The Pan African Medical Journal
The African Field Epidemiology Network
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Impact on refusal rates of house visits by Red Cross volunteers in Benin
Volume: 35, Issue: Suppl 1
DOI 10.11604/pamj.supp.2020.35.1.20885
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Aholoukpe and Davis: Impact on refusal rates of house visits by Red Cross volunteers in Benin

To the editors of the Pan African Medical Journal

The Republic of Benin, and its partners, pursue a two-pronged approach to measles vaccination, both through routine immunization from public and private health facilities, and through periodic mass campaigns, typically targeting 9- to 59-month-olds. During the mass campaigns, social mobilization is done both through conventional mass media approaches (TV, radio, newspapers) and, in selected areas, through house to house social mobilization by Benin Red Cross volunteers.

In Benin, measles control had seen good levels of incidence reduction since the catch-up and follow-up campaigns of 2001, 2003, 2005, 2008, 2011 and 2014. The World Health Organization recommends that countries already engaged in accelerated measles control extend their activities to the problems of rubella and congenital rubella syndrome. It is within this framework that Benin undertook in 2019 a mass campaign against measles and rubella, with the objective of protecting all children from 9 months to 14 years of age against both diseases, with post-campaign introduction of the Measles-Rubella (MR) vaccine into the routine immunization schedule.

There were 5,142,466 children targeted by this campaign. In addition to vaccines, 1.8 million children aged 9 months to 5 years of age were targeted for vitamin A supplementation. The major funders of this campaign were the government of Benin, the GAVI Alliance, the UN Childrens Fund (UNICEF), the World Health Organization, and the American Red Cross.

In its role as an auxiliary to the public authorities, Benin Red Cross (BRC) has in recent years committed itself to social mobilization during measles campaigns, targeting in 2019 the high risk communities in Cotonou (the economic capital of Benin) and communities in Abomey-Calavi, Allada, Djougou, Kpomassé, Porto-Novo, Semé-Podji, So-Ava, Tchaourou, Toffo, and Zé. Starting before the 2019 campaign, which lasted from 6 through 11 March, Red Cross volunteers did house to house social mobilization from 2 through 11 March in the areas listed in the table.

It should be noted that the key to success in convincing the refusals was the strong collaboration of the Benin Red Cross with health actors and local elected representatives in the communities. The latter spared no effort to reassure their community of the relevance of vaccination. This mixing between health actors, politico-administrative authorities and Red Cross actors was due to the daily participation of the BRC in daily wrap-up meetings within the Ministry of Health where joint actions were decided according to the refusals notified (Table 1).

Table 1
Initial refusers and acceptors among Benin caregivers, 2019 measles/rubella campaign
RegionTotal households visitedTotal children in the age rangeTotal initial refusersTotal final refusers
Abomey-Calavi22,50851,172670
Allada16,98240,5173571
Cotonou90,769190,99945025
Djougou21,39055,64144
Kpomassé10,43622,754280
Porto-Novo43,09295,3928424
Semé-Podji35,25983202260
So-Ava11,61931,8621120
Tchaourou21,03351,6614949
Toffo15,12332,888160
14,51433,555269
Totals299,725689,643862111

Source: Social Mobilization in the Framework of the National Measles/Rubella Vaccination Campaign for Children aged 9 Months to 14 Years, with Vitamin A Supplementation for Children aged 9 Months to 5 Years” (Unpublished report, Benin Red Cross, 2019, in French). NB: in the commune of Djougou, there was one ethnic group which, for religious reasons, was categorically opposed to vaccination despite the intervention of health actors and local elected officials. In Tchaourou, the other outlier, the EPI worker in the locality assured us that the cases of refusals were mastered by the end of the campaign with the help of opinion leaders.”

Reasons for initial refusals

When caregivers were asked to explain why they did not initially intend to vaccinate their children, the reasons most often cited by initial refusers were (in descending order) fear of side effects, distance to the vaccination site, mother´s other activities, family problem or maternal illness, ignorance of hours and location of sites, illness of the child, inconvenient clinic hours, absence of the child, and long waiting times at the sites. Taken as a whole, 87 percent of the initial 862 refusers became accepters after revisits by Red Cross volunteers, sometimes accompanied by community leaders. This underlines the difference between “soft refusers” and “hard refusers.”

Conclusion

In Benin, as elsewhere, the historic decline in morbidity and mortality from measles and other childhood diseases has been associated with vaccine hesitancy among a minority of parents [1]. Such reluctance can, at least in some contexts, be overcome by interpersonal communication with trusted members of the community, such as Red Cross volunteers.

Competing interests

The authors declare no competing interests.

Authors’ contributions

All authors have read and agreed to the final manuscript.

Reference

1 

    Ratzan SC, Bloom BR, El-Mohandes A, Fielding J, Gostin LO, Hodge JG, . The Salzburg statement on vaccination acceptance. J Health Comm 2019. 24: 5, pp.581-583
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