Perceptions of childhood diseases and attitudes towards immunization among slum dwellers, Dhaka, Bangladesh

This study describes the knowledge and attitudes of 80 mothers living in the Dhaka slums of Rayer Bazar and Hazaribagh regarding six immuno-preventable diseases -- tetanus, measles, poliomyelitis, whooping cough, diphtheria, and tuberculosis -- and the use of vaccinations to combat them. Of these women"s 90 children, 56.6% had received no immunization, while 27.7% had been partially immunized, and only 14.4% had been fully immunized. The study shows that the symptoms of measles, tetanus, and tuberculosis are well-known, while those for diphtheria, whooping cough, and polio are not. Even in the former cases, traditional remedies are often preferred to vaccination. Many mothers do not understand how a vaccine works inside the body, and fears provoked by this lack of knowledge, compounded by an intimidating health care bureaucracy, are major disincentives to immunization. Among those who did have their children immunized, the prestige associated with allopathy was a primary incentive. Educational efforts are severely constrained by the lack of radios and televisions and the high illiteracy rate among women (86%). Most mothers reported hearing about immunization services through clinics and female friends and relatives. Although decisions on immunization are usually the responsibility of the mother, fathers in more economically secure families tend to take a greater interest in health intervention. However, some of these men object to vaccinations, arguing that it is unnecessary, since they can afford medical care if the child becomes ill. Recommendations are presented for improved targeting of slum dwellers for immunization services.