Exploring the Drivers of Vaccine Hesitancy Toward Childhood and Adolescent Vaccination in Malawi: A Qualitative Study

Abstract Background: Vaccine hesitancy is the delay or refusal of vaccines despite the availability of vaccination services. Although it is considered an important global health threat, it has only rarely been systematically studied within the African context. In this study, we explored the factors that influence vaccine hesitancy among caregivers of children and adolescent girls that are eligible for routine childhood immunisation and the human papillomavirus (HPV) vaccine in Malawi. Methods: The study employed a qualitative exploratory research design. In-depth information was obtained from caregivers of children and adolescent girls eligible for routine immunisation (RI) and the HPV vaccine, respectively, as well as national and district-level representatives of the expanded program on immunisation (EPI) and community stakeholders through key informant interviews and focus-group discussions. These participants were purposively selected using predefined criteria A total of 25 key informant interviews and two focus-group discussions with 13 participants were conducted. Data collection took place between April 20 and May 24, 2020. The interviews were audio-recorded, transcribed verbatim, and then analysed using a thematic content analysis approach. Results: The study shows that most of the vaccine-hesitancy drivers for RI also influenced the newly introduced HPV vaccine. Such drivers were inadequate awareness of the vaccination schedule, rumours and conspiracy theories exacerbated by religious beliefs, inability to translate knowledge and attitudes into actual vaccination behaviour, low literacy levels of caregivers, complacency occasioned by the stress of distance and transportation logistics, and disconnection between the community healthcare system and community leaders, among others. Conclusion: This study provides deeper insights into the determinants of vaccine hesitancy within the Malawian context. The findings can inform the design of context-specific interventions by decision-makers. While the study provided behavioural insights regarding vaccination behaviour in Malawi, there is need for further quantitative studies that can assess the prevalence of the determinants as well as their causal relationships to vaccine uptake.

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Examining Enablers of Vaccine Hesitancy Toward Routine Childhood and Adolescent Vaccination in Malawi

10.21203/rs.3.rs-1097242/v1 ◽

2021 ◽

Author(s):

Gbadebo Collins Adeyanju ◽

Cornelia Betsch ◽

Abdu A. Adamu ◽

Khadijah Sanusi Gumbi ◽

Michael G Head ◽

...

Keyword(s):

Focus Group ◽

Hpv Vaccine ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Focus Group Discussions ◽

Group Discussions ◽

Routine Immunisation ◽

Community Healthcare ◽

Children And Adolescent ◽

Key Informant

Abstract Background: Vaccine hesitancy is the delay or refusal of vaccines despite their availability. Here, we explored factors that influence hesitancy among caregivers of children and adolescent girls eligible for routine immunisation and the human papillomavirus (HPV) vaccine in Malawi. Methods: The study used key informant interviews and focus-group discussions. Information was obtained from caregivers and national and district-level representatives of the expanded program on immunisation (EPI) and community stakeholders. There were 25 key informant interviews, and two focus-group discussions with 13 participants conducted April May 2020. Interviews were audio-recorded, transcribed, and analysed using a thematic content analysis. Results: Most vaccine-hesitancy drivers for routine immunisation were also relevant for the HPV vaccine. Drivers included inadequate awareness of the vaccination schedule, rumours and conspiracy theories exacerbated by religious beliefs, low literacy levels of caregivers, distance and transport to the vaccination clinic, and a disconnect between community healthcare and community leaders. Conclusion: This study provides insights into determinants of vaccine hesitancy within the Malawian context. The findings can inform context-specific interventions by decision-makers. There is need for further study around the prevalence and impact of each factor, as well as their causal relationships to vaccine uptake.

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Uganda’s response to sexual harassment in the public health sector: from “Dying Silently” to gender-transformational HRH policy

Human Resources for Health ◽

10.1186/s12960-021-00569-0 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Constance Newman ◽

Alice Nayebare ◽

Stella Neema ◽

Allan Agaba ◽

Lilian Perry Akello

Keyword(s):

