title: Assessing parents' knowledge and attitudes towards seasonal influenza vaccination of children before and after a seasonal influenza vaccination effectiveness study in low-income urban and rural Kenya, 2010-2011.
abstract: BACKGROUND
  Influenza vaccine is rarely used in Kenya, and little is known about attitudes towards the vaccine. From June-September 2010, free seasonal influenza vaccine was offered to children between 6 months and 10 years old in two Population-Based Infectious Disease Surveillance (PBIDS) sites. This survey assessed attitudes about influenza, uptake of the vaccine and experiences with childhood influenza vaccination.
  
  
  METHODS
  We administered a questionnaire and held focus group discussions with parents of children of enrollment age in the two sites before and after first year of the vaccine campaign. For pre-vaccination focus group discussions, we randomly selected mothers and fathers who had an eligible child from the PBIDS database to participate. For the post-vaccination focus group discussions we stratified parents whose children were eligible for vaccination into fully vaccinated, partially vaccinated and non-vaccinated groups.
  
  
  RESULTS
  Overall, 5284 and 5755 people completed pre and post-vaccination questionnaires, respectively, in Kibera and Lwak. From pre-vaccination questionnaire results, among parents who were planning on vaccinating their children, 2219 (77.6%) in Kibera and 1780 (89.6%) in Lwak said the main reason was to protect the children from seasonal influenza. In the pre-vaccination discussions, no parent had heard of the seasonal influenza vaccine. At the end of the vaccine campaign, of 18,652 eligible children, 5,817 (31.2%) were fully vaccinated, 2,073 (11.1%) were partially vaccinated and, 10,762 (57.7%) were not vaccinated. In focus group discussions, parents who declined vaccine were concerned about vaccine safety or believed seasonal influenza illness was not severe enough to warrant vaccination. Parents who declined the vaccine were mainly too busy [251(25%) in Kibera and 95 (10.5%) in Lwak], or their child was away during the vaccination period [199(19.8%) in Kibera; 94(10.4%) in Lwak].
  
  
  CONCLUSIONS
  If influenza vaccine were to be introduced more broadly in Kenya, effective health messaging will be needed on vaccine side effects and frequency and potential severity of influenza infection.
authors.affiliation: Kenya Medical Research Institute/Centers for Disease Control and Prevention (KEMRI/CDC), Nairobi, Kenya. oriahp@yahoo.com.
authors.forename: Prisca Adhiambo
authors.initials: PA
authors.lastname: Oria
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Arunga
authors.forename: Emmaculate
authors.initials: E
authors.lastname: Lebo
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Wong
authors.forename: Gideon
authors.initials: G
authors.lastname: Emukule
authors.forename: Philip
authors.initials: P
authors.lastname: Muthoka
authors.forename: Nancy
authors.initials: N
authors.lastname: Otieno
authors.forename: David
authors.initials: D
authors.lastname: Mutonga
authors.forename: Robert F
authors.initials: RF
authors.lastname: Breiman
authors.forename: Mark A
authors.initials: MA
authors.lastname: Katz
mesh_terms: D000328:Adult; D002648:Child; D002662:Child Health Services; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D007630:Kenya / Q000453:epidemiology; D008297:Male; D010290:Parents; D012424:Rural Population; D012621:Seasons; D011795:Surveys and Questionnaires; D014505:Urban Population; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D007252:Influenza Vaccines