Impact positif d’un documentaire vidéo-TV sur la vaccination antitétanique des femmes au Cambodge et causes de non-vaccination

Résumé

Pour évaluer l’impact d’un documentaire incitant les femmes à participer à deux vaccinations collectives antitétaniques de rattrapage au Cambodge, on a tiré au sort dix villages sur 65 où ce documentaire a été projeté en vidéo, puis on a tiré au sort dans chaque village 33 résidentes de plus de 11 ans qui ont été interrogées sur leur statut vaccinal tétanos et leur participation aux séances vidéo avant la vaccination. Après la première séance de vaccination collective, on a vérifié leur statut vaccinal sur leurs cartes de vaccination et recensé éventuellement les causes d’absence à cette séance. Le documentaire a été rediffusé une fois, dix mois plus tard, sur une chaîne de télévision (TV) locale juste avant la deuxième vaccination collective. On a alors vérifié si elles avaient vu le documentaire à la TV et si elles avaient participé à cette seconde vaccination collective, en notant les causes d’absence éventuelles. Les données de 323 femmes ont pu être analysées: 24 % d’entre elles avaient vu le documentaire en vidéo contre seulement 2,4 % à la TV. Les femmes ayant vu la vidéo se sont faites, de façon significative, plus vacciner lors de la première vaccination collective que celles qui ne l’avaient pas vue (p = 0,0006; IC 95 %: 1,23 < RR = 1,51 < 1,84). Pour la vaccination de rappel, l’impact du documentaire a été positif sans être significatif (p = 0,27; IC 95 %: 0,91 < RR = 1,23 < 1,66). De façon significative, les femmes de plus de 45 ans ont plus souvent complètement échappé à la vaccination que les femmes en âge de procréer (FAP) [p = 0,00003IC 95 %: 1,53 < RR = 2,13 < 2,97] qui, elles, y ont plus souvent échappé que les écolières (p = 0,002). Les principales causes de non-vaccination lors de ces deux campagnes étaient un intervalle insuffisant avec la dose précédente selon le calendrier OMS (25 %), un rendez-vous pour un travail agricole (18 %), un voyage d’agrément (8 %), une peur des injections (7 %) et le fait d’être complètement vaccinée (7 %). Seulement, 2 % des femmes ont déclaré ne pas avoir été informées de la vaccination.

Abstract

The impact of medical documentaries on attendance to immunization sessions is not documented in developing countries. The impact of a video and TV medical documentary on women’s vaccination during a catch-up tetanus collective immunization was studied in Cambodia (2002–2004). A medical video documentary produced locally was publicly shown in 10 villages chosen at random among 63 villages to be covered by collective tetanus immunization. In each village where the video was shown, 33 women, older than age 11, were selected at random and questioned about their tetanus vaccination records, to assess if they attended the video and to evaluate their knowledge about tetanus. A second interview was conducted after the first collective vaccination to check their attendance and to record reasons for non-attendance. The same interview was conducted 10 months later, after the documentary was shown on a local TV channel and a second collective tetanus vaccination conducted. Data were collected from 323 (98%) women. Seventy-eight (24%) women saw the video documentary and only eight (2.4%) saw it on TV. Compared to farmers, shopkeepers saw significantly less the documentary (Chi²of Yates: 5.77,P = 0.016; 95% CI: 0.10 < RR = 0.29 < 0.88) and no home keeper or civil servant attended it. Women of childbearing age with no school education were significantly more attracted by the video documentary (Chi²of Yates: 5.99,P = 0.01; 95% CI: 1.10 < RR = 1.57 < 2.22) than other childbearing-aged women, although their final immunization coverage was not better. The documentary did not increase the knowledge that contamination for tetanus may come from earth and tools, but not from air and water, and that all ages are at-risk for tetanus, but it increased significantly the knowledge that vaccination can prevent the disease (Chi²of Yates: 13.98;P = 0.0001; 95% CI: 1.28 < RR = 1.57 < 1.93). Women who saw the video documentary attended the first collective session more often than those who did not (Chi²of Yates: 11.00;P = 0.0006; 95% CI: 1.23 < RR = 1.51 < 1.84)in spite of their better vaccination status before the immunization, and this was mostly significant for farmers and women more than 45 years of age. Women who saw the documentary either on video or on TV also attended more the second collective session, but not significantly (Chi²of Yates: 1.23;P = 0.266; 95% CI: 0.91 < RR = 1.23 < 1.66). Forty-nine percent of women had not attended school and the video documentary was re-run twice after the first performance. Women older than 45 years (55%) completely escaped immunization significantly more often than women of childbearing age (35%) (Chi²of Yates: 17.26;P = 0.00003, 95% CI: 1.53 < RR = 2.13 < 2.97), who did it more often than schoolgirls (2%) (Chi²of Yates: 9.69;P = 0.002; 95% CI: 0.01 < RR = 0.09 < 0.65). The main reasons for not being vaccinated during catch-up collective tetanus vaccinations were a too short interval between doses according to the WHO schedule (25%), agricultural task (18%), leisure travel (8%), fear of injections (7%), and being completely vaccinated according to the WHO schedule (7%). Only 2% of women were not informed, showing that vaccination was well-publicized. This educational technique should be re-used in all villages during coming catch-up tetanus collective immunizations in Cambodia, mostly in urban contexts where coverage during these sessions is lower. Video is still the best method in rural context if some education is also provided to the audience. According to the WHO schedule, the interval between two catch-up tetanus sessions should be extended to over a year to be able to give booster shots to women who already received three or more tetanus doses. Vaccination of schoolgirls is significantly easier to achieve with the help of the teachers. Vaccinating women aged over 45 should be encouraged as they are at risk of tetanus even in developed Asian countries.