A recent qualitative study explores how social determinants in informal urban settlements in Ethiopia, Kenya, and Malawi affect both the burden of childhood diarrhoeal disease and uptake of the rotavirus vaccine. Caregivers in all three countries identified poor water, sanitation, and hygiene (WASH) infrastructure, poverty, overcrowding, and limited clean water access as key drivers of frequent diarrhoea. While many mentioned home remedies, shared toilets, or private chemists when illness strikes, there was general awareness of vaccines being protective, yet surprisingly few caregivers recognized the rotavirus vaccine specifically as a preventive measure. Misconceptions regarding causes of diarrhoea, fears around vaccine side-effects, distrust, and “vaccine fatigue” from frequent vaccination campaigns were recurrent barriers.
From an immunization economics perspective, these findings underscore that introducing or expanding vaccine programmes alone may not yield maximal benefit unless paired with broader, cross-sectoral investments. Investing in WASH and urban infrastructure, improving community health literacy (including culturally appropriate naming and communication for vaccines and “antibiotics”), and reducing barriers such as travel distance or perceived coercion could increase vaccine uptake and reduce health inequities. Antimicrobial resistance remains an underlying concern: caregivers’ reliance on incomplete antibiotic regimens and self‐medication in contexts where clinics may lack resources complicates cost-effectiveness calculations and long-term programme sustainability. Policy makers and funders should thus consider integrated interventions that address both the medical and structural roots of childhood diarrhoeal disease.
Thumbnail image credit: Shutterstock / Nkhwazi Aeros
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