title: Association between maternal use of traditional healer services and child vaccination coverage in Pont-Sonde, Haiti.
abstract: BACKGROUND
  Child vaccination is one of the public health interventions that are responsible for the relatively low child morbidity and mortality in developed nations compared to the developing world. We carried out this study to examine the association between mothers' use of traditional healer services and vaccination among Haitian children. Our hypothesis was that children whose mothers used the services of traditional healers were less likely to be vaccinated compared to children whose mothers did not use the services of traditional healers.
  
  
  METHODS
  A two-stage stratified sampling method was used to select 720 mothers from the population of Pont-Sonde, Haiti. Of these mothers, 691 (96%) completed the survey by responding to a standardized questionnaire on vaccination giving unadjusted odds ratios (OR) and adjusted odds ratios (AOR) and 95% confidence intervals (CI) and use of traditional healers. Bivariate and multivariate logistic regression analyses were performed to estimate the effect of explanatory variables on vaccination (the main outcome).
  
  
  RESULTS
  Mother's use of traditional healer services was negatively associated with vaccination after controlling for maternal age, education, religion, and distance from the nearest health care facility. For those children whose mothers often or always used the services of traditional healers, we found a 53% decrease in the odds of vaccination (AOR = 0.47; 95% CI [0.27, 0.83]) compared against children whose mothers never used the services of the traditional healers. There were negative associations between practice of Vodou and vaccination (AOR = 0.56; 95% CI [0.35, 0.92]), and distance from the nearest health care service facility and vaccination (AOR = 0.53; 95% CI [0.29, 0.97] and AOR = 0.34; 95% CI [0.20, 0.59] at 46-60 and more than 60 minutes walk time, respectively).
  
  
  CONCLUSIONS
  We found that mother's use of traditional healer services was negatively associated with vaccination of Haitian children. Findings from this study underscore the potential to enlist the support of traditional healers in promoting child health by educating, mentoring them (the traditional healers) in supporting vaccination efforts.
authors.affiliation: Department of Community Health, University of Malawi, College of Medicine, Blantyre, Malawi. muula@email.unc.edu.
authors.forename: Adamson S
authors.initials: AS
authors.lastname: Muula
authors.forename: Martine Y
authors.initials: MY
authors.lastname: Polycarpe
authors.forename: Jayakaran
authors.initials: J
authors.lastname: Job
authors.forename: Seter
authors.initials: S
authors.lastname: Siziya
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Rudatsikira