Vaccinations : mothers require motivation / Dominique Tuka-Mbiasi

24 World Health • September-october 1992 Vaccinations: mothers require • • moi1Val10n Dominique Tuka-Mbiasi Three-quarters of mothers do not bring their children to all the vaccination sessions. How con mothers be motivated and mobilized? D espite the efforts of the health services in za·ire, immunization coverage leaves much to be desired even today, owing to lack of interest shown by mothers in vaccination sessions. Because of this, nurse educators began a study in February 1991 which has already started to bear fruit. The investigators analysed the records of 2820 children and, in an area of Kinshasa served by eight health centres, they found 1362 unmotivated mothers without means of transport, i.e., 48% of all mothers . The study showed that all the mothers have adequate knowledge of the six diseases preventable by immunization and that 58% of them understand the purpose of vaccination, but about three-quarters of them do not bring their children to all the vaccination sessions. Among the reasons given were lack of time, no money to pay for transport, too much work, bad weather and illness; thus, the substantial resources devoted to education (through songs, pictures, radio and television) have not yet succeeded in motivating the mothers sufficiently. There is therefore a need to look for deeper causes, particularly sociocultural factors in za·irean society. Many people believe that diseases - even infectious ones - are caused by witchcraft or spells, infidelity, the wrath of ancestors, sins, Vaccination in Kenya. Half the battle is to motivate the mothers. disobedience to God and divine punishment. Such beliefs may reduce confidence in health activities such as vaccination, and matters are made worse by the difficult socioeconomic situation of a great number of these mothers, who tend to concentrate on survival activities such as trading, to the detriment of their children's and their own health, but usually with no other choice. Under these circumstances, how can mothers be motivated and mobilized to attend vaccination sessions? As a result of our contacts with the mothers during the survey, we can suggest three specific approaches. • For example, 79% of the women asked for an incentive bonus. We noticed during the survey that women who had been given pictures about vaccination or diarrhoea showed more confidence and regarded these pictures as a "certificate of encouragement". • A second approach would be to make more visits and hold vaccination sessions nearer their homes. This proposal, made by 54% of the women questioned, calls for logistic and financial resources. The mobile health teams could be strengthened so as to perform vaccinations in schools, markets and other community meeting-places. • A third idea would be to incorporate a spiritual dimension in health education programmes. This would help to remove barriers created by the psychospiritual factors listed above and to tap the spiritual resources of the mothers, making them receptive to health activities and motivating them to accept the necessary changes. • Mr Dominique Tuka-Mbiasi is Academic Secretary and Assistant Lecturer in Professional Practice at the Higher Institute of Medical Techniques , BP 77 4 , Kinshasa XI, Zaire.