Abstract
BackgroundDemand side barriers to vaccination among rural and hard-to-reach populations in Chad are not yet well understood. Although innovative approaches such as linking human and animal vaccination increase vaccination uptake among mobile pastoralist communities, vaccination coverage in these communities is still lower than for rural settled populations. We hypothesize that mobile pastoralists’ communities in Chad face specific demand side barriers to access vaccination services. Understanding the factors that caregivers in these communities consider, explicitly or implicitly, in order to decide whether or not to vaccinate a child, in addition to understanding the provider’s perspectives, are essential elements to tailor vaccination programmes towards increasing vaccination acceptance and uptake.MethodsWe conducted a qualitative study in a rural health district in southern Chad in April 2016 with 12 key informant in-depth interviews and four focus group discussions (FGDs) including 35 male and female participants. Participants in the study included caregivers, traditional chiefs, local and religious leaders from mobile pastoralist communities, and health officials and staff. We conducted a content analysis using a pre-defined set of categories for vaccine hesitancy covering issues on harmful effects of vaccination, mistrust with vaccination programmes/services, issues with the health system and other issues.ResultsThe groups of demand side barriers reported most frequently in focus group discussions were mistrust on the expanded programme on immunization (EPI) and polio vaccination outreach services (53%, n = 94), followed by health system issues (34%, n = 94), and concerns related to potential harm of vaccines (13%, n = 94). Concerns identified by caregivers, health professionals and community leaders followed a similar pattern with issues on programme mistrust being most frequently reported and issues with harm least frequently reported. None of the health professionals reported concerns about vaccinations being potentially harmful.ConclusionMobile pastoralist communities face specific demand side barriers to vaccination. Understanding these barriers is essential to reduce vaccine hesitancy and increase vaccination uptake. Local health systems must plan for the periodic presence of pastoralist communities in their zones of responsibility and create more mutual trust.
Highlights
Demand side barriers to vaccination among rural and hard-to-reach populations in Chad are not yet well understood
The international community has made important strides towards improved vaccination coverage [31], but in most low and middle income countries, full immunization coverage of children and women is distributed unevenly according to socio-economic status [22]
A total of 94 coded quotes that reported concerns about hesitancy or barriers to access vaccination in Danamadji were extracted from the transcripts based on 12 individual interviews and four focus group discussions (FGDs)
Summary
Demand side barriers to vaccination among rural and hard-to-reach populations in Chad are not yet well understood. Innovative approaches such as linking human and animal vaccination increase vaccination uptake among mobile pastoralist communities, vaccination coverage in these communities is still lower than for rural settled populations. We hypothesize that mobile pastoralists’ communities in Chad face specific demand side barriers to access vaccination services. Increasing access to vaccination has been the main strategy employed to improve vaccination coverage during the last three decades, policy makers and international institutions have more recently focused on “vaccine hesitancy” (demand side barriers to vaccination) [15]. A recent systematic review of the literature found that despite concerns spread across most of the settings, e.g. the fear that vaccines could produce serious negative effects on children’s health, these were highly influenced by cultural, religious or social beliefs [5]
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