Redefining immunization: Not just a shot in the arm

The study "Immunization Advocacy: Saving Lives of Africa's Children" was carried out in Benin, Nigeria and Senegal with traditional health practitioners, and other community-based leaders. The study focused on community knowledge, attitudes, and perceptions of immunizations as well as other practices that affect infant wellbeing. The research was divided into two different methodologies: a socio-anthropological study of 710 focus group participants, and individual-based interviews of 5461 people. Traditional healers and community leaders were central to questionnaire development. The final questionnaire used an endogenous definition of immunization that included all of the practices that promote child wellness and prevent illness through the support of the immune system, from biomedically-based vaccination to traditional beliefs and practices. This definition allowed the researchers to explore ways in which traditional health-promoting practices are congruent with biomedical belief systems and ways that they differ. The survey results showed a high general fund of knowledge about vaccine availability and appropriate use but most respondents stated that other kinds of practices were required to reinforce the immune status of children. These included traditional dietary, prenatal, and childbirth practices among others. Respondents described obstacles to community acceptance of vaccinations including practical constraints as well as concerns about adverse effects, incompetent vaccination providers, and systematic non-inclusion of community-based leaders. Policy implications of this work include the necessity of quality control with respect to vaccines and health providers. Even more important, the work highlights the importance of traditional healers and community leaders in health service and vaccine campaign planning.