title: Childhood Vaccine Acceptance and Refusal among Warao Amerindian Caregivers in Venezuela; A Qualitative Approach.
abstract: OBJECTIVE
  Acceptance of childhood vaccination varies between societies, affecting worldwide vaccination coverage. Low coverage rates are common in indigenous populations where parents often choose not to vaccinate their children. We aimed to gain insight into reasons for vaccine acceptance or rejection among Warao Amerindians in Venezuela.
  
  
  METHODS
  Based on records of vaccine acceptance or refusal, in-depth interviews with 20 vaccine-accepting and 11 vaccine-declining caregivers were performed. Parents' attitudes were explored using a qualitative approach.
  
  
  RESULTS
  Although Warao caregivers were generally in favor of vaccination, fear of side effects and the idea that young and sick children are too vulnerable to be vaccinated negatively affected vaccine acceptance. The importance assigned to side effects was related to the perception that these resembled symptoms/diseases of another origin and could thus harm the child. Religious beliefs or traditional healers did not influence the decision-making process.
  
  
  CONCLUSIONS
  Parental vaccine acceptance requires educational programs on the preventive nature of vaccines in relation to local beliefs about health and disease. Attention needs to be directed at population-specific concerns, including explanation on the nature of and therapeutic options for side effects.
authors.affiliation: Laboratorio de Tuberculosis, Instituto de Biomedicina, Universidad Central de Venezuela, Caracas, Venezuela.
authors.forename: Jochem
authors.initials: J
authors.lastname: Burghouts
authors.affiliation: Department of Pediatrics, Hospital de Niños J.M. de los Ríos, Caracas, Venezuela.|Facultad de Medicina, Universidad Central de Venezuela, Caracas, Venezuela.
authors.forename: Berenice
authors.initials: B
authors.lastname: Del Nogal
authors.affiliation: Facultad de Medicina, Universidad Central de Venezuela, Caracas, Venezuela.
authors.forename: Angimar
authors.initials: A
authors.lastname: Uriepero
authors.affiliation: Laboratory of Pediatric Infectious Diseases, Department of Pediatrics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Peter W M
authors.initials: PW
authors.lastname: Hermans
authors.affiliation: Laboratorio de Tuberculosis, Instituto de Biomedicina, Universidad Central de Venezuela, Caracas, Venezuela.|Facultad de Medicina, Universidad Central de Venezuela, Caracas, Venezuela.
authors.forename: Jacobus H
authors.initials: JH
authors.lastname: de Waard
authors.affiliation: Laboratorio de Tuberculosis, Instituto de Biomedicina, Universidad Central de Venezuela, Caracas, Venezuela.|Laboratory of Pediatric Infectious Diseases, Department of Pediatrics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Lilly M
authors.initials: LM
authors.lastname: Verhagen
mesh_terms: D000328:Adult; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D005260:Female; D006801:Humans; D007199:Indians, South American / Q000523:psychology*; D008297:Male; D010290:Parents / Q000523:psychology*; D010342:Patient Acceptance of Health Care; D036301:Qualitative Research; D014611:Vaccination / Q000706:statistics & numerical data*; D014687:Venezuela