Public Health ◽

Focus Group ◽

Sexual Harassment ◽

Health Sector ◽

Depth Information ◽

Second Phase ◽

Focus Group Discussions ◽

Group Discussions ◽

Public Health Sector ◽

Key Informant

Abstract Introduction Sexual harassment is a ubiquitous problem that prevents women’s integration and retention in the workforce. Its prevalence had been documented in previous health sector studies in Uganda, indicating that it affected staffing shortages and absenteeism but was largely unreported. To respond, the Ministry of Health needed in-depth information on its employees’ experiences of sexual harassment and non-reporting. Methods Original descriptive research was conducted in 2017 to identify the nature, contributors, dynamics and consequences of sexual harassment in public health sector workplaces and assess these in relation to available theories. Multiple qualitative techniques were employed to describe experiences of workplace sexual harassment in health employees’ own voices. Initial data collection involved document reviews to understand the policy environment, same-sex focus group discussions, key informant interviews and baseline documentation. A second phase included mixed-sex focus group discussions, in-depth interviews and follow up key informant interviews to deepen and confirm understandings. Results A pattern emerged of men in higher-status positions abusing power to coerce sex from female employees throughout the employment cycle. Rewards and sanctions were levied through informal management/ supervision practices requiring compliance with sexual demands or work-related reprisals for refusal. Abuse of organizational power reinforced vertical segregation, impeded women’s productive work and abridged their professional opportunities. Unwanted sexual attention including non-consensual touching, bullying and objectification added to distress. Gender harassment which included verbal abuse, insults and intimidation, with real or threatened retaliation, victim-blaming and gaslighting in the absence of organizational regulatory mechanisms all suppressed reporting. Sexual harassment and abuse of patients by employees emerged inadvertently. Discussion/conclusions Sex-based harassment was pervasive in Ugandan public health workplaces, corrupted management practices, silenced reporting and undermined the achievement of human resources goals, possibilities overlooked in technical discussions of support supervision and performance management. Harassment of both health system patients and employees appeared normative and similar to “sextortion.” The mutually reinforcing intersections of sex-based harassment and vertical occupational segregation are related obstacles experienced by women seeking leadership positions. Health systems leaders should seek organizational and sectoral solutions to end sex-based harassment and make gender equality a human resource for health policy priority.

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Sexual and reproductive health of Syrian refugee adolescent girls: a qualitative study using focus group discussions in an urban setting in Lebanon

Reproductive Health ◽

10.1186/s12978-021-01178-9 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Rayan Korri ◽

Sabine Hess ◽

Guenter Froeschl ◽

Olena Ivanova

Keyword(s):

Focus Group ◽

Reproductive Health ◽

Sexual Harassment ◽

Qualitative Study ◽

Adolescent Girls ◽

Sexual And Reproductive Health ◽

Urban Setting ◽

Focus Group Discussions ◽

Group Discussions ◽

To Receive

Abstract Background The war in Syria caused the forced displacement of millions of Syrians to neighboring countries. Lebanon is the host country with the largest overall number of Syrian refugees per capita. Adolescent refugee girls experience a unique level of vulnerability during human emergencies and are at increased risk of suffering from poor sexual and reproductive health (SRH) outcomes. We conducted an exploratory qualitative study to learn about the SRH perceptions and experiences of refugee adolescent girls living in Bourj Hammoud, an urban setting in Lebanon. Methods We employed a qualitative design with eight focus group discussions (FGDs) conducted with 40 Syrian Arab and Syrian Kurdish adolescent girls between January and March 2020. Every FGD consisted of five participants aged 13 to 17 years. A semi-structured guide was used covering multiple themes: menstruation, puberty, SRH awareness, and sexual harassment. FGDs were transcribed and analyzed using thematic analysis. Findings The participants discussed adolescent girls’ health and named six elements of good health, such as healthy activities and self-protection. The majority of the FGD participants reported a lack of awareness about menstruation when they experienced it for the first time and the social stigma associated with menstruation. When defining puberty, they indicated its social link to a girl’s readiness for marriage and her need to become cautious about sexual harassment. Most FGD participants had very poor knowledge of the female reproductive system. Mothers were the most approached persons to receive information on SRH issues; however, the girls indicated a wish to receive advice from specialists in a comfortable and private atmosphere. All the girls reported that either they themselves, or an acquaintance, had experienced some type of sexual harassment. The girls rarely reported those incidents due to fear of being blamed or subjected to mobility restrictions, or forced to drop out of school. Conclusions The findings show the refugee girls need for satisfactory knowledge on SRH issues and interventions to prevent sexual and gender-based violence that take into consideration the complexity of urban settings.

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Drivers and barriers to workplace-based HIV self-testing among high-risk men in Uganda: a qualitative study

BMC Public Health ◽

10.1186/s12889-021-11041-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Patience A. Muwanguzi ◽

Robert C. Bollinger ◽

Stuart C. Ray ◽

LaRon E. Nelson ◽

Noah Kiwanuka ◽

...

