Abstract
There is limited understanding of the potential impact of information sources on vaccination attitudes and behaviors in low-income countries. We examined how exposure to immunization information sources may be associated with vaccination uptake in Sierra Leone. In 2019, a household survey was conducted using multistage cluster sampling to randomly select 621 caregivers of children aged 12-23 months in 4 districts in Sierra Leone. We measured exposure to various sources of immunization information and 2 outcomes: (1) vaccination confidence using an aggregate score (from 12 Likert items, informed by previously validated scale) that was dichotomized into a binary variable; (2) uptake of the third dose of diphtheria-pertussis-tetanus-hepatitis B-Haemophilus influenzae type-b-pentavalent vaccine (penta-3) based on card record or through caregiver recall when card was unavailable. Associations between information sources and the outcomes were examined using modified Poisson regression with robust variance estimator. Weighted estimate for penta-3 uptake was 81% (75.2%-85.5%). The likelihood of uptake of penta-3 was significantly greater when caregiver received information from health facilities (adjusted prevalence ratio [aPR]=1.26, 95% confidence interval [CI]=1.1, 1.5), faith leaders (aPR=1.16, 95% CI=1.1, 1.3), and community health workers (aPR=1.13, 95% CI=1.003, 1.3). Exposure to greater number of information sources was associated with high penta-3 uptake (aPR=1.05, 95% CI=1.02, 1.1). Immunization information received during health facility visits and through engagement with religious leaders may enhance vaccination uptake. Assessments to understand context-specific information dynamics should be prioritized in optimizing immunization outcomes.
Highlights
There is limited understanding of the potential impact of information sources on vaccination attitudes and behaviors in low-income countries
Sociocultural settings and media environment, along with other contextual factors play an important role in shaping immunization information,[1,2] which is delivered via diverse sources.[3]
Recognizing that contextspecific information plays a crucial role in vaccine confidence, it was important to understand in a setting who are the key actors that can be lever
Summary
There is limited understanding of the potential impact of information sources on vaccination attitudes and behaviors in low-income countries. We examined how exposure to immunization information sources may be associated with vaccination uptake in Sierra Leone. The likelihood of uptake of penta-3 was significantly greater when caregiver received information from health facilities (adjusted prevalence ratio [aPR]=1.26, 95% confidence interval [CI]=1.1, 1.5), faith leaders (aPR=1.16, 95% CI=1.1, 1.3), and community health workers (aPR=1.13, 95% CI=1.003, 1.3). Role of Information Sources in Vaccination Uptake in Sierra Leone www.ghspjournal.org trust in the vaccine itself (i.e., efficacy, safety, and product formulation), the health systems that deliver vaccinations, and trust in policies related to vaccines.[5] Social and behavioral drivers such as perceptions of benefits, safety of vaccines, and social norms related to vaccination, and related motivations can play an important role in vaccination confidence.[6] Recognizing that contextspecific information plays a crucial role in vaccine confidence, it was important to understand in a setting who are the key actors that can be lever-. Understanding the association the association between the exposure to varied sources of inforbetween the mation and vaccine confidence and uptake may exposure to varied inform the tailoring of effective immunization sources of communication strategies
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