Redefining Immunization: Not Just a Shot in the Arm

The persistence and periodic resurgence of vaccine-preventable diseases have raised questions about the determinants of poor immunization coverage. In Sub-Saharan Africa, traditional health practitioners (THPs) play a major role in providing health care and health education, particularly in rural areas where Western health care is unavailable. The project, Immunization Advocacy: Saving Lives of Africa’s Children, funded by the Bill and Melinda Gates Foundation, was carried out in three countries, Benin, Nigeria, and Senegal, with THPs and other community-based leaders to gain insight into their basic knowledge, attitudes, and perceptions about immunization. In this article, the authors present the results from the Senegal study. In Senegal, 696 THPs involved in community culture, rites, education, and health were surveyed. THPs and community leaders were centrally involved in defining the term immunization during survey development, and their definition was integrated into the survey questionnaire. Results of the study in Senegal show that although knowledge about vaccination is high among THPs, their perceptions of vaccines may hinder the acceptance of vaccines in their communities. THPs define immunization as a comprehensive program of health promotion and provision that includes attention to traditional beliefs and behaviors, overall access to health care and, potentially, vaccination. Effective educational programs that involve THPs in vaccine campaigns from inception, that address their perceptions and integrate their cultural belief systems into vaccine advocacy programs in a culture-centered manner, and that recognize and respect the importance of comprehensive primary health care will be necessary to improve essential vaccine coverage in this population.