Are Kenyan healthcare workers willing to receive the pandemic influenza vaccine? Results from a cross-sectional survey of healthcare workers in Kenya about knowledge, attitudes and practices concerning infection with and vaccination against 2009 pandemic influenza A (H1N1), 2010

doi:10.1016/j.vaccine.2011.01.063

Vaccine

Volume 29, Issue 19, 27 April 2011, Pages 3617-3622

https://doi.org/10.1016/j.vaccine.2011.01.063 Get rights and content

Abstract

Over 1200 cases of 2009 pandemic influenza A H1N1 (pH1N1) have been identified in Kenya since the first case in June 2009. In April 2010 the Kenyan government launched a program to immunize high-risk groups and healthcare workers (HCWs) with pH1N1 vaccines donated by the World Health Organization. To characterize HCWs’ knowledge, attitudes and practices regarding pH1N1 vaccination, we conducted a quantitative and qualitative survey in 20 healthcare facilities across Kenya between January 11 and 26, 2010. Of 659 HCWs interviewed, 55% thought there was a vaccine against pH1N1, and 89% indicated that they would receive pH1N1 vaccine if it became available. In focus group discussions, many HCWs said that pH1N1 virus infection did not cause severe disease in Kenyans and questioned the need for vaccination. However, most were willing to accept vaccination if they had adequate information on safety and efficacy. In order for the influenza vaccination campaign to be successful, HCWs must understand that pH1N1 can cause severe disease in Kenyans, that pH1N1 vaccination can prevent HCWs from transmitting influenza to their patients, and that the vaccine has been widely used globally with few recognized adverse events.

Introduction

The first confirmed cases of 2009 pandemic A (H1N1) influenza (pH1N1) were reported in two children in Southern California [1], and the World Health Organization (WHO) declared the presence of a pandemic on June 11, 2009 [2]. pH1N1 vaccine first became available in October 2009 in North America, Europe, and Australia. Initially, limited doses were available. WHO recommended that all countries prioritize immunization of healthcare workers (HCWs) to protect vital health infrastructure and to limit transmission to vulnerable patients [3].

Transmission of seasonal and pandemic influenza within hospitals and nursing homes, including transmission from staff to patients, has been widely documented [4], [5], [6], [7], [8], [9], [10], [11]. Transmission of influenza among medical staff causes absenteeism and considerable disruption of health care services [12], [13], [14]. Nosocomial outbreaks have typically been associated with low vaccination rates among healthcare workers [15], highlighting the need for continued efforts to develop efficient influenza immunization programs for hospital staff [12].

While influenza has been recognized as an important cause of acute respiratory infections (ARI) in many developed countries, little is known about influenza in tropical countries in Africa, and influenza vaccine is rarely used in this part of the world [16], [17]. Influenza vaccination is an effective way to prevent influenza virus infection [18], [19]. In Kenya, a country of 39 million people, only 30,000 doses of seasonal influenza vaccine are administered annually; HCWs are seldom vaccinated routinely [20].

The first case of pH1N1 was confirmed in Kenya in June 2009 [21]. Since then, more than 1200 cases have been identified through hospital-based and population-based surveillance. The introduction of pandemic influenza to Kenya was of concern to the Kenyan Ministry of Health and the Kenyan public [21], [22]. In November 2009, WHO announced that Kenya and Togo would be the first two countries in Sub-Saharan Africa to receive WHO-donated pH1N1 vaccines. The government of Kenya, through the Ministry of Public Health and Sanitation (MoPHS) and the Ministry of Medical Services (MoMS), subsequently adopted a plan that prioritized vaccinating the country's 120,000 HCWs with donated vaccine. The pH1N1 vaccination campaign was launched in April 2010.

In order to inform a campaign to promote pH1N1 vaccination for HCWs, we conducted a cross-sectional survey to assess HCWs’ knowledge, attitudes and practices (KAP) about infection with and vaccination against pH1N1.

Section snippets

Materials and methodology

We conducted a cross-sectional survey of HCWs in selected health care facilities in Kenya from January 11, 2010 through January 26, 2010. We used qualitative and quantitative research methods including a questionnaire and focus group discussions. We chose this mixed-methods approach because pairing quantitative and qualitative components of a study can generate more comprehensive data, corroborate findings, and allow the use of results from one method to enhance insights attained with the

Demographics of respondents

A total of 659 HCWs from 20 healthcare facilities in Kenya completed the questionnaire. The majority (62%) of respondents were female (Table 1). The mean age was 35 (range: 18–59). Most survey respondents were nurses [205 (32%)], followed by clinical officers [74 (11%)]. Of all respondents, 246 (37%) had a child <5 years old at home, 26 (4%) were pregnant, 24 (4%) had a chronic medical condition and 19 (3%) had a pregnant person living within their household. Overall, 571 (88%) had patient

Discussion and conclusion

We found that although most surveyed HCWs in Kenya expressed willingness to get the pH1N1 vaccine if it were offered for free, many group discussion respondents said they would be hesitant to be vaccinated because of lack of information about pH1N1 vaccine safety and efficacy. The overall reported willingness to accept the vaccine among Kenyan HCWs was much higher than reported acceptance levels of HCWs towards pH1N1 vaccine in other more developed countries [26], [27], [28]. In a recent survey

Acknowledgements

The authors wish to thank Rosalia Kalani, Abdirizack Mohamed, and Joseph Njau from the Ministry of Public Health and Sanitation for participating in data collection. We also thank all the 20 facility administrators who arranged for the data collection sessions and all the respondents who participated in this study. We also acknowledge CDC-Kenya for funding this study.

