The social shaping of childhood vaccination practice in rural and urban Gambia

Abstract

Improving childhood vaccination coverage is a key health policy objective in Africa, and as availability increases, it will depend on addressing issues of demand and timely schedule completion. This paper explores vaccination demand in urban and rural areas of The Gambia as shaped by prevailing local vaccination cultures (comprising maternal knowledge and understandings, socio-cultural contexts and interactions with health providers). A survey of 1,600 mothers constructed on the basis of prior ethnography finds a high level of social demand for vaccination, based on lay theories of the general value of immunization in complementing traditional child protection practices. For most rural mothers, strong social networks encourage routine clinic attendance and vaccination 'default' arises only through day-to-day problems and contingencies. However, more pervasive patterns of schedule non-completion are found amongst poorer urban mothers, including recent immigrants, who experience social exclusion at infant welfare clinics. These findings point to the need for health education dialogue grounded in mothers' own understandings and for particular policy attention to improving the clinic experiences of vulnerable social groups in rapidly expanding urban areas.

Do maternal knowledge and attitudes towards childhood immunizations in rural Uganda correlate with complete childhood vaccination?

“…Variables such as parental education [4,[17][18][19][20][21][22][23], mothers' age [18,19], household income or wealth [4,11,17,19,22,24], family size or mothers' parity [4,[17][18][19], religion of caregivers [25,26], and location of labor and delivery [23] are well documented as correlates with the vaccination status of a child. We are only aware of four published studies conducted in SSA in the past 15 years that assessed KATCI [18,[27][28][29]. Only one of these studies analyzed how maternal attitudes towards immunizations correlate with the vaccination status of a child by undergoing a limited bivariate analysis of mother's negative attitudes towards local healthcare facilities providing vaccinations and child's measles vaccination status [18].…”

Sociocultural Determinants of Anticipated Vaccine Acceptance for Acute Watery Diarrhea in Early Childhood in Katanga Province, Democratic Republic of Congo

“…A study in the Gambia equally suggests that witchcraft beliefs are not necessarily competing with vaccination campaigns. 31 Prevailing gender inequality may offer an explanation for this paradox. In many societies, women tend to be blamed for their children's illness.…”

“…27 In low-income countries, fears are also linked to suspicion that vaccines are sometimes expired and may then become dangerous for a child. 28 Costs and accessibility problems are other important barriers to vaccination in low-income settings, [29][30][31][32][33] and gender inequality plays a major role in health-related decisionmaking. 34,35 A low maternal education also negatively influences immunization status of children.…”

Investigating the Important Correlates of Maternal Education and Childhood Malaria Infections

“…[1][2][3][4] Findings from these studies have played key roles in informing policy discourses, especially those relating to investment in education and health. 5,6 The potential societal benefits realized by investing in women's education are best described through the indirect benefits that educated mothers enjoy as the socioeconomic status of their household improves.…”

“…A study from Gambia reported that peer influence among mothers in rural areas was important in their use of antenatal care services. 3 Maternal education has the potential to help mothers organize themselves and advocate for their children's health including voicing support for various malaria control programs like subsidize or free ITNs. In rural Tanzania, social marketing was, at one time, a bedrock strategy for bed-net distribution.…”