Drivers of hesitancy towards recommended childhood vaccines in African settings: a scoping review of literature from Kenya, Malawi and Ethiopia

ABSTRACT

Introduction

There is a dearth of literature on vaccine hesitancy in Africa. In this study, we aimed to explore the drivers of hesitancy toward recommended childhood vaccines in Kenya, Malawi, and Ethiopia.

Methods

A scoping review methodology was used as this evidence synthesis approach is suitable for mapping existing literature and identifying knowledge gaps. For this study, we systematically searched four electronic databases for published and unpublished literature from the three African countries. The methodological framework that was used is in line with Arksey and O’Malley’s recommendations as modified by Levac.

Results

A total of 23 publications met the inclusion criteria and were included in the study. Majority of the studies were published after 2012. In these three African countries, hesitancy toward recommended childhood vaccines is driven by a mix of caregiver-related factors, health systems-related factors as well as the influence of community context.

Conclusion

This study demonstrated that vaccine hesitancy in Kenya, Malawi, and Ethiopia is a complex phenomenon that is driven by multiple interrelated and interconnected factors.

KEYWORDS:

• Vaccine hesitancy
• childhood
• Africa
• scoping review
• Kenya
• Malawi
• Ethiopia

ARTICLE HIGHLIGHTS

• Vaccines are an effective tool for reducing child morbidity and mortality that are associated with common childhood infectious diseases such as measles, poliomyelitis, diphtheria, pertussis among others, but their uptake can be affected by hesitancy.

• Vaccine hesitancy has been recognized as an important threat to global health because it can potentially derail the performance of national immunization programs.

• After scoping existing literature from Kenya, Malawi, and Ethiopia, it was found that vaccine hesitancy in African settings is driven by a complex set of interrelated and interdependent factors. The factors are categorized into three, namely caregiver-related factors, health systems-related factors, and community context.

• The caregiver-related factors are personal perception or influences arising from the caregiver’s social environment that makes them hesitant about vaccines such as increasing birth order, increasing child age, increasing maternal age, sickness in a family member at the scheduled time for vaccination, trust in herbal medicines, lack of faith in immunization, fear of side effects of vaccine(s), fear of injections, low birth weight in the child, and negative rumors about vaccines.

• The health systems-related factors are vaccine or vaccination specific issues (immunization sub-systems) or other health sub-systems issues that make caregivers hesitant about vaccines such as poor maternal immunization, delivery in a non-health facility, poor utilization of postnatal care, and low antenatal care service utilization.

• Factors related to community context are socio-cultural, environmental, and political influences that can make caregivers hesitant about vaccines such as low autonomy among women, nomadic lifestyle, vaccination due in rainy season, belonging to minority ethnic group, and influence of religious leaders.

Declaration of interest

A Adamu is affiliated with Cochrane South Africa, South African Medical Research Council, South Africa. TA Essoh and A Aplogan work for the Agencie Agence de Médecine Préventive (AMP) Afrique – Preventive Medicine Agency for Africa. CS Wiysonge is supported by the South African Medical Research Council. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author Contributions

AAA, TAE and GCA conceptualized the study. AAA, TAE, GCA, RIJ, YS, AA and CSW designed, developed and refined the methodology. RIJ and YS were involved in screening and data extraction. AAA developed the first draft and revised subsequent drafts. AAA, TAE, GCA, RIJ, YS, AA and CSW contributed to subsequent drafts. All authors approved the final draft.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This work was supported by an unconditional educational grant from Merck Sharp and Dohme (MSD) to the Agence de Médecine Préventive (AMP) Afrique – Preventive Medicine Agency for Africa. While the support and contribution of the abovementioned institutions and individuals is appreciated, the authors are fully responsible for the content and views expressed in this paper.