Évaluation des stratégies de communication sur le vaccin contre le paludisme RTS,S dix mois après son introduction au Bénin: étude transversale à deux bras en Allada-Toffo-Zè, février-mars 2025
Abstract
Contexte: Le Bénin a introduit le RTS,S/AS01 le 25 avril 2024 à Allada-Toffo-Zè (428 000 habitants, 80% rural), zone pilote parmi trois. Paludisme première cause morbidité: 2 069 294 cas déclarés, 5,1 millions estimés en 2023 (World Malaria Report 2024). La communication est essentielle mais non évaluée à 10 mois en milieu rural. Objectif: évaluer les stratégies de communication du 23 février au 03 mars 2025 (dix mois post-introduction) en distinguant initiation et rétention. Méthodes: étude transversale à deux volets STROBE, 30 grappes. Population 1: 255 ménages avec enfant 6-24 mois (LQAS, 14 lots de 19, PPS, itinéraire aléatoire, réponse 95,8%, carnet vu 90,6%). Population 2: 198 acteurs (choix raisonné). Questionnaires structurés pré-testés, traduits Fon/Aizo avec rétro-traduction, KoboCollect. Analyses: proportions IC95% Wilson, chi2/Fisher, régression logistique multivariée. Résultats: exposition 84,7% (216/255; IC95% 80,3-89,1): agents santé 85,6%, relais/ASCQ 83,3%, radio 46,8%; Fon 84,7%, Aizo 40,3%, Mina/Dindi/Sahouè 7,4%. Couverture OMS: réception 65,1%, VAP1 55,7%, VAP2 37,9%, VAP3 21,3%; abandon VAP1→VAP3 62,4%. Exposition associée à réception (17,9% vs 73,6%, p<0,0001) et VAP1 (10,3% vs 63,9%, p<0,0001); ORa=9,60 [3,59-25,69]. Rumeurs 72,2%, craintes effets 65,0%, manque informations 68,8%; contrat signé 13,3%, rémunérés 10,6%. Conclusion: stratégies de proximité efficaces pour initiation mais insuffisantes pour rétention; renforcer rappel rendez-vous, contractualisation/rémunération, canaux innovants et briefing systématique.
Background: Benin introduced RTS,S/AS01 on 25 April 2024 in Allada-Toffo-Zè (428,000 inhabitants, 80% rural), one of three pilot zones. Malaria remains leading cause of morbidity: 2,069,294 reported cases, 5.1 million estimated in 2023 (World Malaria Report 2024). Communication is critical but unevaluated at 10 months in rural settings. Objective: Evaluate communication strategies from 23 February to 03 March 2025 (ten months post-introduction) distinguishing initiation and retention. Methods: Two-arm cross-sectional study per STROBE, 30 clusters. Population 1: 255 households with child 6-24 months (LQAS, 14 lots of 19, PPS, random route, response 95.8%, card seen 90.6%). Population 2: 198 stakeholders (purposive). Structured pre-tested questionnaires translated Fon/Aizo with back-translation, KoboCollect. Analyses: Proportions with Wilson 95%CI, chi-square/Fisher, multivariable logistic regression. Results: Exposure 84.7% (216/255; 95%CI 80.3-89.1): health workers 85.6%, community relays/ASCQ 83.3%, radio 46.8%; Fon 84.7%, Aizo 40.3%, Mina/Dindi/Sahouè 7.4%. WHO coverage: receipt 65.1%, VAP1 55.7%, VAP2 37.9%, VAP3 21.3%; dropout VAP1→VAP3 62.4%. Exposure associated with receipt (17.9% vs 73.6%, p<0.0001) and VAP1 (10.3% vs 63.9%, p<0.0001); aOR=9.60 [3.59-25.69]. Rumors 72.2%, fear of adverse effects 65.0%, lack of information 68.8%; signed contract 13.3%, paid 10.6%. Conclusion: Proximity strategies effective for initiation but insufficient for retention; strengthening appointment reminders, formalizing/paying community actors, innovative channels and systematic briefing needed.
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