Qualitative Assessment of Caregiver Experiences when Navigating Childhood Immunisation in Urban Communities in Sierra Leone

Overview

Journal BMJ Open

Specialty General Medicine

Date 2022 May 9

PMID 35534060

Authors

Mohamed F Jalloh

Palak Patel

Roberta Sutton

Shibani Kulkarni

Mame Toure

Kerrie Wiley

Tom Sessay

Maria Lahuerta

Affiliations

Soon will be listed here.

Abstract

Objective: To gain in-depth understanding of the caregiver experience when navigating urban immunisation services for their children.

Design: An exploratory qualitative assessment comprising 16 in-depth interviews using an interpretative phenomenology approach.

Setting: Caregivers were purposively recruited from slums (n=8) and other urban communities (n=8) in the capital city of Sierra Leone.

Participants: Caregivers of children ages 6-36 months old who were fully vaccinated (n=8) or undervaccinated (n=8).

Results: Emotional enablers of vaccination were evident in caregivers' sense of parental obligation to their children while also anticipating reciprocal benefits in children's ability to take care of their parents later in life. Practical enablers were found in the diversity of immunisation reminders, information access, information trust, getting fathers more involved, positive experiences with health workers and postvaccination information sharing in the community. Underlying barriers to childhood vaccination were due to practical constraints such as overcrowding and long waiting times at the clinic, feeling disrespected by health workers, expecting to give money to health workers for free services and fear of serious vaccine side effects. To improve vaccination outcomes, caregivers desired more convenient and positive clinic experiences and deeper community engagement.

Conclusions: Health system interventions, community engagement and vaccination outreach need to be tailored for urban settings. Vaccine communication efforts may resonate more strongly with caregivers when vaccination is framed both around parental responsibilities to do the right thing for the child and the future benefits to the parent.

References

Feldstein L, Sutton R, Jalloh M, Parmley L, Lahuerta M, Akinjeji A . Access, demand, and utilization of childhood immunization services: A cross-sectional household survey in Western Area Urban district, Sierra Leone, 2019. J Glob Health. 2020; 10(1):010420. PMC: 7243070. DOI: 10.7189/jogh.10.010420. View

Bester J . Measles Vaccination is Best for Children: The Argument for Relying on Herd Immunity Fails. J Bioeth Inq. 2017; 14(3):375-384. DOI: 10.1007/s11673-017-9799-4. View

Brolin Ribacke K, Saulnier D, Eriksson A, von Schreeb J . Effects of the West Africa Ebola Virus Disease on Health-Care Utilization - A Systematic Review. Front Public Health. 2016; 4:222. PMC: 5056406. DOI: 10.3389/fpubh.2016.00222. View

Amin A, Bednarczyk R, Ray C, Melchiori K, Graham J, Huntsinger J . Association of moral values with vaccine hesitancy. Nat Hum Behav. 2019; 1(12):873-880. DOI: 10.1038/s41562-017-0256-5. View

Allport B, Johnson S, Aqil A, Labrique A, Nelson T, Kc A . Promoting Father Involvement for Child and Family Health. Acad Pediatr. 2018; 18(7):746-753. DOI: 10.1016/j.acap.2018.03.011. View

Dawson A . What are the moral obligations of the traveller in relation to vaccination?. Travel Med Infect Dis. 2007; 5(2):90-6. DOI: 10.1016/j.tmaid.2006.01.005. View

Foss H, Oldervoll A, Fretheim A, Glenton C, Lewin S . Communication around HPV vaccination for adolescents in low- and middle-income countries: a systematic scoping overview of systematic reviews. Syst Rev. 2019; 8(1):190. PMC: 6670236. DOI: 10.1186/s13643-019-1100-y. View

Wiley K, Massey P, Cooper S, Wood N, Quinn H, Leask J . Pregnant women's intention to take up a post-partum pertussis vaccine, and their willingness to take up the vaccine while pregnant: a cross sectional survey. Vaccine. 2013; 31(37):3972-8. DOI: 10.1016/j.vaccine.2013.06.015. View

Sodeinde K, Amoran O, Abiodun O, Adekoya A, Abolurin O, Imhonopi B . A rural/urban comparison of paternal involvement in childhood immunisation in Ogun Central Senatorial District, Nigeria. Niger Postgrad Med J. 2020; 27(4):336-342. DOI: 10.4103/npmj.npmj_101_20. View

10.

