that the mother's partner's opinions strongly affected women's attitudes and actions toward vaccinations; the study also noted that immunization campaigns should be directed toward men, as well as mothers. 23,24 Additionally, research conducted in Saudi Arabia revealed that about a quarter of women surveyed were unwilling to get the maternal influenza vaccine, and that women with limited knowledge of vaccinations were significantly less likely to get vaccinated than those with greater knowledge of vaccinations.…”

Section: Considering Maternal Vaccine Knowledge Attitudes and Beliefsmentioning

confidence: 92%

Maternal vaccine knowledge in low- and middle-income countries—and why it matters

Williams

Mitrovich

Mwananyanda

et al. 2018

Human Vaccines & Immunotherapeutics

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Maternal vaccines have the potential to reduce the global burden of neonatal morbidity and mortality by accessing the infant immune system before a vaccine administered in childhood would be effective. Maternal vaccines for influenza, tetanus, and pertussis have been shown to reduce neonatal disease and mortality, and other candidate vaccines for group B streptococcus and respiratory syncytial virus are being developed to continue this trend. However, safe and effective maternal vaccines will only successfully reduce neonatal illness if mothers decide to receive them. Maternal knowledge, attitudes, and beliefs around vaccines are key determinants to vaccine acceptance or vaccine hesitancy, and yet this issue is often understudied in low and middle-income country settings. A deeper understanding of these factors and how they influence maternal decision-making will allow public health practitioners and global and national policymakers to design more effective interventions. Addressing barriers to immunization at the policy and programmatic levels such as mothers' knowledge, attitudes, and beliefs of maternal vaccines is essential to increasing vaccination rates at a global scale and reducing global vaccine-preventable neonatal deaths.

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Section: Considering Maternal Vaccine Knowledge Attitudes and Beliefsmentioning

confidence: 92%

Maternal vaccine knowledge in low- and middle-income countries—and why it matters

Williams

Mitrovich

Mwananyanda

et al. 2018

Human Vaccines & Immunotherapeutics

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“…Religious beliefs, traditional remedies and mistrust of western medicine also in uence program performance. [11] Health system factors such as funding constraints, human resource factors such as health worker shortages, training de ciencies, poor attitude of health workers and vaccination teams, inadequate infrastructure and equipment, and structural factors such as long distance from health facility are critical for successful programs. [12,13] Although these several studies have shed light on the multiple factors that may in uence immunization performance, there is limited data on how geographic distribution of health facilities may in uence immunization performance.…”

Section: Introductionmentioning

confidence: 99%

Geographic location of health facility and immunization program performance in Hoima district, western Uganda, a facility level assessment

Kwikiriza¹,

Bajunirwe

Bagenda

2020

Preprint

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Background Globally immunization coverage for childhood vaccines is below the immunization target of achieving at least 90% coverage with the pentavalent vaccine. In Uganda, a recent survey shows 80% of districts had poor immunization program performance. However, there is significant variation in performance within and between districts. We hypothesized that geographic location of health facility may influence performance of their immunization programs. Therefore, the purpose of this study was to examine whether geographical location of health facility within a district is associated with performance of the immunization program in Hoima district, western Uganda. Methods We conducted a cross sectional study using a mixed methods approach. The study unit was a health center and we interviewed health workers in-charge of the facilities and reviewed their health facility records. We reviewed the Uganda Health Management Information System (HMIS) 105 reports of six months to obtain data on immunization program performance. Performance was categorized using World Health Organization’s Reach Every District (RED) criteria and classified as poor if a facility fell in category 3 or 4 and good if 1 or 2. We also conducted key informant interviews with immunization focal persons in the district. We examined the association between dependent and independent variables using Fisher’s exact test. Results We collected data at 49 health facilities. Most of the health units (55.1%) had poor immunization program performance. Proximal location to the central district headquarters was significantly associated with poor immunization program performance (p<0.05). Attitudes of health workers in the more urban areas, differences in strategies for outreach site selection and community mobilization in the rural and urban areas were suggested as possible explanations. Conclusions Proximal location to the urban setting near district headquarters was strongly associated with poor immunization program performance. To be able to reach larger numbers of children for vaccination, interventions to improve performance should target health facilities in urban settings.

