Epidemiology and Infection

Gastrointestinal infection and helicobacter

Community perceptions of bloody diarrhoea in an urban slum in South Asia: implications for introduction of a Shigella vaccine

W. ARVELOa1 c1, L. S. BLUMa2, N. NAHARa2, L. VON SEIDLEINa3, L. NAHARa2, R. P. PACKa4, A. W. BROOKSa2, A. PACHa3, R. F. BREIMANa1, S. P. LUBYa1 and P. K. RAMa1a5

a1 Centers for Disease Control and Prevention, Atlanta, GA, USA

a2 ICDDR,B: International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh

a3 International Vaccine Institute, Seoul, Republic of South Korea

a4 East Tennessee State University, College of Public Health, TN, USA

a5 University at Buffalo, Buffalo, USA


Understanding local perceptions of disease causation could help public health officials improve strategies to prevent bloody diarrhoea. A cross-sectional survey was conducted in Dhaka, Bangladesh to elicit community beliefs about the causes of and prevention strategies for bloody diarrhoea. Between March and June 2003, we interviewed 541 randomly selected respondents. Overall, 507 (93%) respondents perceived that a vaccine could prevent bloody diarrhoea. If a vaccine provided lifetime protection, 445 (83%) respondents stated that they would opt to get the vaccine and would pay a median of $0·05 (range U.S.$0·01–0·15) for it, equivalent to <1% of their median weekly income. There was almost universal perception that an effective vaccine to prevent bloody diarrhoea was highly beneficial and acceptable. While respondents valued a vaccine for prevention of bloody diarrhoea, they were only willing to pay minimally for it. Therefore, achieving a high rate of Shigella vaccine coverage may require subsidy of vaccine purchase.

(Accepted May 20 2010)

(Online publication June 14 2010)


c1 Author for correspondence: W. Arvelo, M.D., M.Sc., Centers for Disease Control and Prevention, Unit 3190, Box 150, DPO, AA, 34024, Atlanta, GA, USA. (Email: warvelo@gt.cdc.gov)