Jalloh M, Kinsman J, Conteh J, Kaiser R, Jambai A, Ekstrom A . Barriers and facilitators to reporting deaths following Ebola surveillance in Sierra Leone: implications for sustainable mortality surveillance based on an exploratory qualitative assessment. BMJ Open. 2021; 11(5):e042976. PMC: 8126305. DOI: 10.1136/bmjopen-2020-042976. View

11.

Yerger P, Jalloh M, Coltart C, King C . Barriers to maternal health services during the Ebola outbreak in three West African countries: a literature review. BMJ Glob Health. 2020; 5(9). PMC: 7476472. DOI: 10.1136/bmjgh-2020-002974. View

12.

Drezner D, Youngster M, Klainer H, Youngster I . Maternal vaccinations coverage and reasons for non-compliance - a cross-sectional observational study. BMC Pregnancy Childbirth. 2020; 20(1):541. PMC: 7493363. DOI: 10.1186/s12884-020-03243-w. View

13.

Abbas K, Procter S, van Zandvoort K, Clark A, Funk S, Mengistu T . Routine childhood immunisation during the COVID-19 pandemic in Africa: a benefit-risk analysis of health benefits versus excess risk of SARS-CoV-2 infection. Lancet Glob Health. 2020; 8(10):e1264-e1272. PMC: 7367673. DOI: 10.1016/S2214-109X(20)30308-9. View

14.

Du F, Chantler T, Francis M, Sun F, Zhang X, Han K . The determinants of vaccine hesitancy in China: A cross-sectional study following the Changchun Changsheng vaccine incident. Vaccine. 2020; 38(47):7464-7471. DOI: 10.1016/j.vaccine.2020.09.075. View

15.

Witter S, Brikci N, Harris T, Williams R, Keen S, Mujica A . The free healthcare initiative in Sierra Leone: Evaluating a health system reform, 2010-2015. Int J Health Plann Manage. 2018; 33(2):434-448. DOI: 10.1002/hpm.2484. View

16.

Elston J, Cartwright C, Ndumbi P, Wright J . The health impact of the 2014-15 Ebola outbreak. Public Health. 2017; 143:60-70. DOI: 10.1016/j.puhe.2016.10.020. View

17.

DI Pietro M, Poscia A, Teleman A, Maged D, Ricciardi W . Vaccine hesitancy: parental, professional and public responsibility. Ann Ist Super Sanita. 2017; 53(2):157-162. DOI: 10.4415/ANN_17_02_13. View

18.

Giubilini A, Douglas T, Savulescu J . The moral obligation to be vaccinated: utilitarianism, contractualism, and collective easy rescue. Med Health Care Philos. 2018; 21(4):547-560. PMC: 6267229. DOI: 10.1007/s11019-018-9829-y. View

19.

Makwe C, Anorlu R . Knowledge of and attitude toward human papillomavirus infection and vaccines among female nurses at a tertiary hospital in Nigeria. Int J Womens Health. 2011; 3:313-7. PMC: 3181212. DOI: 10.2147/IJWH.S22792. View

20.

Frew P, Chung Y, Fisher A, Schamel J, Basket M . Parental experiences with vaccine information statements: Implications for timing, delivery, and parent-provider immunization communication. Vaccine. 2016; 34(48):5840-5844. PMC: 6026860. DOI: 10.1016/j.vaccine.2016.10.026. View