Abstract
BackgroundCholera remains a serious public health problem in low-income countries despite efforts in the past to promote oral rehydration therapy as major treatment. In 2007, the majority of worldwide cases (94%) and deaths (99%) were reported from Africa. To improve cholera control efforts in addition to maintaining and improving existing water supply, sanitation and hygiene behaviour measures, the World Health Organization has recently started to consider the use of vaccines as an additional public health tool. To assess this new approach in endemic settings, a project was launched in Zanzibar to vaccinate 50,000 individuals living in communities at high risk of cholera with an oral two-dose vaccine (Dukoral®).Immunisation programmes in low-income countries have suffered a reduced coverage or were even brought to a halt because of an ignorance of local realities. To ensure the success of vaccination campaigns, implementers have to consider community-held perceptions and behaviours regarding the infectious disease and the vaccine of interest.The main aim of this study is to provide advice to the Ministry of Health and Social Welfare of Zanzibar regarding routine introduction of an oral cholera vaccine from a socioeconomic and behavioural perspective as part of a long-term development for a sustained cholera prevention strategy.Methods and designQualitative and quantitative methods of health social science research will be applied on four stakeholder levels before and after the mass vaccination campaign. Rapid assessment individual interviews and focus groups will be used to describe cholera- and vaccine-related views of policy makers, health care professionals and community representatives. The cultural epidemiological approach will be employed on the individual household resident level in a repeated cross-sectional design to estimate determinants of anticipated and actual oral cholera vaccine acceptance.DiscussionThe study presented here is designed to inform about people's perceptions regarding cholera and about socioeconomic and behavioural factors determining anticipated and actual oral cholera vaccine acceptance in Zanzibar. Its pre- and post-intervention design using a mixed-methods approach on different stakeholder levels in communities at high risk of cholera outbreaks will ensure the collection of locally valid data relevant for public health action and planning.
Highlights
The main aim of this study is to provide advice to the Ministry of Health and Social Welfare of Zanzibar regarding routine introduction of an oral cholera vaccine from a socioeconomic and behavioural perspective as part of a long-term development for a sustained cholera prevention strategy
The study presented here is designed to inform about people's perceptions regarding cholera and about socioeconomic and behavioural factors determining anticipated and actual oral cholera vaccine acceptance in Zanzibar
Its preand post-intervention design using a mixed-methods approach on different stakeholder levels in communities at high risk of cholera outbreaks will ensure the collection of locally valid data relevant for public health action and planning
Summary
Study setting Zanzibar consists of two major islands, Unguja ( named Zanzibar) and Pemba. Data collection Level I to III Strategy Rapid assessment individual interviews and focus groups will collect qualitative information on policy makers' considerations and need for information for planning the introduction of a cholera vaccination programme This phase of the study will involve data collection with health care providers and community leaders on their perceptions of cholera, its importance to community residents, and their interest in the OCV. - Sampling method: stratified random sample among confirmed vaccinated (two doses of OCV) and unvaccinated (one to two doses) people with gender ratio 1:1; Data management and analysis Level I to III: rapid assessment data The rapid assessment interviews and focus group discussions will generate lengthy textual material which will be tape-recorded, followed by transcription and translation This information will be organised and analysed using the qualitative analysis software of Ethnograph 6.0. Back-translation into English will ensure the validity of the translation and that no ethical alternation is introduced in the informed consent forms
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