Menu
Menu
Menu
Menu
Background: Malaria is a leading cause of morbidity and mortality in children younger than 5 years in Kenya. Within the context of planning for a vaccine to be used alongside existing malaria control methods, this study explores sociocultural and health communications issues among individuals who are responsible for or influence decisions on childhood vaccination at the community level. Methods: This qualitative study was conducted in two malaria-endemic regions of Kenya – South Coast and Busia. Participant selection was purposive and criterion based. A total of 20 focus group discussions, 22 in-depth interviews, and 18 exit interviews were conducted. Results: Participants understand that malaria is a serious problem that no single tool can defeat. Communities would welcome a malaria vaccine, although they would have questions and concerns about the intervention. While support for local child immunization programs exists, limited understanding about vaccines and what they do is evident among younger and older people, particularly men. Even as health care providers are frustrated when parents do not have their children vaccinated, some parents have concerns about access to and the quality of vaccination services. Some women, including older mothers and those less economically privileged, see themselves as the focus of health workers’ negative comments associated with either their parenting choices or their children’s appearance. In general, parents and caregivers weigh several factors – such as personal opportunity costs, resource constraints, and perceived benefits – when deciding whether or not to have their children vaccinated, and the decision often is influenced by a network of people, including community leaders and health workers. Conclusions: The study raises issues that should inform a communications strategy and guide policy decisions within Kenya on eventual malaria vaccine introduction. Unlike the current practice, where health education on child welfare and immunization focuses on women, the communications strategy should equally target men and women in ways that are appropriate for each gender. It should involve influential community members and provide needed information and reassurances about immunization. Efforts also should be made to address concerns about the quality of immunization services – including health workers’ interpersonal communication skills. © 2011 Ojakaa et al; licensee BioMed Central Ltd.
The formative study was conducted in two regions of Kenya. Sites were selected based on a variety of factors, with the primary and secondary factors being malaria endemicity and local community and stakeholder support for conducting the study. High endemicity was sought to obtain data rich in experiences with malaria. Thereafter, variations in data were sought based on criteria such as ability to sample rural and urban populations, diversity in ethnic groups, and variation in religion. The two study regions selected were the larger Busia region in Western Province and South Coast in Coast Province. Busia, situated in the Uganda-Kenya border region near Lake Victoria, is considered a highly endemic malaria region with year-round transmission [18]. Within the Busia region, study participants resided in the following areas: Busia Township, Bunyala, Samia, Butula, and Nambale. This predominantly Christian region is primarily home to the Luhya tribe. Dominant languages spoken by study participants were Luhya and Kiswahili. The South Coast region is considered highly endemic with perennial malaria transmission; however, more recent data indicate that malaria is declining in the region [19]. The rural and urban areas sampled included Kwale, Kinango, Msambweni, and Mombasa. The South Coast region has greater Arab influence, is of Swahili culture, and has a higher proportion of Muslims than other parts of the country. Languages spoken by study participants were Digo, a dialect of the Mijikenda language, and Kiswahili. Participant selection was largely purposive and criterion based. Criteria were based on a literature review and an ecological conceptual framework, commonly used in health planning formative studies [20]. This framework was successfully adapted for use by PATH in other new child vaccine planning studies [21]. The framework recognizes levels or categories of people who influence whether a child is immunized. These levels constitute important target audiences for developing a health communications strategy aimed at engaging communities in new vaccine introduction activities. They include: 1. The individual level: Parents and other caregivers of children. 2. The interpersonal level: Secondary influencers such as teachers, health workers, and the media and other communicators. 3. The community level: Community leaders, local administrators, and local government officials. 4. The institutional level: Health care personnel and administrators. Seven research assistants (four in the Coast region and three in the Busia region) were recruited for data collection. All seven (three men and four women) had degrees in related social sciences and had prior experience with qualitative interviewing. They were native speakers of the relevant local languages and speakers of the second national language, Kiswahili. Training of the research assistants and pre-testing of tools were carried out in October 2009. The training, which took place in the coastal city of Mombasa, covered an introduction to MVI’s Community Perceptions Study and a re-orientation on such qualitative research approaches as data collection, obtaining informed consent, and analysis. Study tools were also reviewed, translated, and back-translated. Thereafter, pilot-testing was completed in the Coast region, and data collection activities began in November 2009. All activities were monitored by senior research staff. A total of 20 focus group discussions (FGDs) were held, with 234 participants; 22 key informant interviews were conducted; and 18 exit interviews were completed in maternal and child health clinics (Table (Table1).1). FGDs were held with similarly situated respondents (e.g., mothers between 18 and 24 years of age) in an effort to solicit more candid responses. In addition, data were collected on vaccine delivery, immunizations, and administrative services from the health facilities visited. Sampling framework and final sample size FGDs and in-depth interviews were both noted and recorded, then later transcribed and translated from the local languages–Luhya, Digo, and Kiswahili–to English. Researchers carried out thematic content analysis using a codebook process on the translated English transcripts. To ensure maximum data validity and verification of findings at different levels, two iterations of analysis were conducted. Researchers first reviewed the transcripts for key themes using an iterative discursive process and developed a master codebook. At the second level, the researchers worked with an analyst versed in Atlas. ti software to code the data electronically and then generate reports to further explore thematic relationships and variations in the data by site, age, category of focus group participants, and type of interview. The study was reviewed in Kenya by the AMREF Ethics and Scientific Review Committee and in the United States by the PATH Research Ethics Committee.
N/A
