Household cost-benefit equations and equity in immunisation: a randomised cluster controlled trial of knowledge translation for sustainable universal childhood immunisation in south Pakistan

Conditions

Immunisation Infections and Infestations Vaccination

Anne Cockcroft, Khalid Omer, Yagana Gidado, Adamu Ibrahim Gamawa, Neil Andersson

BMC Health Services Research2018-07-0326 citations

10.1186/s12913-018-3319-z

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Andersson N, Beauchamp M, Nava-Aguilera E, Paredes-Solís S, Šajna M.

2017-05-3029 citations

10.1186/s12889-017-4301-0

Camino Verde (The Green Way): evidence-based community mobilisation for dengue control in Nicaragua and Mexico: feasibility study and study protocol for a randomised controlled trial.

Andersson N, Arostegui J, Nava-Aguilera E, Harris E, Ledogar RJ.

2017-05-3026 citations

10.1186/s12889-017-4289-5

Evidence-based discussion increases childhood vaccination uptake: a randomised cluster controlled trial of knowledge translation in Pakistan.

Andersson N, Cockcroft A, Ansari NM, Omer K, Baloch M, Ho Foster A, Shea B, Wells GA, Soberanis JL.

2009-10-1467 citations

10.1186/1472-698x-9-s1-s8

Interventions

We propose to test the importance of this household cost-benefit equation that decision-makers for children derive from their knowledge, attitudes, social norms, intentions, sense of agency and degree

Eligibility

Sex/Gender

All

Inclusion criteria

Inclusion criteria: This project is a randomised controlled trial; randomisation will be computer generated. There will be 2000 participating households (1000 intervention; 1000 control); 20 locations are to be chosen and randomised by computer (10 intervention; 10 control) and interviewers will interview 100 households with parents of children less than 5 years or parents planning on having children in the next year in each of these locations.

Exclusion criteria

Exclusion criteria: Does not comply with the above inclusion criteria

Design outcomes

Primary

Measure	Time frame
Survey content: In addition to baseline data about the coverage with and obstacles to immunisation, the standard Knowledge, Attitudes, and Practices (KAP) approach will be enriched by a modification: steps to behaviour change model developed by Community Information and Epidemiological Technology (CIET) to measure youth responses to risk. CIET?s beyond-KAP approach, "cascade", refers to knowledge about: 1. Immunisation and its side effects 2. Attitudes to childhood immunisation 3. Social norms (what neighbours do) and positive or negative deviation from those norms 4. Intentions to vaccinate in the future 5. Agency (self-efficacy expectancy about immunisation) and degree of socialisation or discussion about immunisation, its benefits and side effects The outcome of this "cascade" is immunisation, which will be documented in detail. Attention will be paid to perceived or real costs of immunisation and non-immunisation, and the weigh up costs and benefits. Gender and poverty affect the household cost-benefit equation. The poor, who typically have less access to services and less information about services, will almost certainly weigh up the cost and benefit in a different way than will the rich. Some diseases like measles and pertussis may be an inconvenience for the well nourished but, for the malnourished, they are a question of life or death. Costs of not vaccinating (disease burden, care and funerals) are borne disproportionately by the poor and, in a single epidemic; they can wipe out household economies.	—

Measure

Time frame

Survey content: In addition to baseline data about the coverage with and obstacles to immunisation, the standard Knowledge, Attitudes, and Practices (KAP) approach will be enriched by a modification: steps to behaviour change model developed by Community Information and Epidemiological Technology (CIET) to measure youth responses to risk. CIET?s beyond-KAP approach, "cascade", refers to knowledge about: 1. Immunisation and its side effects 2. Attitudes to childhood immunisation 3. Social norms (what neighbours do) and positive or negative deviation from those norms 4. Intentions to vaccinate in the future 5. Agency (self-efficacy expectancy about immunisation) and degree of socialisation or discussion about immunisation, its benefits and side effects The outcome of this "cascade" is immunisation, which will be documented in detail. Attention will be paid to perceived or real costs of immunisation and non-immunisation, and the weigh up costs and benefits. Gender and poverty affect the household cost-benefit equation. The poor, who typically have less access to services and less information about services, will almost certainly weigh up the cost and benefit in a different way than will the rich. Some diseases like measles and pertussis may be an inconvenience for the well nourished but, for the malnourished, they are a question of life or death. Costs of not vaccinating (disease burden, care and funerals) are borne disproportionately by the poor and, in a single epidemic; they can wipe out household economies.

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Secondary

Measure	Time frame
No secondary outcome measures	—

Countries

Pakistan

Outcome results

None listed