January 30, 2019

Ann Klassen, PhD, professor in the department of Community Health and Prevention in the Drexel University Dornsife School of Public Health (DSPH), is the principal investigator for a $146,441 award given to DSPH by UNICEF Tajikistan to conduct formative research to investigate factors influencing vaccine hesitancy in Tajikistan.

The new contract continues work by the Drexel team to improve child health in Tajikistan in partnership with UNICEF. Tajikistan is a small mountainous former Soviet country in Central Asia, working to improve many areas of maternal and child health.

The new study will investigate influences on vaccine hesitancy, focusing on family, community and health system deterrents to timely and complete childhood vaccination. Tajikistan has experienced significant outbreaks of vaccine-preventable diseases, including measles and polio. The goal of this formative research is to identify both the system-level changes needed, as well as audiences and messaging for immunization education efforts.

The work is the second project awarded to Drexel by UNICEF Tajikistan, under a long-term agreement for services between Drexel and UNICEF in the area of communication for development (C4D). A recently completed study on infant and young child feeding (IYCF) was led by Klassen, in collaboration with Brandy-Joe Milliron, PhD, and Beth Leonberg, MA, RDN, of Drexel’s College of Nursing and Health Professions. The team studied community and household food-related environments, as well as knowledge and practices in 13 villages across the country, including audits of foods available in markets and shops, structured observations of household water, sanitation and hygiene, food storage, preparation and meals, dietary recalls, and in-depth interviews of multiple stakeholders.

The study, published in September 2018 in the journal Maternal and Child Nutrition, found that despite seasonal limitations, maternal dietary diversity was mostly adequate, with 87 percent meeting World Health Organization (WHO) diversity guidelines, but that just 42 percent of children 6–24 months met WHO guidelines for diversity, and only 34 percent met minimum acceptable diet criteria.

In addition to Professors Klassen, Milliron and Leonberg, Drexel co-authors include Suzanne Grossman, M.Sc., a Doctor of Public Health candidate in the Department of Community Health and Prevention, Lisa Bossert, and Jalal Maqsood, 2016 Masters of Public Health graduates, and Margaret Chenault, 2016 graduate of the MS program in nutrition in Drexel’s College of Nursing and Health Professions.

In addition to issues of poverty and food scarcity, qualitative findings revealed many behavioral barriers to timely introduction of diverse foods. Although infant health is highly prioritized within the household, child nutritional activities focus on satiety and gradual socialization to the family diet, rather than strategic planning for optimal infant nutrition. Foods such as meat were seen as costly and thus inappropriate for infant and young child feeding (IYCF), and food taboos (i.e., fresh vegetables) further reduced diversity. Infant food preparation methods such as grinding were seen as impractical, and many foods were withheld until children developed teeth. The findings will inform nutritional education initiatives, involving multiple family members and utilize multiple channels, including schools, mosques, health care providers, and point-of-purchase communication.