Base-line Survey: COMBI-Immunization Plan for Georgia

Prepared for the United Nations Children's Fund (UNICEF), this report shares findings from a baseline survey carried out as part of the communication-for-behavioural impact (COMBI) plan for immunisation in Georgia.

Both qualitative and quantitative research was carried out. As part of the latter, a census (establishing the proportion of children aged 6-18 months) was completed, followed by interviews carried out, first, in 8 regions of Georgia, and then in the Samtskhe-Javakheti and Kvemo Kartli regions.

Main findings:

• The level of awareness of parents related to vaccinations against controlled infections (e.g., measles, rubella, mumps, whooping cough, hepatitis B, tetanus, tuberculosis, polio) is rather low. Even in cases when mothers regularly vaccinate their children, they often do not know against which disease the child is vaccinated. And the mothers who are reluctant to vaccinate their children do not acknowledge the severity of the disease; they consider it better to refrain from vaccination due to the fact that they believe that the probability of catching the infectious disease and consequent complication is much less than the post-vaccination complications. The parents are informed about the complications of vaccinations, but they are not aware of the outcomes / consequences of the disease.
• The attitudes of parents towards the safety of vaccination are dissimilar. Despite the fact that vaccination can cause undesirable reactions (swelling of the puncture, fever, weakness), the mothers who regularly vaccinate their children consider that it is better for a child to undergo a complication for few days than to increase the probability of catching the disease. As for the mothers who refuse to vaccinate, they say that one of the main reasons for their refusal is post-vaccination complications; they worry that vaccination might pose a threat to the health of a child. There is a significant circumstance that the mother and, in some cases, doctors think that vaccines produced in India are dangerous.
• The results of the research indicate that attitudes toward immunisation and regular vaccination for children are linked to the level of education of parents: Families with higher levels of education were found to pay more attention to their relationships with doctors and the doctors' qualifications, and they sought more information about medical issues and visited various doctors for consultations. Those who did seek various consultations were found to be influenced by information provided by these various doctors. Because there are various opinions even among doctors related to the need of vaccination, quality of vaccines, and the country of origin, these parents were found to get confused and find it difficult to make a decision on whether to have a child vaccinated or not. On the other hand, per information of the district doctors, the families whose economic and educational level is relatively high are attentive and organised. The second tendency refers to the families with a relatively low level of education. On one hand, it is easy for the doctors to have a relationship with such families if they have trust in medical sectors; in that case, the trust level in paediatricians is high and, consequently, they take the doctor's consultations about immunisation into consideration. On the other hand, the families with a relatively low level of education are found to be under the influence of the older generation. The research results suggest that the older generation has, relatively speaking, a negative attitude towards vaccination, due to the fact that there were many accidents related to vaccination years ago. Consequently, the fear of complications resulted from vaccination represents one of the most important factors for the reluctance to have children vaccinated.
• "...[A]ttitudes towards immunisation are influenced by the distrust that exists in general towards the medical sector. The negative events that were recently highlighted by the mass media related to the accidents caused by the mistakes of doctors cause quite a negative effect. The distrust towards doctors is exacerbated by the undesirable facts that are related to the post-vaccination complications. Despite [the fact that] such examples are quite rare and are mainly related to the periods in the past, the mothers of newborns think that they are related to risk factors, thus such cases represent one of the factors of reluctance towards immunization."
• For families living in Tbilisi and for residents of districts who are in closer touch with Tbilisi (mainly Marneuli), the country of origin and the quality of vaccines are the things that weigh heavily. There are cases, mostly at Tbilisi polyclinics or private clinics, when mothers are offered French vaccines (not free of charge, but of high quality) and Indian vaccines (imported by the State, but of low quality), which cause some parents to worry that free Indian vaccines are of low quality and are dangerous to the health of a child. This doubt is often confirmed by the doctors themselves who suggest French vaccines. The distrust towards district doctors and Indian vaccines is especially strong in Marneuli.
• In many cases, doctors, and especially neuropathologists, contribute to the reluctance of parents to have children vaccinated. Even in cases when the doctors say that there is no adverse effect of non-vaccination for the child, often the neuropathologists suggest that mothers refrain from vaccination and avoid possible complications.