Causes of low attendance at national immunization days for polio eradication in Bushenyi district, Uganda

The purpose of this study was to investigate the factors influencing attendance for polio National Immunization Days (NIDs) using the Attitudes-Social-influence-self-Efficacy (ASE) model as a guiding theoretical framework. The data was collected in Bushenyi district of south-western Uganda in 6 focus group discussions about outcomes of attendance at NIDs, about who decides on attendance, and about attendance barriers and supports. The purpose of NIDs - eradicating polio - was not known to the informants. The main reason mentioned for attending NIDs and other immunization was to weaken childhood diseases or to strengthen the children's capability in fighting diseases, whether they are immunizable or not. However, it was strongly believed that the previous NIDs had caused a severe malaria epidemic with a very high mortality, and this led to most parents not attending the next. Sources of social influence were mostly opinion and local leaders in communities, health workers, friends and relatives. Opinion leaders who did not immunize their children were said to hinder attendance at NIDs by other lay people. NIDs cards, on the other hand, were regarded as valuable means of support for attendance. Thus to improve immunization coverage, there is need for issuing NIDs cards, for using health education to change the belief that NIDs cause malaria, and to encourage local leaders to attend NIDs.