A rapid qualitative assessment of oral cholera vaccine anticipated acceptability in a context of resistance towards cholera intervention in Nampula, Mozambique

Rachel Démolis, Carlos Botão, Léonard W Heyerdahl, Bradford D Gessner, Philippe Cavailler, Celestino Sinai, Amílcar Magaço, Jean-Bernard Le Gargasson, Martin Mengel, Elise Guillermet, Rachel Démolis, Carlos Botão, Léonard W Heyerdahl, Bradford D Gessner, Philippe Cavailler, Celestino Sinai, Amílcar Magaço, Jean-Bernard Le Gargasson, Martin Mengel, Elise Guillermet

Abstract

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.

Keywords: Anthropology; Attitude to health; Cholera vaccines; Mozambique; Politics; Public health.

Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Figures

Fig. 1
Fig. 1
Flowchart of study participants included in the quantitative and qualitative analyses, pre-campaign assessment, June 2016, Nampula, Mozambique.
Fig. 2
Fig. 2
Map of the neighborhoods targeted by the OCV campaign, pre- campaign assessment, June 2016, Nampula, Mozambique.

References

    1. Langa J.P., Sema C., De Deus N., Colombo M., Taviani E. Epidemic waves of cholera in the last two decades in Mozambique. J Infect Dev Ctries. 2015:635–641.
    1. INE. Inquérito de Indicadores Múltiplos 2008 (MICS). Maputo: Instituto Nacional de Estatística; 2009.
    1. Serra C. Imprensa Universitária, Universidade Eduardo Mondlane; Maputo: 2003. Cólera e catarse : infra-estruturas sociais de um mito nas zonas costeiras de Nampula (1998/2002)
    1. Jackson, J T. Text messages help fight cholera in Mozambique. Mail and Guardian, ; 2013.
    1. Pires P, Ahmed Abdirazak A, Ivandra N, Lisete C, Maida JI. Conhecimentos sobre cólera em Namicópo, Nampula, Moçambique. ; 2014; 1–12.
    1. Merten S., Schaetti C., Manianga C., Lapika B., Chaignat C. Local perceptions of cholera and anticipated vaccine acceptance in Katanga province, Democratic Republic of Congo. BMC Public Health. 2013
    1. Cavailler P., Lucas M., Perroud V., McChesney M., Ampuero S., Guérin P.J. Feasibility of a mass vaccination campaign using a two-dose oral cholera vaccine in an urban cholera-endemic setting in Mozambique. Vaccine. 2006;24(22):4890–4895.
    1. WHO. Oral cholera vaccines in mass immunization campaigns: guidance for planning and use. Geneva: WHO Library Cataloguing-in-Publication Data. ; 2010.
    1. Kanungo S, Desai SN, Saha J, Nandy RK, Sinha A, Kim DR, et al. An Open Label Non-inferiority Trial Assessing Vibriocidal Response of a Killed Bivalent Oral Cholera Vaccine Regimen following a Five Year Interval in Kolkata, India. PLoS Negl Trop Dis 2015; 29;9(5). DOI: 10.1371/journal.pntd.0003809
    1. Newes-Adeyi G., Helitzer D.L., Caulfield L.E., Bronner Y. Theory and practice: applying the ecological model to formative research for a WIC training program in New York State. Health Edu Res. 2000;15(3):283–291.
    1. Kaljee L., Pack R., Pach A., Nyamete A., Stanton B. Sociobehavioural research methods for the introduction of vaccines in the Diseases of the Most Impoverished Programme. J Health Popul Nutr. 2004;22(3):293–303. PMID: 15609782.
    1. Stanton B.F. Assessment of relevant cultural considerations is essential for the success of a vaccine. J Health Popul Nutr. 2004;22(3):286–292. PMID: 15609781.
    1. Nichter M. Vaccinations in the Third World: a consideration of community demand. Soc Sci Med. 1995;41:617–632.
    1. Penn A. Quantitative and qualitative analysis of the knowledge, attitudes and social representations of cholera in the extreme northern region of Cameroon: the case of Maroua I, Maroua Ii And Mokolo. Pan Afr Med J. 2014;17:253.
    1. Bernard H.R., Gravlee C.C. 2nd ed. Rowman and Littlefield; London: 2015. Handbook of Methods in Cultural Anthropology.
    1. Renne. Perspectives on polio and immunization in Northern Nigeria. Social Science and Medicine; 2006.
    1. Abimbola The final push for polio eradication. PLOS Med. 2013;10:e1001529.
    1. Obadare E. A crisis of trust: history, politics, religion and the polio controversy in Northern Nigeria Patterns of Prejudice 2005;39(3).
    1. Pool R., Munguambe K., Macete E., Aide P., Juma G., Alonso P., Menendez C. Community response to intermittent preventive treatment delivered to infants (IPTi) through the EPI system in Manhiça, Mozambique. Trop Med Int Health. 2006 Nov;11(11):1670–1678.
    1. Hanlon J. Mozambique: The Panic and Rage of the Poor. Review of African Political Economy 2009; 119(36).
    1. Trentini D. ‘The Night War of Nampula’: Vulnerable Children, Social Change and Spiritual Insecurity in Northern Mozambique. Africa. 2016;86(3):528–551.
    1. Closser Polio eradication and health systems in Karachi. Global Health Commun. 2015;1(1):32–40.
    1. Briggs and Briggs . University of California Press; 2003. Stories in the Time of Cholera. Racial Profiling during a medical Nightmare.
    1. Brewer T. Meta-analysis of the relationship between risk perception and health behavior: the example of vaccination. Health Psychol. 2007;26(2):136–145.
    1. Arvelo W., Blum L.S., Nahar N., von Seidlein L., Nahar L., Pack R.P. Community perceptions of bloody diarrhoea in an urban slum in South Asia: implications for introduction of a Shigella vaccine. Epidemiol Infect. 2011;139:599–605.
    1. Schaetti C., Ali S.M., Hutubessy R., Khatib A.M., Chaignat C.L., Weiss M.G. Social and cultural determinants of oral cholera vaccine uptake in Zanzibar. Human Vaccines & Immunother. 2012;8(9):1223–1229.
    1. Rosenstock I.M. Historical origins of the health belief model. Health Educ Monogr. 1974;2:328–386.
    1. Bingham A., Gaspar F., Lancaster K., Conjera J., Collymore Y. Ba-Nguz A. Community perceptions of malaria and vaccines in two districts of Mozambique. Malaria J. 2012;11:394.

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