title: Sociocultural determinants of anticipated oral cholera vaccine acceptance in three African settings: a meta-analytic approach.
abstract: BACKGROUND
  Controlling cholera remains a significant challenge in Sub-Saharan Africa. In areas where access to safe water and sanitation are limited, oral cholera vaccine (OCV) can save lives. Establishment of a global stockpile for OCV reflects increasing priority for use of cholera vaccines in endemic settings. Community acceptance of vaccines, however, is critical and sociocultural features of acceptance require attention for effective implementation. This study identifies and compares sociocultural determinants of anticipated OCV acceptance across populations in Southeastern Democratic Republic of Congo, Western Kenya and Zanzibar.
  
  
  METHODS
  Cross-sectional studies were conducted using similar but locally-adapted semistructured interviews among 1095 respondents in three African settings. Logistic regression models identified sociocultural determinants of OCV acceptance from these studies in endemic areas of Southeastern Democratic Republic of Congo (SE-DRC), Western Kenya (W-Kenya) and Zanzibar. Meta-analytic techniques highlighted common and distinctive determinants in the three settings.
  
  
  RESULTS
  Anticipated OCV acceptance was high in all settings. More than 93% of community respondents overall indicated interest in a no-cost vaccine. Higher anticipated acceptance was observed in areas with less access to public health facilities. In all settings awareness of cholera prevention methods (safe food consumption and garbage disposal) and relating ingestion to cholera causation were associated with greater acceptance. Higher age, larger households, lack of education, social vulnerability and knowledge of oral rehydration solution for self-treatment were negatively associated with anticipated OCV acceptance. Setting-specific determinants of acceptance included reporting a reliable income (W-Kenya and Zanzibar, not SE-DRC). In SE-DRC, intention to purchase an OCV appeared unrelated to ability to pay. Rural residents were less likely than urban counterparts to accept an OCV in W-Kenya, but more likely in Zanzibar. Prayer as a form of self-treatment was associated with vaccine acceptance in SE-DRC and W-Kenya, but not in Zanzibar.
  
  
  CONCLUSIONS
  These cholera-endemic African communities are especially interested in no-cost OCVs. Health education and attention to local social and cultural features of cholera and vaccines would likely increase vaccine coverage. High demand and absence of insurmountable sociocultural barriers to vaccination with OCVs indicate potential for mass vaccination in planning for comprehensive control or elimination.
authors.affiliation: Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland. neisha.sundaram@unibas.ch.|University of Basel, Petersplatz 1, 4003, Basel, Switzerland. neisha.sundaram@unibas.ch.|Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Singapore, 117549, Singapore. neisha.sundaram@unibas.ch.
authors.forename: Neisha
authors.initials: N
authors.lastname: Sundaram
authors.affiliation: Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland.|University of Basel, Petersplatz 1, 4003, Basel, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Schaetti
authors.affiliation: Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland.|University of Basel, Petersplatz 1, 4003, Basel, Switzerland.
authors.forename: Sonja
authors.initials: S
authors.lastname: Merten
authors.affiliation: Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland.|University of Basel, Petersplatz 1, 4003, Basel, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Schindler
authors.affiliation: Public Health Laboratory Ivo de Carneri, Chake-Chake, Pemba, Zanzibar, United Republic of Tanzania.
authors.forename: Said M
authors.initials: SM
authors.lastname: Ali
authors.affiliation: Department of Sociology and Anthropology, Maseno University, Private Bag, Maseno, Kenya.
authors.forename: Erick O
authors.initials: EO
authors.lastname: Nyambedha
authors.affiliation: Department of Anthropology, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
authors.forename: Bruno
authors.initials: B
authors.lastname: Lapika
authors.affiliation: Global Task Force on Cholera Control, World Health Organization, 20, Avenue Appia, 1211, Geneva 27, Switzerland.
authors.forename: Claire-Lise
authors.initials: CL
authors.lastname: Chaignat
authors.affiliation: Initiative for Vaccine Research, World Health Organization, 20, Avenue Appia, 1211, Geneva 27, Switzerland.
authors.forename: Raymond
authors.initials: R
authors.lastname: Hutubessy
authors.affiliation: Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland.|University of Basel, Petersplatz 1, 4003, Basel, Switzerland.
authors.forename: Mitchell G
authors.initials: MG
authors.lastname: Weiss
mesh_terms: D000284:Administration, Oral; D000328:Adult; D002771:Cholera / Q000453:epidemiology / Q000517:prevention & control*; D022121:Cholera Vaccines / Q000008:administration & dosage; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D003466:Cultural Characteristics; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D019353:Endemic Diseases; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D012067:Religion; D012111:Residence Characteristics; D012424:Rural Population; D012959:Socioeconomic Factors; D013636:Tanzania / Q000453:epidemiology; D014611:Vaccination; D055815:Young Adult
chemical_list: D022121:Cholera Vaccines