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A Qualitative Analysis of Vaccine Safety Perceptions and Concerns Among Caretakers in Uganda

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Abstract

Parents and caretakers of young children often have concerns about vaccine safety and adverse events following immunization (AEFI). Little is known about vaccine safety perceptions in Uganda and their influence on parental decision-making about infant immunization. The study objectives were: to identify community sources of information on immunization, vaccine safety and AEFI; determine caretakers’ knowledge of immunization; identify community concerns/fears about immunization and AEFI and their influence on caretakers’ decisions to vaccinate; and obtain an understanding of knowledge, perceptions, and experience of health care workers (HCWs) and policy administrators on vaccine safety and AEFI. Twelve focus group discussions with 136 caretakers who were very or somewhat concerned about vaccine safety and 25 key informant interviews were conducted in two districts (1 urban and 1 rural) with district authorities and health facility staff as well as national level decision-makers between December and April 2006. Content analysis was used to analyze the results. The main themes identified related to general lack of information among caretakers about immunization, perceived immunization benefits, immunization concerns, and misconceptions. Specific caretaker concerns related to vaccine administration, immunization services and vaccine safety. Experiences with AEFI and concerns about vaccine safety negatively affected caretakers’ decisions to vaccinate their children, notably in rural areas. HCWs demonstrated knowledge about AEFI and their management although incidences reported to facilities were rare. Inadequate communication between HCWs and caretakers was noted. Concerns and misconceptions about vaccination still exist among caretakers in Uganda and influence decisions to vaccinate. Effective inter personal communication initiated by HCWs towards caretakers is needed.

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Notes

  1. Sub national administrative level with approximately 500,000 population.

  2. Sub district administrative level with approximately 10,000 population.

  3. Sub county administrative level with approximately 5,000 population.

  4. Informants included the National EPI Manager and selected EPI staff, Senior MoH Officials, District Directors of Health, Heads of health facilities, health workers and Village leaders.

  5. The term is commonly inappropriately used to refer to the redness and swelling at the injection site following BCG vaccination.

    .

  6. Specific batches of BCG vaccine in 1990 caused abscesses and lymph node swellings in a large number of children. 361 children were investigated. A joint WHO and UNICEF investigation team concluded that the vaccine was highly concentrated leading to the adverse events observed. Similar incidents were reported in Namibia and South Africa. The vaccine was withdrawn from all districts and an explanation of the incident was given to all districts by the Ministry of Health. There were no associated deaths however the incident affected turn out for subsequent immunization sessions.

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Acknowledgments

This study was funded by the World Health Organization with technical support from CDC. We thank Dina Pfeifer for her assistance in coordinating the International Vaccine Safety Project (IVSP), as well as Monic Bazibu (MoH), Annet Kisakye (WHO/UNEPI) and Bob Chen (CDC). We extend our gratitude to the team of interviewers for their work in data collection and to the participants for their insights.

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Authors and Affiliations

  1. World Health Organization, Uganda Country Office, Kampala, Uganda

    Fiona Braka & Rosamund F. Lewis

  2. Makerere University Institute of Social Research, Kampala, Uganda

    Delius Asiimwe

  3. Centers for Disease Control and Prevention, Atlanta, GA, USA

    Fatma Soud & Deborah Gust

  4. Ministry of Health, Kampala, Uganda

    Issa Makumbi

  5. World Health Organization, P.O. Box 3069, AddisAbaba, Ethiopia

    Fiona Braka

Authors
  1. Fiona Braka
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  2. Delius Asiimwe
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  3. Fatma Soud
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  4. Rosamund F. Lewis
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  5. Issa Makumbi
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  6. Deborah Gust
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Correspondence to Fiona Braka.

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Braka, F., Asiimwe, D., Soud, F. et al. A Qualitative Analysis of Vaccine Safety Perceptions and Concerns Among Caretakers in Uganda. Matern Child Health J 16, 1045–1052 (2012). https://doi.org/10.1007/s10995-011-0826-5

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