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“…The disconnect between supply and demand has been attributed to a lack of knowledge surrounding the vaccine's indication, e cacy and safety (13), as well as a lack of community engagement to address concerns and misunderstandings, particularly in rural districts (11,14). Women's limited decision-making power compared to their husbands regarding their daughters receiving the HPV vaccination, coupled with a lack of engagement with male community members during the vaccine's roll-out has also been attributed to low uptake (15,16).…”

Section: Hpv Vaccination In Zambiamentioning

confidence: 99%

“…Participants will be purposively sampled from communities in the district Chongwe in Lusaka province, as Lusaka has the highest incidence of cervical cancer compared to other provinces in Zambia (36) and most research on HPV vaccination hesitancy in Zambia has been conducted there (13,14,37). Furthermore, Chongwe was chosen for its rural setting, where community groups have been shown to be most effective (23).…”

Section: Recruitmentmentioning

confidence: 99%

“…The value of community group PLA is thought to lie in the process of collectively reaching solutions, rather than solely the solutions themselves (21). In this context, PLA community groups are predicted to help communities identify factors which facilitate HPV uptake such as motivation, trust and social support (22) and address barriers such as lack of knowledge (13), concerns and misunderstandings (14), women's limited decision-making power (15), social norms (15), stigma (17), religious beliefs (33) as well as nancial and geographical barriers to access (22, 43).…”

Section: Theory Of Changementioning

confidence: 99%

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Community groups to increase Human papillomavirus (HPV) vaccination through Participatory Learning and Action, Reducing barriers and increasing community Mobilisation in Zambia (CHARMZ) project.

Hoernke¹

2020

Preprint

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Background Zambia has a high incidence of cervical cancer. Uptake of the human papillomavirus (HPV) vaccine has been low since it first became available in Zambia in 2013. Community mobilisation and engagement with civil society has been identified as a key component of HPV vaccination programs in low and middle-income countries. Of the evidence available on community-based interventions in the context of HPV, participatory approaches which work closely with local stakeholders to identify and overcome barriers to HPV vaccination uptake have shown promising results. This is a proposal for a community-based cluster randomised controlled trial to increase HPV vaccination uptake in Zambia through a participatory learning and action (PLA) cycle approach in community groups. PLA is an approach in which participants identify and prioritise problems, and subsequently develop, implement and evaluate solutions to improve the health needs of their community. Key stakeholders to be engaged in this project include government members, policymakers, healthcare, donors and relevant non-governmental organisations (NGO), religious leaders, and civil society members. Formative research will be carried out with key stakeholders through semi-structured interviews and focus group discussions. The community group intervention will be facilitated by local healthcare workers from the cervical cancer prevention program in Zambia (CCPPZ).Results Success will be indicated by an increase in HPV vaccination uptake. The primary outcome will be HPV vaccination rates measured quantitatively. Data will be gathered once at the start of the study, once midway through the PLA phase and once during the post-intervention phase. Questionnaires and semi-structured interviews will allow for measurement of secondary outcomes both quantitatively and qualitatively, including perceived (i) HPV vaccination and cervical cancer knowledge, (ii) acceptability, accessibility and equitability of the HPV vaccination, as well as (iii) attitudes of female group members towards other cervical cancer screening and treatment services.Conclusions There is a need to address the high cervical cancer disease burden in Zambia. This would be the first intervention aiming to increase HPV vaccination uptake in Zambia through a low-cost, sustainable and scalable community-based participatory learning and action cycle approach.

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Factors influencing vaccine acceptance and hesitancy in three informal settlements in Lusaka, Zambia

Cited by 102 publications

References 31 publications

Maternal vaccine knowledge in low- and middle-income countries—and why it matters

Maternal vaccine knowledge in low- and middle-income countries—and why it matters

Geographic location of health facility and immunization program performance in Hoima district, western Uganda, a facility level assessment

Community groups to increase Human papillomavirus (HPV) vaccination through Participatory Learning and Action, Reducing barriers and increasing community Mobilisation in Zambia (CHARMZ) project.

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