Sociocultural determinants of anticipated oral cholera vaccine acceptance in three African settings: a meta-analytic approach.
Sociocultural determinants of anticipated oral cholera vaccine acceptance in three African settings: a meta-analytic approach.
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DOI：
10.1186/s12889-016-2710-0
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发表时间：
2016-01-14
影响因子：
4.5
通讯作者：
Weiss MG
中科院分区：
文献类型：
--
作者：
Sundaram N;Schaetti C;Merten S;Schindler C;Ali SM;Nyambedha EO;Lapika B;Chaignat CL;Hutubessy R;Weiss MG
在撒哈拉以南非洲，控制霍乱仍然是一项重大挑战。在获得安全饮用水和卫生设施有限的地区，口服霍乱疫苗(OCV)可以拯救生命。建立OCV全球库存反映了在流行环境中使用霍乱疫苗的日益优先事项。然而，社区对疫苗的接受是至关重要的，接受的社会文化特征需要注意有效实施。这项研究确定并比较了刚果民主共和国东南部、肯尼亚西部和桑给巴尔地区人群预期接受口服避孕药的社会文化决定因素。在三个非洲背景下的1095名受访者中，使用类似的但适合当地的半结构化访谈进行了横断面研究。Logistic回归模型从这些研究中确定了在刚果民主共和国东南部(SE-DRC)、肯尼亚西部(W-肯尼亚)和桑给巴尔的流行区接受OCV的社会文化决定因素。元分析技术强调了三个环境中共同和独特的决定因素。在所有环境中，预期的OCV接受率都很高。超过93%的社区受访者表示对免费疫苗感兴趣。在较少获得公共卫生设施的地区，预期接受率较高。在所有情况下，对霍乱预防方法(安全食物消费和垃圾处理)的认识以及与霍乱病因有关的摄入与更多人接受霍乱有关。年龄较高、家庭人数较多、缺乏教育、社会脆弱性和对口服补液剂自我治疗的了解与预期的口服补液剂接受度呈负相关。具体情况的接受决定因素包括报告可靠的收入(西肯尼亚和桑给巴尔，而不是东南部-刚果民主共和国)。在SE-DRC中，购买开放式课程的意向似乎与支付能力无关。在肯尼亚西部，农村居民接受OCV的可能性低于城市居民，但在桑给巴尔接受OCV的可能性更大。在东南部刚果民主共和国和西部肯尼亚，祈祷作为一种自我治疗形式与疫苗接受度有关，但在桑给巴尔没有。这些霍乱流行的非洲社区对免费的口服脊髓灰质炎特别感兴趣。健康教育以及对霍乱和疫苗的当地社会和文化特征的关注可能会增加疫苗覆盖率。对口服脊髓灰质炎疫苗接种的高需求和缺乏不可逾越的社会文化障碍表明，在规划全面控制或消除疫苗时，有可能进行大规模接种。
Controlling cholera remains a significant challenge in Sub-Saharan Africa. In areas where access to safe water and sanitation are limited, oral cholera vaccine (OCV) can save lives. Establishment of a global stockpile for OCV reflects increasing priority for use of cholera vaccines in endemic settings. Community acceptance of vaccines, however, is critical and sociocultural features of acceptance require attention for effective implementation. This study identifies and compares sociocultural determinants of anticipated OCV acceptance across populations in Southeastern Democratic Republic of Congo, Western Kenya and Zanzibar. Cross-sectional studies were conducted using similar but locally-adapted semistructured interviews among 1095 respondents in three African settings. Logistic regression models identified sociocultural determinants of OCV acceptance from these studies in endemic areas of Southeastern Democratic Republic of Congo (SE-DRC), Western Kenya (W-Kenya) and Zanzibar. Meta-analytic techniques highlighted common and distinctive determinants in the three settings. Anticipated OCV acceptance was high in all settings. More than 93 % of community respondents overall indicated interest in a no-cost vaccine. Higher anticipated acceptance was observed in areas with less access to public health facilities. In all settings awareness of cholera prevention methods (safe food consumption and garbage disposal) and relating ingestion to cholera causation were associated with greater acceptance. Higher age, larger households, lack of education, social vulnerability and knowledge of oral rehydration solution for self-treatment were negatively associated with anticipated OCV acceptance. Setting-specific determinants of acceptance included reporting a reliable income (W-Kenya and Zanzibar, not SE-DRC). In SE-DRC, intention to purchase an OCV appeared unrelated to ability to pay. Rural residents were less likely than urban counterparts to accept an OCV in W-Kenya, but more likely in Zanzibar. Prayer as a form of self-treatment was associated with vaccine acceptance in SE-DRC and W-Kenya, but not in Zanzibar. These cholera-endemic African communities are especially interested in no-cost OCVs. Health education and attention to local social and cultural features of cholera and vaccines would likely increase vaccine coverage. High demand and absence of insurmountable sociocultural barriers to vaccination with OCVs indicate potential for mass vaccination in planning for comprehensive control or elimination.