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Citation Excerpt :
We also identified vaccine safety and efficacy concerns and lack of endorsement from local community leaders and peers as potential barriers to future influenza vaccination. During the 2009 pandemic, Kenyan healthcare professionals were assessed about their knowledge, attitudes and practices about the influenza A/H1N1pdm09 virus circulating and causing illness in the community, and about acceptance and beliefs towards pandemic influenza vaccination [17]. Compared to the survey that was conducted in 2010 we observed some changes in knowledge and perceptions of Kenyan HCWs towards pandemic influenza and vaccination.
Healthcare workers (HCWs) are at high risk of exposure and transmission of infectious respiratory pathogens like influenza. Despite the potential benefits, safety and efficacy of influenza vaccination, vaccines are still underutilized in Africa, including among HCWs.
From May-June 2018, we conducted a cross-sectional, self-administered, written survey among HCWs from seven counties in Kenya and assessed their knowledge attitudes and perceptions towards pandemic influenza disease and vaccination. Using regression models, we assessed factors that were associated with the HCW’s knowledge of pandemic influenza and vaccination.
A total of 2,035 HCWs, representing 49% of the targeted respondents from 35 health facilities, completed the question. Sixty eight percent of the HCWs had ever heard of pandemic influenza, and 80.0% of these were willing to receive pandemic influenza vaccine if it was available. On average, Kenyan HCWs correctly answered 55.0% (95% CI 54.0–55.9) of the questions about pandemic influenza and vaccination. Physicians (65.6%, 95% CI 62.5–68.7) and pharmacists (61.7%, 95% CI 57.9–65.5) scored higher compared to nurses (53.1%, 95% CI 51.7–54.5). HCWs with 5 or more years of work experience (55.8, 95% CI 54.5–57.0) had marginally higher knowledge scores compared to those with less experience (53.9%, 95% CI 52.5–55.3). Most participants who were willing to receive pandemic influenza vaccine did so to protect their relatives (88.7%) or patients (85.9%).
Our findings suggest moderate knowledge of pandemic influenza and vaccination by HCWs in Kenya, which varied by cadre and years of work experience. These findings highlight the need for continued in-service health education to increase the HCW’s awareness and knowledge of pandemic influenza to increase acceptance of influenza vaccination in the case of a pandemic.
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Various serosurveys and studies were conducted globally on pandemic influenza. H1N1 virus reported so far provides ample evidence of differing perspectives, regarding its epidemiology especially with regard to prevalence, populations groups, and behaviour related to vaccine acceptance. A multigroup, cross-sectional survey among 658 healthy subjects was carried out, in Pune among students, health-care workers (HCWs), and soldiers to assess the seroprevalence of pandemic influenza H1N1 virus and its associated factors.
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Uptake and effectiveness of monovalent influenza A (H1N1) pandemic 2009 vaccine among healthcare personnel in Kenya, 2010
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Are Kenyan healthcare workers willing to receive the pandemic influenza vaccine? Results from a cross-sectional survey of healthcare workers in Kenya about knowledge, attitudes and practices concerning infection with and vaccination against 2009 pandemic influenza A (H1N1), 2010

Abstract

Introduction

Section snippets

Materials and methodology

Demographics of respondents

Discussion and conclusion

Acknowledgements

Lancet Infect Dis

J Hosp Infect

J Hosp Infect

Vaccine

Swine Influenza A(H1N1) infection in two children—Southern California, March–April 2009

MMWR Dispatch

World now at the start of 2009 influenza pandemic

Suspected nosocomial influenza cases in an intensive care, unit

MMWR Morb Mortal Wkly Rep

A nosocomial outbreak of 2009 pandemic influenza A (H1N1) in paediatric oncology ward in Italy, October–November 2009

Eurosurveillance

Healthcare personnel and nosocomial transmission of pandemic 2009 influenza

Crit Care Med

Nosocomial influenza A (H1N1) infection

Am J Med Technol

Nosocomial swine influenza (H1N1) pneumonia: lessons learned from an illustrative case

J Hosp Infect

Nosocomial influenza B virus infection in the elderly

Ann Intern Med

Influenza A among hospital personnel and patients. Implications for recognition, prevention, and control

Arch Intern Med

Absenteeism among hospital staff during an influenza epidemic: implications for immunoprophylaxis

Can Med Assoc J

Influenza vaccination of healthcare personnel: Recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Advisory Committee on Immunization (ACIP), 2006

Morb Mort Wkly Rep

Surveillance and management of influenza on the African continent

Expert Rev Respir Med

Influenza in Africa

PLoS Med

Prevention and control of influenza: recommendations of the advisory committe on immunization practices (ACIP), 2008

Morb Mort Wkly Rep

Should healthcare workers have the swine flu vaccine?

BMJ