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Enablers and barriers to rotavirus vaccine coverage in Assam, India- A qualitative study
Rashmi Mehra1, Arindam Ray2, Sabita Das3
1John Snow India, New Delhi, India.
Insights
Rotavirus vaccine coverage in Assam, India, faces challenges like difficult terrain and limited staff. Information in local languages and strong partner support are key enablers for improving vaccination rates in children.
Area of Science:
- Public Health
- Vaccinology
- Pediatric Gastroenterology
Background:
- Rotavirus gastroenteritis causes significant child mortality in India, with Assam reporting high pediatric diarrheal admissions positive for rotavirus.
- Rotavirus vaccine (RVV) introduction in Assam in 2017 was followed by low and uneven vaccine coverage, as per NFHS-5 (2019).
Purpose of the Study:
- To identify the enablers and barriers affecting rotavirus vaccine coverage in Assam.
- To inform strategies for improving RVV uptake in the region.
Main Methods:
- A qualitative study was conducted in 5 randomly selected districts of Assam.
- Data collection involved 35 in-depth interviews and 5 focus group discussions with healthcare officials, service providers, and caregivers.
- Thematic framework analysis was applied to the transcribed qualitative data.
Main Results:
- Barriers to RVV coverage included difficult terrain, limited healthcare provider availability, and lack of refresher training for new recruits.
- Enablers identified were Information, Education & Communication (IEC) materials in vernacular languages, the vaccine's safety profile, development partner support, and adequate vaccine supply.
Conclusions:
- Recommendations include enhancing inter-sectoral coordination, implementing regular monitoring, and conducting frequent refresher training sessions.
- Further research with larger sample sizes and existing coverage data is needed to triangulate findings.
Background:
Estimates suggest that 78,000 children died due to rotavirus gastroenteritis annually between 2011 and 2013 in India. The north eastern state of Assam reported 38.4% pediatric diarrheal admissions testing positive for rotavirus. Rotavirus vaccine (RVV) was introduced in Assam in 2017 following which the National Family Health Survey-5 (NFHS-5) (2019) revealed low RVV coverage in Assam with wide variation between the districts. the current study was conceptualized and undertaken to capture the enablers and barriers to RVV coverage in Assam.
Methods:
Qualitative study conducted in 5 randomly selected districts in Assam. Participants (key informants) were recruited by purposive sampling at each level of the health system including healthcare officials, service providers and caregivers based on availability. Thirty-five in-depth interviews (IDIs) and five focus group discussions (FGDs) were conducted. Interviews were tape recorded and transcribed. Data was coded and analyzed using the thematic framework approach.
Results:
Findings from the qualitative data collection were collated and analyzed under 7 identified themes. Difficult terrain, limited service provider availability and no catch-up training for new recruits were some of the barriers to RVV coverage. In contrast, Information, Education & Communication (IEC) in vernacular language, RVV safety profile, development partner support and adequate RVV supply were identified as some of the enablers of RVV coverage.
Conclusion:
Few broad recommendations to overcome identified barriers include comprehensive inter-sectoral coordination, regular monitoring and frequent refresher training sessions. There is a need for a future study utilizing existing coverage data and larger sample size to triangulate the findings of this study.
