Sociocultural concepts of pandemic influenza and determinants of community vaccine acceptance ...

254 Pages·2015·5.38 MB·English

Sociocultural concepts of pandemic
influenza and determinants of community
vaccine acceptance in Pune, India

Inauguraldissertation

zur
Erlangung der Würde einer Doktorin der Philosophie
vorgelegt der
Philosophisch-Naturwissenschaftlichen Fakultät der
Universität Basel

von
Neisha Sundaram
aus Bangalore, India

Basel, 2015

Original document stored on the publication server of the University of Basel
edoc.unibas.ch

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0
International License.
Genehmigt von der Philosophisch-Naturwissenschaftlichen Fakultät auf Antrag
von Prof. Dr. Marcel Tanner, Prof. Dr. Mitchell G. Weiss und Dr. Heidi Larson

Basel, 23 June 2015

Prof. Dr. Jörg Schibler
Dekan der Philosophisch-
Naturwissenschaftlichen Fakultät
Let us read, and let us dance; these two amusements will never do any harm to
the world
~Voltaire

Table of Contents
Acknowledgements ii
Summary vii
Zusammenfassung xi
सारांश xvi
Abbreviations xxi
List of Figures xxiii
List of Tables xxiv
1. Introduction 1
2. Research aims and objectives 31
3. Study description 33
4. Cultural epidemiology of pandemic influenza in urban and rural Pune, India:
a cross-sectional, mixed-methods study 43
5. Community awareness, use and preference for pandemic influenza vaccines
in Pune, India 69
6. Sociocultural determinants of anticipated acceptance of pandemic influenza
vaccine in Pune, India: a community survey using mixed-methods 101
7. Discussion 127
8. Appendix 150

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List of Appendices
1. 8.1 Additional figures for chapter 7 150
2. 8.2 Comparing sociocultural features of cholera in three endemic African
settings 153
3. 8.3 Sociocultural determinants of anticipated oral cholera vaccine
acceptance in three African settings: a meta-analytic approach 170
4. 8.4 Socio-cultural determinants of anticipated acceptance of an oral
cholera vaccine in Western Kenya 189
5. 8.5 EMIC Interview 202
6. 8.6 Vignette 223
7. 8.7 Curriculum vitae 225

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Acknowledgements
I am deeply grateful to my supervisor, Mitchell Weiss, for his invaluable support
and guidance. His dedication to research and learning, organization, systematic
method of working and quest for excellence, have set very high standards for
me to emulate besides ingraining in me values that I hope to draw upon
throughout my life. I thank him for his patience and enthusiasm in teaching me
concepts of cultural epidemiology, academic writing and the best software to use
at any point! He has always found the time to answer my questions and explain
things to me. A truly remarkable gentleman with varied interests and incredible
modesty, his breadth and depth of knowledge on almost any topic is amazing. I
have learned much from him, and that includes among many other things,
where I can find good food in less-known restaurants of Pune, an appreciation of
what my hometown looked like before I was born and recommendations for
excellent independent films! Mitchell has helped me stay “on track” since we first
met six years ago to discuss my Master’s research project. I am also grateful to
him for the profound influence he has had on my development as a researcher
and thank him for making this thesis possible.

From Marcel Tanner, the faculty representative on my PhD committee and
beloved director of our institute, I learned another transport-related life-lesson:
“we’re all in the same boat” and to “never give up”. He is a truly inspirational
leader and his positivity, motivation and genuine concern for everyone, makes
the Swiss TPH work environment utopic. Five minutes with Marcel can provide a
quick dose of inspiration for the year. I am very grateful for his allowing two
cheeky Masters students, to switch courses mid-semester to study epidemiology
and public health because it was what they were passionate about. That was one
of the best things that has ever happened to me, for which I will be eternally
grateful.

Heidi Larson, the co-referee on my PhD committee, has been a fine teacher to
me through her research and writing during the course of my doctoral studies
and during the brief interactions that we have had. Her work has been
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Acknowledgements

inspirational to me and I thank her for that. I am appreciative of the advice that
she has provided and for her concern in my development as a researcher. Our
interactions have always left me with plenty of food for thought. I especially
thank her for reviewing my thesis and for her willingness to participate in my
defence, despite other commitments.

I owe a debt of gratitude to the external expert on my PhD committee and boss
at the National University of Singapore (NUS), Joanne Yoong. She has been
extremely generous in providing me a job at NUS and has shown patience and
understanding of the challenges I faced while simultaneously working on my PhD
thesis. On one hand she is exceedingly kind and on the other hand she is tough
as nails: always knows the right thing to say and has a razor sharp mind. On the
third hand (I have learned some jargon used by economists!), she is an enabler
who is great fun to be around. I am very thankful to have the opportunity to
work with her and learn a few things about health economics. More importantly
for many life-skills I’ve learned, Joanne has been a role-model.

Christian Schaetti, a collaborator on this research project, was a mentor to me
during my Master’s work and has also provided valuable guidance during my
doctoral research. Working with him over the past six years has been an
absolute pleasure and I am fortunate to have also found in him a close friend.
He has always been ready to provide critical feedback on my work to help me
improve, provided a listening ear and advice, and in addition, has provided
merciless teasing! I appreciate the good times we had during field work in Kenya
and India and most of all for him being always there for me. I also thank him for
being an excellent teacher, proofreading my thesis and carefully translating the
summary into German.