Keyword(s):

Focus Group ◽

Hiv Testing ◽

Private Security ◽

Focus Group Discussions ◽

Group Discussions ◽

Private Security Companies ◽

Self Testing ◽

Key Informant ◽

Hiv Testing Services ◽

Security Companies

Abstract Background Men in Sub-Saharan Africa are less engaged than women in accessing HIV testing and treatment and, consequently, experience higher HIV-related mortality. Reaching men with HIV testing services is challenging, thus, increasing the need for innovative ways to engage men with low access and those at higher risk. In this study, we explore men’s perceptions of drivers and barriers of workplace-based HIV self-testing in Uganda. Methods An exploratory study involving men working in private security companies employing more than 50 men in two districts, in central and western Uganda. Focus group discussions and key informant interviews were conducted. Data were analyzed using inductive content analysis. Results Forty-eight (48) men from eight private security companies participated in 5 focus group discussions and 17 key informant interviews. Of the 48 men, 14(29.2%) were ages 26–35 years. The majority 31(64.6%) were security guards. The drivers reported for workplace-based HIV self-testing included convenience, autonomy, positive influence from work colleagues, the need for alternative access for HIV testing services, incentives, and involvement of employers. The barriers reported were the prohibitive cost of HIV tests, stigma, lack of testing support, the fear of discrimination and isolation, and concerns around decreased work productivity in the event of a reactive self-test. Conclusions We recommend the involvement of employers in workplace-based HIV self-testing to encourage participation by employees. There is need for HIV self-testing support both during and after the testing process. Both employers and employees recommend the use of non-monetary incentives, and regular training about HIV self-testing to increase the uptake and acceptability of HIV testing services at the workplace.

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Study on Potentiality of Biogas Plants and Their Role for the Conservation of Environment

Nepal Journal of Science and Technology ◽

10.3126/njst.v15i2.12114 ◽

2015 ◽

Vol 15 (2) ◽

pp. 51-56

Author(s):

Dinesh Ghimire ◽

Jagannath Shrestha ◽

Anup K.C

Keyword(s):

Focus Group ◽

Science And Technology ◽

Primary Data ◽

Household Surveys ◽

Focus Group Discussions ◽

Group Discussions ◽

The People ◽

Key Informant ◽

Biogas Plants ◽

Biogas Technology

This study presents the potentiality of biogas plants and their role for the conservation of environment. It is basedon primary data collected from 84 household surveys, 6 key informant interviews and two focus group discussions. It was observed that more than 95% of the people residing in the VDCs were using firewood as a main source ofenergy. The total amount of firewood consumed was 510.570 ton/year which emits 775.052tCO2e/year. Due to the presence of agriculture based livestock holding population, there is a great potential of biogas technology. Thestudy showed that biogas technology could saved 34.40% of firewood which conserves 5.415 ha of forests area. There is a potentiality of 58 biogas plants of size 6 cu.m which will reduce 440.800 tCO2e/year.DOI: http://dx.doi.org/njst.v15i2.12114Nepal Journal of Science and Technology Vol. 15, No.2 (2014) 51-56

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Assessing determinants of programmatic performance of community management of malaria, pneumonia, and diarrhea in children in Africa: Protocol and data collection for a mixed-methods evaluation of iCCM (Preprint)

10.2196/preprints.33076 ◽

2021 ◽

Author(s):

Aliya Karim ◽

Don de Savigny ◽

Serge Ngaima ◽

Daniel Mäusezahl ◽

Daniel Cobos Muñoz ◽

...

Keyword(s):

