- from Combatting Antivaccination Rumours: Lessons Learned from Case Studies in East Africa

Effect of Rumours on Routine EPI

NIDs coverage in Uganda has been successful, and most of the districts were positive about NIDs. But some of the people interviewed for the 1998 KAP study expressed concerns that NIDs affected routine immunisation because mothers were tending to wait for NIDs and forgetting routine immunisation. “The first round of NIDs affected immunisation. People thought they had finished all immunisation.” [9]

Although there was uncertainty among participants in FGDs at the sub-county level about whether routine immunisation was declining, many were uninformed.

Others interviewed for the KAP study offered the following reasons as possibilities for the decline in routine immunisation:

• Family planning has reduced the number of children born (therefore the projected number of children to be vaccinated has dropped)
• AIDS has caused a decline in the number of mothers and children.
• Long distances make it difficult for mothers to come; they are tired.[10]
• Morale is poor among health workers.
• The masses lack understanding about routine immunisation.
• There is mistrust of health workers.
• There are rumours and fears about mass polio immunisation.
• Expired drugs breed mistrust of the health services in general.

Most striking from the KAP study, however, among those interviewed – including women and men with children three to 20 months old, youth, opinion leaders and others – is the lack of understanding about the differences between routine immunisation and the mass polio campaigns. The study notes that opinion leaders could have easily advised parents that there was no need for subsequent immunisations after the NIDs.[11]

For the purpose of this study on rumours, figures for four routine antigens in the districts thought to be most influenced by Greater Afrikan Radio are given in the following tables. These figures were taken from data provided by UNEPI.

Source: UNEPI

The decline in routine immunisation in Bushenyi District appears to have started in 1997.

Source: UNEPI

The decline in routine immunisation in Mbarara District appears to have started in 1998.

Note: Ntungamo District was created in 1993.

Source: UNEPI

The decline in routine immunisation appears to have started in Ntungamo District in 1998.

It has been reported that EPI was low before NIDs. It seems that a number of factors account for poor routine coverage. Kihura Nkuba's broadcasts have most likely had some negative impact when combined with already existing fears created by the deaths from malaria right after children received OPV in 1997. But most important, mothers and fathers never got the information they needed following those deaths.

In addition, Dr. Grabowsky pointed out that while much effort is given to raising coverage, the "other side" controls the message because there is not informed consent and mothers are not prepared to handle adverse effects. In other words, the lack of information for parents creates fertile ground for the opposition to create rumours and confusion. One of the fathers interviewed said that if he gets conflicting information, he takes a wait and see attitude.

Mr. Paul Kagwa, in an interview at the Ministry of Health, concluded that NIDs have helped officials to understand what is going on in villages and the importance of communication. Now, he says, is an opportunity to broaden alliances, form relationships with the media, and raise awareness.

But what is the most effective way to fight rumours, or, better, what is the most effective tool for stopping rumours from getting started? Give the people the right information, give the people all of the information, and trust the people to make the best choices for their children.

The best method for getting good coverage is social mobilisation -- ongoing. Don't ever stop.

11 KAP Study Report on Immunisation Services in Uganda. 1998. Health Management Consult Uganda funded by UNICEF. P. 85.