Abstract
ObjectiveTo evaluate vaccination coverage, identify reasons for non-vaccination and assess satisfaction with two innovative strategies for distributing second doses in an oral cholera vaccine campaign in 2016 in Lake Chilwa, Malawi, in response to a cholera outbreak.MethodsWe performed a two-stage cluster survey. The population interviewed was divided in three strata according to the second-dose vaccine distribution strategy: (i) a standard strategy in 1477 individuals (68 clusters of 5 households) on the lake shores; (ii) a simplified cold-chain strategy in 1153 individuals (59 clusters of 5 households) on islands in the lake; and (iii) an out-of-cold-chain strategy in 295 fishermen (46 clusters of 5 to 15 fishermen) in floating homes, called zimboweras.FindingVaccination coverage with at least one dose was 79.5% (1153/1451) on the lake shores, 99.3% (1098/1106) on the islands and 84.7% (200/236) on zimboweras. Coverage with two doses was 53.0% (769/1451), 91.1% (1010/1106) and 78.8% (186/236), in the three strata, respectively. The most common reason for non-vaccination was absence from home during the campaign. Most interviewees liked the novel distribution strategies.ConclusionVaccination coverage on the shores of Lake Chilwa was moderately high and the innovative distribution strategies tailored to people living on the lake provided adequate coverage, even among hard-to-reach communities. Community engagement and simplified delivery procedures were critical for success. Off-label, out-of-cold-chain administration of oral cholera vaccine should be considered as an effective strategy for achieving high coverage in hard-to-reach communities. Nevertheless, coverage and effectiveness must be monitored over the short and long term.
Highlights
In Malawi, cholera outbreaks occur frequently during the rainy season between November and March, with districts surrounding Lake Chilwa among the most affected.[1]
At risk are people living on the six islands in the lake and fishermen who settle temporarily during the fishing season in floating homes, known locally as zimboweras
A similar approach was used to calculate the frequency of adverse events following immunization. Especially those relating to knowledge of cholera vaccination, using descriptive statistics
Summary
In Malawi, cholera outbreaks occur frequently during the rainy season between November and March, with districts surrounding Lake Chilwa among the most affected.[1] at risk are people living on the six islands in the lake and fishermen who settle temporarily during the fishing season in floating homes, known locally as zimboweras. Zimboweras are huts built by fishermen on platforms constructed with grasses that emerge from the surface of the shallow lake (Fig. 1). They are typically a few hours from shore by paddle canoe. The inhabitants of zimboweras live in unsanitary conditions and have limited access to safe drinking water or health care.[2] As they do not store food, fishermen rely on communal facilities on larger and slightly better-equipped zimboweras, known as tea rooms, where they purchase foodstuffs. Tea rooms are used for recreation and to sell catches to fish retailers
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