Mixed Methods ◽

Focus Group ◽

Child Health ◽

Data Collection ◽

Intervention Effectiveness ◽

Focus Group Discussions ◽

Group Discussions ◽

Middle Income ◽

Key Informant ◽

Low And Middle Income

BACKGROUND Integrated community case management (iCCM) is a child health program designed to provide integrated, community-based care for pneumonia, malaria and diarrhea for children in hard-to-reach areas of low- and middle-income countries (LMICs). The foundation of the intervention is service-delivery by community health workers (CHWs) who depend on reliable provision of drugs and supplies, consistent supervision, comprehensive training, and community acceptance and participation to perform optimally. The effectiveness of the program may also depend on a number of other elements, including an enabling policy environment, financing mechanisms from the national to the local level, data transmission systems, and appropriate monitoring and evaluation. The extent to which these factors act upon each other to influence the effectiveness and viability of iCCM is both variable and challenging to assess, especially across different implementation contexts. OBJECTIVE In this paper, we describe a mixed-methods systems-based study protocol to assess the programmatic components of iCCM which are associated with intervention effectiveness, and report preliminary results of data collection. METHODS This protocol employs a mixed qualitative and quantitative study design based on a Systems Thinking approach within four iCCM programs in Malawi, Democratic Republic of the Congo, Niger State, and Abia State, Nigeria. Routine monitoring data is collected to determine intervention effectiveness, namely testing, treatment and referral outcomes. Surveys with CHWs, supervisors, and caregivers are performed to collect quantitative data on their demographics, activities, and experiences within the program, and how these relate to the areas of intervention effectiveness. Focus group discussions are conducted with these stakeholders as well as local traditional leaders to contextualize this data. Key informant interviews are undertaken with national and district-level program stakeholders and officers knowledgeable in critical program processes. RESULTS We performed 3,836 surveys and 45 focus group discussions with CHWs, supervisors, and caregivers, and traditional leaders; 120 key informant interviews with district and national-level program managers, health officers, and ministry officials. Policy and program documents were additionally collected for review. CONCLUSIONS Evidence from this study will inform child health programs and practice in low- and middle-income settings, and future policy development within the iCCM intervention.

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Understanding the Livelihood Characteristics of the Migratory and Non-Migratory Fishers of the Padma River, Bangladesh

Journal of Scientific Research ◽

10.3329/jsr.v10i3.34492 ◽

2018 ◽

Vol 10 (3) ◽

pp. 261-273

Author(s):

M. I. Khan ◽

M. M. Islam ◽

G. K. Kundu ◽

M. S. Akter

Keyword(s):

Focus Group ◽

Well Water ◽

Full Time ◽

Age Group ◽

Focus Group Discussions ◽

Group Discussions ◽

Key Informant ◽

Part Time ◽

Tube Well ◽

Padma River

The Padma is the second longest and one of the trans-boundary rivers of Bangladesh that significantly contributes to fisheries production and supports the fishers’ livelihoods. This study assesses the livelihood characteristics of the Padma river-dependent migratory and non-migratory fishers, employing household interviews, focus group discussions (FGDs), and key informant interviews from July to October, 2015. All migratory fishers were full-time fishers, whereas, non-migratory fishers included full time (88.89%), part-time and occasional fishers (11.11%). Maximum fishers were belonging to the age group of 31 to 50 years of which 94.74% were migratory and 57.4% were non-migratory fishers. Half of the migratory and non-migratory fishers were illiterate. 89.47% migratory fishers used river water for drinking and other purposes, whereas, 94.44% non-migratory fishers used tube-well water. Average annual incomes of both migratory (58%) and non-migratory (65%) fishers ranged from Tk. 30,000 to 60,000, whereas 26% migratory and 5% non-migratory fishers had average annual incomes above Tk. 60,000. The overall livelihood status of the migratory and non-migratory fishers was not satisfactory as they have faced problems like conflicts with elite groups for resources, lack of fish preservation facilities. Effective initiatives and their proper implementations are very crucial to develop the Padma river fisher’s livelihood conditions.

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‘Sometimes you are forced to play God…’: a qualitative study of healthcare worker experiences of using continuous positive airway pressure in newborn care in Kenya

BMJ Open ◽

10.1136/bmjopen-2019-034668 ◽

2020 ◽

Vol 10 (8) ◽

pp. e034668

Author(s):

Helen M Nabwera ◽

Jemma L Wright ◽

Manasi Patil ◽

Fiona Dickinson ◽

Pamela Godia ◽

...

Keyword(s):

Continuous Positive Airway Pressure ◽

Focus Group ◽

Airway Pressure ◽

Healthcare Workers ◽

Positive Airway Pressure ◽

Scale Up ◽

Newborn Care ◽

Focus Group Discussions ◽

Group Discussions ◽

Key Informant

ObjectiveTo explore the experiences of using continuous positive airway pressure (CPAP) in newborn care among healthcare workers in Kenya, and to identify factors that would promote successful scale-up.Design and settingA qualitative study using key informant interviews and focus group discussions, based at secondary and tertiary level hospitals in Kenya.ParticipantsHealthcare workers in the newborn units providing CPAP.Primary and secondary outcome measureFacilitators and barriers of CPAP use in newborn care in Kenya.Results16 key informant interviews and 15 focus group discussions were conducted across 19 hospitals from September 2017 to February 2018. Main barriers reported were: (1) inadequate infrastructure to support the effective delivery of CPAP, (2) shortage of skilled staff rendering it difficult for the available staff to initiate or monitor infants on CPAP and (3) inadequate knowledge and training of staff that inhibited the safe care of infants on CPAP. Key facilitators reported were positive patient outcomes after CPAP use that increased staff confidence and partnership with caregivers in the management of newborns on CPAP. Healthcare workers in private/mission hospitals had more positive experiences of using CPAP in newborn care as the relevant support and infrastructure were available.ConclusionCPAP use in newborn care is valued by healthcare workers in Kenya. However, we identified key challenges that threaten its safe use and sustainability. Further scale-up of CPAP in newborn care should ensure that staff members have ready access to optimal training on CPAP and that there are enough resources and infrastructure to support its use.EthicsThis study was approved through the appropriate ethics committees in Kenya and the UK (see in text) with written informed consent for each participant.

