VIEWS OF ZULUS AND SOUTHERN SOTHOS ON IMMUNISATION ALWYN

The promotion of good health and the prevention of disease are two of the aims of community health care that can, to a large extent be realis­ ed by means of immunisation. Im­ munisation does not only make it possible to control the spread of a number of infectious diseases, but also enhances the overall health status of a community. In a report from the United Nations International Childrens’ Emergency Fund, it is pointed out that . . . immunisation o f all chil­ dren against the major diseases would also be an indirect immuniza­ tion against malnutrition itself. Any increase in protection against malnu­ trition would, in its turn, reduce the risk o f infection. A malnourished child who contracts measles, for example, is approximately 400 times more likely to die o f the disease than a child who is adequately fed.* In order to enhance the general state of heatlh of a community, it is furthermore necessary to introduce health guidance programmes by means of which encouragement can be given for the development of a sense of responsibility in order to obtain active participation in health OPSOMMING


INTRODUCTION AND AIM
The promotion of good health and the prevention of disease are two of the aims of community health care that can, to a large extent be realis ed by means of immunisation.Im munisation does not only make it possible to control the spread of a number of infectious diseases, but also enhances the overall health status of a community.
In a report from the United Nations International Childrens' Emergency Fund, it is pointed out that . . .immunisation o f all chil dren against the major diseases would also be an indirect immuniza tion against malnutrition itself.A ny increase in protection against malnu trition would, in its turn, reduce the risk o f infection.A malnourished child who contracts measles, fo r example, is approximately 400 times more likely to die o f the disease than a child who is adequately fed.* In order to enhance the general state of heatlh of a community, it is furthermore necessary to introduce health guidance programmes by means of which encouragement can be given for the development of a sense of responsibility in order to obtain active participation in health care.However, guidance can only best be given if the counsellor keeps abreast of the views of a community on specific health matters.

OPSOMMING
Against this background the Human Sciences Research Council and the Departm ent of Health and Welfare, as a part of an extensive project, conducted an investigation into the views of inter alia urban and rural Zulus and Southern Sothos with regard to health m at ters.2,3

SAMPLES AND DATA COLLECTION
The project was carried out among urban and rural Zulu and Southern Sotho men and women between the ages of 15 and 64.The urban re search areas were Soweto, Durban and Bloemfontein, whereas Balfour/Standerton, Bergville and Dewetsdorp were included in the rural investigation.
In order to compose representa tive samples in the research areas involved, the names of a number of street blocks (urban) and farms (rural) were drawn at random.A number of residential units were next drawn from the selected areas, and only one person per residential unit was eventually selected in a random manner.The composition of the samples, subdivided accord ing to research area, age and sex is explained in Table 1.The data was obtained by means of a questionnaire that had been translated into Zulu and Southern Sotho.The questionnaires were completed by Black fieldworkers during interviews with the questionees (respondents).Before the in vestigation was launched, the ques tionnaire was tested by means of a preliminary investigation and the fieldworkers concerned were prop erly trained in the technique of in terviewing people.

FINDINGS
The findings of the investigation into the views of Zulus and South ern Sothos with regard to immuni sation can be summarised as fol lows:

Awareness of immunisation
In order to determine the aware ness of the respondents with regard to immunisation, it had first to be ascertained whether they had ever before heard of immunisation.The following percentage of respon dents in the respective urban reseach areas indicated that they had h eard of im m u n isatio n : Z ulus (Soweto): 95; Zulus (Durban): 80; Southern Sothos (Soweto): 74 and Southern Sothos (Bloemfontein): 96.From these figures it can be de ducted that the majority of the urban Zulus and Southern Sothos were in fact aware of immunisation.
Those who claimed to know what immunisation was, were asked a number of additional questions on immunisation, such as the age at which a child should receive the first immunisation and the diseases against which people could be im munised.

Immunisation
When asked why children had to be immunised, the majority of both the urban (81 to 94 % ) and rural (56 to 92 %) respondents who had been aware of immunisation were of the opinion that the aim of immunisa tion was to prevent disease.Less than a third of the respondents in the different research areas referred specifically to the prevention of in fectious diseases.

