Community perception regarding childhood vaccinations and its implications for effectiveness: a qualitative study in rural Burkina Faso

Abstract

BackgroundVaccination has contributed to major reductions in global morbidity and mortality, but there remain significant coverage gaps. Better knowledge on the interplay between population and health systems regarding provision of vaccination information and regarding health staff organization during the immunization sessions appears to be important for improvements of vaccination effectiveness.MethodsThe study was conducted in the Nouna Health and Demographic Surveillance System (HDSS) area, rural Burkina Faso, from March to April 2014. We employed a combination of in-depth interviews (n = 29) and focus group discussions (n = 4) including children’s mothers, health workers, godmothers, community health workers and traditional healers. A thematic analysis was performed. All material was transcribed, translated and analyzed using the software ATLAS.ti4.2.ResultsThere was better social mobilization in the rural areas as compared to the urban area. Most mothers know the Expanded Program of Immunization (EPI) target diseases, and the importance to immunize their children. However, the great majority of informants reported that mothers don’t know the vaccination schedule. There is awareness that some children are incompletely vaccinated. Mentioned reasons for that were migration, mothers being busy with their work, the practice of not opening vaccine vials unless a critical number of children are present, poor interaction between women and health workers during immunization sessions, potential adverse events associated with vaccination, geographic inaccessibility during rainy season, and lack of information.ConclusionsWell organized vaccination programs are a key factor to improve child health and there is a clear need to consider community perceptions on program performance. In Burkina Faso, a number of factors have been identified which need attention by the EPI managers for further improvement of program effectiveness.

Barriers to Childhood Immunization in Sub-Saharan Africa: A Systematic Review

“…It was revealed that children from large families have low vaccine uptakes, considering the burden of other children at home in taking up immunization services [11,13,25,46,50]. Migration was also cited as a hindrance to childhood immunization coverage [30,35,44,48]. Feeling ashamed of poverty-associated reasons was reported as barrier.…”

“…Health workers were reported to cover long distances on outreach services due to inadequate health centers [11,13,15,43]. The restricted vaccine opening policy (Use of multi-dose vails and the limited time for their use) was noted as a barrier specifically for the BCG vaccine [18,30,43]. It was also cited that reminders were not sent on time about routine immunization or outreach days [48]…”

Barriers to Childhood Immunization in Sub-Saharan Africa: A Systematic Review

“…Forty-eight articles met all inclusion criteria for this study; 28 articles were excluded for various reasons. [See supplementary materials 3] Nine articles employed second-hand data analysis [7,12,18,27,37,40,41,47,42]; thirty-six used crosssectional design [1][2][3]11,[13][14][15][16][17]19,[21][22][23][24][25][26][28][29][30][31][32][33][34][35][36][38][39]42,[45][46][48][49][50][51]53,54] and three used case-control study [20,[43][44]. All described studies were conducted on Africa populations (103,655 adults and 76,327 children).…”

“…One critically examined barriers speci c to vaccination doses at birth 0 -1day [18] in the Gambia. Thirty articles reported national immunization coverage [1][2]7,[11][12][13][14][15][16][20][21][22][23][24][25][28][29]32,[34][35][38][39][40][43][44][45][46]49,50,[52][53][54], eighteen did not [3,[17][18][19]22,24,[26][27][30][31]33,[36][37][41][42]47,48,…”

“…But it was noted with strong emphasis that women were in charge of taking children for immunization and sometimes the husbands opposed immunization and stopped their wives from immunizing their children by denying them the social and nancial support necessary [3,16,17,22,33,38]. The nature of occupation of the mother/caretaker was reported as a major determinant to childhood immunization [1,11,14,15,[21][22]25,30]. Housewives were reported to have complied with higher coverage of full immunization status than other occupations such as merchants or public/private employees [11].…”