Academic journal article Journal of Health Population and Nutrition

The Health Belief Model and Factors Relating to Potential Use of a Vaccine for Shigellosis in Kaeng Koi District, Saraburi Province, Thailand

Academic journal article Journal of Health Population and Nutrition

The Health Belief Model and Factors Relating to Potential Use of a Vaccine for Shigellosis in Kaeng Koi District, Saraburi Province, Thailand

Article excerpt


Shigella, the enteric pathogen, is still an important cause of morbidity and mortality throughout the world. Approximately, 1.1 million deaths occur each year due to shigellosis, making it the fourth leading cause of mortality worldwide (1,2). Because of growing limitations in its treatment and in community-control measures against it, there has been an increasing international interest in an effective vaccine against the disease (1,3). Reduced efficacy of treatment of shigellosis is partly due to the progressive growth of drug-resistant strains of Shigella. This development has potentially devastating consequences for endemic and epidemic outbreaks of shigellosis. In addition, government resources needed to combat its spread through improved sanitation and water supplies are often inadequate in areas where it is most prevalent (4,5).

Attempts to produce a vaccine that is effective against the various species of Shigella, such as Shigella dysenteriae, S. flexneri, and S. sonnei, have not yet been successful. However, there is increasing promise for the production of a safe and effective vaccine in the near future (3). Therefore, a policy and planning context for instituting vaccination against shigellosis needs to be considered in countries with a history of endemic and epidemic shigellosis. Critical in such considerations are the level of community demand and the associated barriers and facilitators that may affect the acceptance and accessibility of a vaccine (6,7).

Based on a history of both epidemic and endemic conditions of the disease, this paper explores local interest in and potential use of a vaccine for the disease in Thailand where it poses an important public-health concern. Information for this study was collected in a sociobehavioral household survey conducted from June to November 2002 in Kaeng Koi district in central Thailand. The community demand and likely use of a vaccine were examined in relation to the Health Belief Model which provides analytical constructs for investigating multiple issues of local readiness to accept and access a new vaccine (8,9). This information is critical for developing policy and planning for the introduction of a new vaccine. This study also demonstrates the utility of applying the constructs of the Health Belief Model to assess community demand and means to introduce a new preventive health measure.


Study background

This study is part of the International Vaccine Institute's (IVI) Diseases of the Most Impoverished (DOMI) Programme which supports the introduction of new-generation vaccines in several Asian countries. This effort partly entails disease burden, economic, policy and sociobehavioural studies to ascertain the importance and feasibility of introducing a vaccine against shigellosis in Pakistan, Thailand, Bangladesh, Vietnam, Indonesia, and China.

The sociobehavioural survey on shigellosis in Thailand is a follow-up activity based on the findings of an IVI policy study with Thai government policy-makers in which a vaccine against shigellosis was identified as an important addition to the immunization programme of Thailand. The policy-makers noted the importance of a vaccine to meet its disease-burden levels and the uncertainty of continued improvements in water and sanitation conditions (10).

The epidemiological evidence also indicates the need for a vaccine for shigellosis in Thailand. ADOMI disease-burden study in Kaeng Koi district, which involved a two-year passive surveillance at 20 community health centres, found that, of 5,202 cases of diarrhoea reported during May 2000-December 2001, 182 (3.5%) cases were of shigellosis. While this finding suggests endemic conditions of the disease (11), epidemic outbreaks of shigel-losis have also been reported in Thailand (12). Moreover, drug-resistant strains of Shigella have emerged in Thailand over the past 20 years (13,14). …

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