I am grateful to Leticia Grize and Christian Schindler for their expert statistical
advice and support. I have received many valuable statistics lessons and learned
SAS tips from them. Their warmth and approachability have made our work
discussions very productive and fun.

I would like to thank Abhay Kudale, co-investigator of the research project in
Pune at the Maharashtra Association of Anthropological Sciences (MAAS), for
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Acknowledgements

excellent execution of the project. Special thanks are due to MAAS colleagues for
their kindness, friendship and contributions to the project, notably: Vidula
Purohit, Vinita Datye, Saju Joseph, Deepa Thakur, Prashant Kulkarni, Vinayak
Amle and Arun Awale. The challenges of field work were fun thanks to the
wonderful company of research investigators: Abhijeet Bhalerao, Aarti
Waghmare, Dynaneshwar Sangle, Mrudula Holkar, Ganesh Hulge, Vandana
Lohana, Gandhaali Pisal and Gayatri Tejankar; and their contributions to the field
research are highly appreciated. Vidula Purohit is especially thanked for
translating the thesis summary into Marathi. I also sincerely thank the urban and
rural study communities, village leaders and community health workers for their
participation in the study.

I am grateful to Vasudeo Paralikar and his wonderful family for being my family
and providing a great source of support during my fieldwork. I also thank the
Late Anjali Jawahire, Kanad Jawahire, Mona and Haiderali Wadiwala, and Mohan
Agashe for their cheerful company and support during my stay in Pune.

At the Swiss TPH, a special thank you goes to Jürg Utzinger for chairing the
defence. I especially thank Brigit Obrist and Jakob Zinsstag for reviewing my
PhD proposal and providing valuable feedback. A special thank you is extended
to Brigit for letting me study her qualitative data analysis courses remotely and
to Constanze Pfeiffer for organizing the health social sciences group. I really
enjoyed sharing research experiences in our Society, Gender and Health Unit
headed by Elizabeth Zemp. I would also like to thank everyone at the PhD house
where there is never a dull moment! Special thanks to friends and colleagues
over the years in Basel for all the laughter and lunch-time fun: Joëlle Schwarz,
Ayoung Jeong, Erin Stuckey, Kristina Pelikan, Abdulsalam Alkaiyat, Anna Dean,
Sarah Rajkumar, Fabian Schär, Monique Léchenne, Anna Schöni, Katharina
Roser, Samuel Fuhriman, Peiling Yap, Martin Bratschi, Sarah Kerber, Mari
Dumbaugh, Henry Owusu, Carine Weiss, Nerina Vischer, Samuel Oppong, Nadia
Pillai, Philipp Bless, Mohamad Sater, Peter Steinmann, Afona Chernet, Nicolas
Maire, Irene Küpfer, Sandro Schmidlin and Benjamin Speich. A very special
thank you goes to dear friends Harris Héritier, Stephanie Mauti, Ashley Warren,
Astrid Knoblauch, Sofie Hansen, Randee Kastner, Simone Sutherland, Patrizia
Frei and Geethanjali Ram for their hugs and delicious meals during the thesis-
v
Acknowledgements

writing process. A big thank you to Margrit Slaoui, Christine Walliser, Dagmar
Batra, Laura Innocenti, IT department, HR department and Swiss TPH library for
their support. Christine Mensch has been a source of comfort since the day I
first arrived at the Swiss TPH. I am grateful to her for having the answer to
every question, solution to every problem and for being a ray of sunshine.

I thank my wonderful colleagues in the health economics and sociology group at
NUS. Special thanks to Cynthia Chen, Joan Thomas, Clarence Tam, Quake Ai Li,
Milawaty Nurjono, Ong Suan Ee and Emily Sullivan and for their encouragement
and friendship. I thank our collaborators in the oral cholera vaccine (OCV)
project, Erick Nyambedha and Lilian Akeyo from Maseno University, Kenya, and
Sonja Merten from Swiss TPH. Raymond Hutubessy and Clarie-Lise Chaignat
from the World Health Organization (WHO) are also sincerely thanked for their
guidance in the OCV work. Raymond has been very supportive and inspirational,
for which I am thankful.

This work was financially supported by the WHO, Switzerland, a start stipend
offered by the PhD program in Health Sciences, University of Basel and the
Swiss TPH. I am very grateful for the funding that was provided that allowed me
to undertake and complete this extremely interesting project.

A great big thank you is due to my large extended family, my sister, our Ali
Asker Road family and friends in India and abroad for their love. Thanking my
parents is an impossible task as no words can do justice and words are perhaps
superfluous. Everything that I am today, I owe to them. They truly define
unconditional love and sacrifice. My sister and I are extremely fortunate to have
the best role-models as our parents. Last but the opposite of the least, I thank
my best friend and soul mate, who challenges and delights me, Suman Bhat. He
has been incredibly supportive during my long absences in the field, my crazy
work hours while around, doing far more than his fair share of the housework,
and in helping me with thesis formatting in the final stages. Thank you for
believing in me often more than I believe in myself. This thesis, as everything
else in my life, is dedicated to you.
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