First immunisation
Respondents were also questioned on the age at which a child should be immunised for the first time.Ac cording to the D epartm ent of Health and W elfare a child should be immunised against as many of the common infectious diseases as possible during the first year of his life.It is desirable to have adminis tered the first dose of the majority of these immunisations by the age of three months.For example, B.C .G .can be administered shortly after birth, whereas the first dose of D .P.T. and poliomyelitis vaccine should be administered at the age of three m onths.1 According to the vast majority (between 83 and 95 %) of the urban respondents, a child should be im munised for the first time within the first three months after birth.As far as the rural research areas were concerned, only between 3 and 27 % of the respondents held a similar view.

Diseases against which people can be immunised
Those respondents who intimated that they had heard of immunisa tion were also asked to indicate in respect of a num ber of questions whether a child could be immunised against these diseases or not.Of the infectious diseases against which immunisation is available, the fol lowing were selected for this pur pose: measles, rubella (German measles) and mumps.Chickenpox and gastro-enteritis were also in cluded.
There were alarmingly few re spondents who provided the correct answers in the case of each of these five diseases.In the urban research areas four repondents indicated five correct answers, whereas only one respondent from the rural areas managed to give the correct ans wers in the case of all five diseases.It appeared as if correct answers were particularly obtained with regard to three diseases, namely m e a s le s , r u b e l l a a n d m u m p s , whereas answers provided regard ing the immunisation against chick enpox and gastro-enteritis were mostly incorrect.
Details of the percentage of re spondents who answered correctly are displayed in Figure 1.

Herbalist
Finally respondents were also asked whether a herbalist was able to pro tect one against diseases with the help of his medicines.Between 8 % (Zulus: Soweto) and 22 % (South ern Sothos: Soweto) of the urban respondents answered this question in the affirmative.Regarding the rural areas concerned, between 21 % (Southern Sothos: Dewetsdorp) and 55 % (Zulus: Balfour/ Standerton) were of a similar opinion.

FACTORS THAT MIGHT PROBABLY HAVE AFFECTED THE RESPONSES
In processing the data a statistical m ethod -the logit model of the loglinear technique of analysiswas used to determ ine whether the age, sex and educational level of the respondents had any effect on the answers (responses).The process ing of these data was done sepa rately in the urban and rural re search areas.Because of statistical considerations the effect of educa tional level could not be checked in the rural areas of investigation.Furtherm ore, attention was paid to the role of ethnicity in the responses of both the urban and rural respon dents.It was however, found that neither of these two factors had any effect on the answers of the respon dents.

CONCLUSION
Despite the fact that the majority (50 % and m ore) of the respon dents in the various research areas were aware of immunisation and were of the opinion that immunisa tion was used to prevent disease, relatively many of these persons were unable to distinguish between those diseases against which chil dren can be protected by means of immunisation and those diseases for which immunisation cannot be ad ministered.It also became evident that rural respondents in particular were not aware of the necessity of early immunisation.

BOOK REVIEWS BOEKRESENSIES
Breastfeeding -how to succeed Questions and answers for mothers DEREK LLEWELLYN-JONES (OBE, MD, MAO, FRCOG, FRACOG)

Faber and Faber, 1983
The author has made an admirable move by consulting with experienced breastfeeders, namely the highly rep utable organisation Nursing Mothers of Australia Asso ciation.
The chapter Preparing fo r breastfeeding is particu larly well-done.The illustrations are excellent.It would be advantageous for nursing staff to study this chapter.
Questions that breastfeeding mothers ask makes in teresting reading.The author makes a very valid state ment in this section regarding test-weighing: is a meddle some, unscientific procedure, which may cause unneces sary concern to the mother.It tends to make the mother anxious and so reduce the efficiency o f the let down reflex.

I
feel the author puts unnecessary emphasis on the use of gadgets and formula.I feel very uncomfortable when complimentary feeds are mentioned in a breast feeding book.Experience indicates that those are greatly abused and can lead to lactation failure.
Otherwise the author gives a well-balanced accurate guide to breastfeeding.He certainly provides the for mula for success.

I
would recommend the book to midwives, com munity health nurses, paediatric nurses and medical students.

Figure
Figure 1 Percentage of respondents who answered correctly