title: Desirability for a typhoid fever vaccine among rural residents, Pemba Island, Tanzania.
abstract: BACKGROUND
  Surveillance data indicate that Salmonella enterica serotype Typhi (S. Typhi) is a significant cause of morbidity and mortality in Africa. With limited anticipated short-term improvements in sanitation and water infrastructure, targeted vaccination campaigns may be an important prevention tool for typhoid fever.
  
  
  METHODS
  A cross-sectional survey was conducted with 435 randomly selected households in four rural villages on Pemba Island, Tanzania. A dichotomous 'readiness to pay' variable was created to assess vaccine desirability. Data analyses included univariate and bivariate descriptive statistics and binary logistic regression. Bivariate outcomes (ANOVA, t-tests, and chi-square) and odds ratios with 95% confidence intervals are reported.
  
  
  RESULTS
  A total of 66% respondents stated that they would pay for a typhoid fever vaccine in the future. Readiness to pay was not significantly associated with household expenditures. Readiness to pay was associated with use of local Primary Health Care Units (PHCUs) compared to use of cottage or district hospitals (OR 1.8 [95% CI, 1.2-2.7]: p=.007) and with knowledge of someone being sick from typhoid fever (OR 2.2 [95% CI, 1.0-4.5]: p=.039). Respondents perceiving prevention measures as more effective (OR 1.0 [95% CI, 1.0-1.2]: p=.009) were also more likely ready to pay. Preferred methods of communication of information about a typhoid fever vaccine included broadcasting via microphone ('miking'), radio, and door-to-door visits.
  
  
  CONCLUSIONS
  With rapid increase in numbers of licensed and promising vaccines, policy makers and health administrators are faced with decisions regarding allocation of scarce health resources for competing interventions. Community residents need to be informed about diseases which may not be readily recognized, diagnosed, and treated. Perceived vulnerability to the disease may increase likelihood of vaccine desirability. A better local understanding of typhoid fever is needed for general prevention measures, increasing treatment access, and future vaccination campaigns.
authors.affiliation: Pediatric Prevention Research Center, Wayne State University, 4707 St. Antoine Street, Suite W534, Detroit, MI 48201, USA. lkaljee@yahoo.com
authors.forename: Linda M
authors.initials: LM
authors.lastname: Kaljee
authors.forename: Alfred
authors.initials: A
authors.lastname: Pach
authors.forename: Kamala
authors.initials: K
authors.lastname: Thriemer
authors.forename: Benedikt
authors.initials: B
authors.lastname: Ley
authors.forename: Mohamed
authors.initials: M
authors.lastname: Jiddawi
authors.forename: Mahesh
authors.initials: M
authors.lastname: Puri
authors.forename: Leon
authors.initials: L
authors.lastname: Ochiai
authors.forename: Thomas
authors.initials: T
authors.lastname: Wierzba
authors.forename: John
authors.initials: J
authors.lastname: Clemens
authors.forename: Said M
authors.initials: SM
authors.lastname: Ali
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007195:Indian Ocean Islands / Q000453:epidemiology; D012424:Rural Population; D012485:Salmonella typhi; D013636:Tanzania / Q000453:epidemiology; D014435:Typhoid Fever / Q000453:epidemiology* / Q000276:immunology / Q000517:prevention & control*; D014436:Typhoid-Paratyphoid Vaccines / Q000008:administration & dosage* / Q000191:economics*; D014611:Vaccination / Q000191:economics* / Q000523:psychology*
chemical_list: D014436:Typhoid-Paratyphoid Vaccines