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UNDERSTANDING LOW UPTAKE OF MASS TREATMENT FOR INTESTINAL SCHISTOSOMIASIS AMONG SCHOOL CHILDREN: A QUALITATIVE STUDY IN JINJA DISTRICT, UGANDA

Journal of Biosocial Science ◽

10.1017/s002193201400011x ◽

2014 ◽

Vol 47 (4) ◽

pp. 505-520 ◽

Cited By ~ 11

Author(s):

SIMON MUHUMUZA ◽

ANNETTE OLSEN ◽

FRED NUWAHA ◽

ANNE KATAHOIRE

Keyword(s):

Focus Group ◽

Qualitative Study ◽

School Children ◽

Primary Schools ◽

School Teachers ◽

Focus Group Discussions ◽

Group Discussions ◽

School Feeding ◽

Intestinal Schistosomiasis ◽

Key Informant

SummaryDespite attempts to control intestinal schistosomiasis through school-based mass drug administration (MDA) with praziquantel using school teachers in Uganda, less than 30% of the school children take the treatment in some areas. The aim of the study was to understand why the uptake of praziquantel among school children is low and to suggest strategies for improved uptake. This was a cross-sectional qualitative study in which 24 focus group discussions and 15 key informant interviews were conducted 2 months after MDA. The focus group discussions were held with school children in twelve primary schools and the key informant interviews were held with school teachers, sub-county health assistants and the District Vector Control Officer. The study shows that the low uptake of praziquantel among school children is a result of a complex interplay between individual, interpersonal, institutional, community and public policy factors. The individual and interpersonal factors underpinning the low uptake include inadequate information about schistosomiasis prevention, beliefs and attitudes in the community about treatment of schistosomiasis and shared concerns among children and teachers about the side-effects of praziquantel, especially when the drug is taken on an empty stomach. The institutional, policy and community factors include inadequate preparation and facilitation of teachers and the school feeding policy, which requires parents to take responsibility for providing their children with food while at school, yet many parents cannot meet the cost of a daily meal due to the prevailing poverty in the area. It is concluded that strategies to improve uptake of praziquantel among school children need to be multi-pronged addressing not only the preparation and motivation of teachers and health education for children, but also the economic and political aspects of drug distribution, including the school feeding policy.

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Levels of Equivalence in Interpreter-mediated Sermons from English into Luhya Varieties

International Journal of English Language Studies ◽

10.32996/ijels.2021.3.5.4 ◽

2021 ◽

Vol 3 (5) ◽

pp. 26-30

Author(s):

Annet Aromo Khachula ◽

Lucy Mandillah ◽

Bernard Angatia Mudogo

Keyword(s):

Focus Group ◽

Participant Observation ◽

Relevance Theory ◽

Target Language ◽

Focus Group Discussions ◽

Group Discussions ◽

Source Language ◽

Key Informant ◽

Audio Recorder

Languages have different concepts for conveying meanings; hence there is a problem in finding equivalents between the source language (SL) and the target language (TL) in the process of interpreting. The transfer of meaning is identified as one of the basic problems in interpreting due to the absence of equivalence between two languages. This paper identifies levels of equivalence in the interpretation of selected sermons from English into Luhya varieties. Data was collected through key-informant interviews of interpreters, Focus Group Discussions by the congregants, and the researcher’s non-participant observation during church services. An audio recorder was used to collect the corpus for analysis which was later transcribed and translated for analysis. Relevance Theory by Sperber and Wilson (1986) provided the background for the discussion of the data. The findings revealed the following levels of equivalence in the interpretation of English sermons into Luhya varieties; one to many, one to part-of-one and nil equivalence. Further, it was also revealed that interpreters need to identify these three levels of equivalence in interpreting English sermons into Luhya varieties to determine the appropriate measures to counteract the situation.

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