From the Community Medicine, Surat Municipal
Institute of Medical Education & Research, Surat, Gujarat, India.
Correspondence to: Dr. Anupam Verma,
Epidemiologist-cum-Lecturer, Department of Community Medicine, Surat
Municipal Institute of Medical Education & Research, Surat, Gujarat,
India.
E-mail:
[email protected]
Manuscript received: September 3, 2003; Initial
review completed: October 20, 2003; Revision accepted: February 9,
2004.
Abstract:
A child aged 26 months could not be vaccinated
initially during pulse polio immunisation due to parental fear of
untoward side effects. Owning responsiblity of child’s welfare,
indepth counselling and involvement of community leaders are crucial
in this regard.
Key words: Oral polio vaccine.
We report of a female child aged 26 months residing
in a slum like area of Surat whose migrant family had refused OPV,
despite repeated counselling. This case was presented to us as a
challenge during the Sub-National Pulse Polio monitoring process.
Initially this family refused to meet us as they
did not wish to receive OPV. We cajoled and persisted with holding a
dialogue irrespective of outcomes. They felt no need for vaccination
as their 5 children had escaped vaccine preventable diseases despite
no vaccinations. Upon entry we persisted with efforts to convince both
of them for vaccination and the fact that this was the only case of
refusal in that area, so their daughter alone was at the peril of
lameness. Would he like to see children playing around and his
daughter limping about? Since we had given this vaccine to all
children, we were concerned that his daughter should not be the sole
victim. We also explained that their children had luckily escaped from
vaccine preventable diseases due to operational health programs,
concept of chances and risk and herd immunity. Our strategy utilised
various psychosocial theories of behavior and behavioral change such
as Risk Perception Models, Fear Arousal, Social Comparison Theories,
etc.(1).
Their refusal and nervousness was based on rumors
that OPV had caused harm among recipients from the area that they had
migrated from there. Their nervousness had convinced them not to get
their children vaccinated. We allayed their fear and owned
responsibility for their child’s welfare. Another reason for their
resentment was poor health services provided to them and they had
retaliated by their refusal. We introduced them to health team of
their area and promised cooperation in future. The family had not seen
or heard of any case of vaccine preventable diseases in their
neighborhood, relatives or any acquaintances. This incident highlights
need for dialogues, persistence and training in behavioral change
communica-tion(2) among health staff while dealing with resistance.
Rude behavior of people could hide their fears, frustrations and anger
as in this case. Similarly, religious leaders and opinion leaders need
to be mobilised. The universal administration of OPV is necessary in
our current eradication drive. Fortunately, this Herculean task is
aided by an excellent Public-Private-Partnership in India. Yet, India
accounts for maximum cases worldwide. Though health authorities report
of over 100 percent coverage of children, monitoring reveals
non-vaccinated children. We need to bring to notice such cases to
health experts and openly deal with such issues.
