Health care preferences for children with typhoid fever in two slum communities in Karachi, Pakistan.

This study examined health care preferences and influences in response to initial and persistent symptoms of typhoid fever among children in two slum communities in Karachi, Pakistan. Typhoid fever in this area is endemic and has a high rate of multi-drug resistantce. The study involved a household survey of 502 respondents. Private practitioners, including qualified medical specialists, were the preferred providers for initial symptoms, with government and private hospitals preferred for continuing symptoms. A number of cases continued to select initial health care choices regardless of the severity of symptoms. The findings point to factors of cost, access to care, previous use of a provider and perceived quality of care as key influences regarding health care choices. These findings suggest that cases of typhoid fever in these communities are at risk for not receiving appropriate diagnoses and treatment for children who are at risk for severe cases of multi-drug resistant disease. Suggestions are made for improving the care of children with typhoid in this context.

Adults' perceived prevalence of enteric fever predicts laboratory-validated incidence of typhoid fever in children.

This study was undertaken to develop a model to predict the incidence of typhoid in children based on adults' perception of prevalence of enteric fever in the wider community. Typhoid cases among children, aged 5-15 years, from epidemic regions in five Asian countries were confirmed with a positive Salmonella Typhi culture of the blood sample. Estimates of the prevalence of enteric fever were obtained from random samples of adults in the same study sites. Regression models were used for establishing the prediction equation. The percentages of enteric fever reported by adults and cases of typhoid incidence per 100,000, detected through blood culture were 4.7 and 24.18 for Viet Nam, 3.8 and 29.20 for China, 26.3 and 180.33 for Indonesia, 66.0 and 454.15 for India, and 52.7 and 407.18 for Pakistan respectively. An established prediction equation was: incidence of typhoid (1/100,000= -2.6946 + 7.2296 x reported prevalence of enteric fever (%) (F=31.7, p<0.01; R2=0.992). Using adults' perception of prevalence of disease as the basis for estimating its incidence in children provides a cost-effective behavioural epidemiologic method to facilitate prevention and control of the disease.

Sociobehavioural research methods for the introduction of vaccines in the Diseases of the Most Impoverished Programme.

Participation in vaccination campaigns worldwide, particularly the Expanded Programme on Immunization, has increased significantly in recent years. However, there remain multiple and integrated behavioural, sociocultural and political-economic barriers to vaccination. The Diseases of the Most Impoverished (DOMI) Programme has undertaken shigellosis disease-burden studies and oral cholera and typhoid Vi polysaccharide vaccine trials in seven Asian countries. As part of these projects, sociobehavioural studies have been undertaken to determine the potential demand for vaccines for these diseases and the obstacles and enabling factors that may affect acceptance, delivery, and use of vaccines. A theoretical model of acceptance of vaccination and a triangulation of qualitative and quantitative methods have been used for fully elucidating the range of issues relating to vaccination for shigellosis, cholera, and typhoid fever. In this paper, the theoretical and methodological basis of the DOMI projects has been reviewed in a context of current sociobehavioural research on the acceptability and desirability of vaccination.

Assessment of relevant cultural considerations is essential for the success of a vaccine.

This paper explores applications of social science research to international vaccine development and implementation. The paper discusses examples of vaccine-implementation controversies, suggesting that many of these issues could have been avoided with a greater focus on cultural issues regarding perceptions of disease, vaccination, and health services. The paper also discusses the relationship of theory-based behavioural interventions with the development of an overall vaccine strategy and examines experience of growing vaccine research with regard to perceptions of medical decision-making, acceptable practices, and authority and how these perceptions impact vaccine usage. The importance of social science in the ethical conduct of research is also discussed.

Perceptions of Shigella and of Shigella vaccine among rural Chinese: compatibility with Western models of behavioral change.

Shigella remain a major source of morbidity and mortality in developing countries, including China. In response, national and international researchers are actively working to develop vaccines that will be effective against dysentery and diarrhea caused by shigella dysentariae. With the growing recognition of the problems associated with sustained vaccine acceptance and usage, researchers and policy makers recognize the importance of conducting theory-based qualitative research to inform vaccine development program efforts. Accordingly we undertook this qualitative study involving 81 residents of one of China's rural communities with high rates of dysentery. The semi-structured interviews suggest that a Western model of behavioral change offered a useful research construct. Consistent with the model is the community's strong perception of 'response efficacy' of vaccines, particularly in comparison with water and sanitation and disease treatment. Residents were eager to vaccinate their children despite variable perception of disease severity, while they were less consistent in their interest in vaccinating adults; this enthusiasm for vaccinating children was attributed to China's 'one child per couple' policy. Intervention implications are discussed.