Community Perceptions and Attitudes Toward Vaccination in Madagascar

Area of Science:

• Public Health
• Sociology
• Anthropology

Background:

• Low vaccination coverage and persistent zero-dose children challenge immunization in Madagascar.
• A socio-anthropological study was conducted to identify barriers to vaccination.

Purpose of the Study:

• To identify determinants of vaccination and non-vaccination in eight Malagasy districts.
• To understand factors influencing vaccine acceptance and hesitancy.

Main Methods:

• Qualitative approach using 162 semi-structured interviews and 41 focus group discussions.
• Inclusion of diverse key informants: authorities, healthcare workers, and parents.
• District selection based on immunization performance and socio-cultural diversity.

Main Results:

• Vaccination benefits are widely recognized; anti-vaccine rumors are sporadic and reversible.
• Barriers include fluctuating community health worker motivation and structural challenges.
• Vaccine acceptance is linked to trust in vaccinators and understanding, improved by sensitization.

Conclusions:

• Vaccine acceptance is not linked to rural settings or low-performing areas; rumors are not group-specific.
• Primary obstacles are economic risk prioritization and side effect concerns.
• Recommendations include strengthening awareness, trust, and community health worker support.