Perceptions of childhood immunisations in rural Transkei--a qualitative study.

OBJECTIVES To examine perceptions of childhood illnesses, and the role of immunisation in preventing them, among caretakers of young children in Mhlakulo, a rural community in Transkei, Eastern Cape, and to suggest reasons for the low uptake of immunisations in that area. DESIGN In-depth qualitative research using semi-structured questionnaires, focus groups, and free listing. METHODS Detailed interviews were conducted using standardised semi-structured questionnaires. Interviews involved 60 caretakers of children aged under 5 years brought to a community health centre. Interviews were followed by two focus groups and free listing interviews to validate results of these questionnaires. RESULTS There was widespread acceptance of the value of immunisations in preventing childhood illnesses, but only vague knowledge of why they are given, and for what illnesses. The most common knowledge was of measles and polio, but there was only limited knowledge of BCG, DPT and other immunisations. Childhood illnesses were seen as multi-causal in origin, but there was a marked absence of germ theory in explaining them. Attitudes to the use of traditional medicines in childhood were generally negative. CONCLUSIONS Despite positive perception of immunisations, there is widespread ignorance of what they are for, and how they work. This suggests the need for increased health education, more community participation, and organisational changes in primary care clinics to make them more user-friendly to caretakers of infants and young children.