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Strengthening routine immunization services and sustainable financing for immunization

Q&A About Immunization - Archives

Question:
What is the association of mother literacy and immunization levels of children under five?

Answer:
Many (but not all) studies, including Demographic and Health Surveys conducted in many countries, have shown a correlation between higher mothers’ education and child immunization; however, more in-depth, qualitative studies indicate that there is NOT a strong causal relationship.  Education may therefore not be one of the more important determinants of immunization coverage. More important factors are: mothers' general belief that immunization is good for her child; trust in the health services and sources of information on vaccination; access to services; the quality, reliability, and friendliness of those services; mothers' ability to take time away from their responsibilities, etc. We DO know from several in-depth studies that low knowledge of vaccine-preventable diseases is not a significant impediment to high coverage, which also implies an indirect, secondary role for education. 

As long as mothers believe and trust the general concept that vaccination will protect their children from some dangerous diseases, they do not HAVE to know precisely which diseases are prevented nor know the details about the diseases or the vaccines themselves.   If services are of good quality and effective in tracking and monitoring children, mothers do not even need to be able to recite the precise immunization schedule.  What mothers do need to know is that multiple visits for vaccination are needed and when and where to bring their child for the next immunization. They also need to have basically positive attitudes and beliefs about immunization and the persons immunizing.

Regardless of parental educational level, it is important for doctors and nurses to have a basic understanding of vaccines and vaccine-preventable diseases.  In communicating with parents who have access to multiple media sources and information resources like the internet, doctors and nurses should provide counseling on the importance and benefits of vaccination and be able to respond to questions and concerns on relative risk of vaccination.

You can find more recent citations in the literature by doing a Medline search.  Some good, older sources are:

  • Heggenhouggen, K. and J. Clements. Acceptability of childhood immunization, social science perspectives: a review and annotated bibliography. London: Evaluation and Planning Center for Health Care, London School of Hygiene and Tropical Medicine, Summer 1987.

  • Pillsbury, B. Immunization: the behavioral issues. Behavioral issues in child survival programs, monograph #3. Prepared for the Office of Health, U.S. Agency for International Development. International Health and Development Associates, December 1989.

  • Streatfield, K. and M. Singarimbun. Social factors affecting use of immunization in Indonesia. Social Science and Medicine 1988; 27(11): 1237-45.

  • Health Access International. Community demand for immunizations. A literature review of opportunities and obstacles in increasing community demand for immunizations. Prepared for Children’s Vaccine Initiative. Cambridge, 20 November 1999.