Imagine your child getting vaccinated and you are not aware of the name of the vaccine or its use. Scary, isn’t it? Well, that’s the case with majority of parents in the villages of Dalsinghsarai in Samastipur, Bihar. This lack of information often fosters negligence on the part of parents who do not get their children immunized on time. It also creates a sense of fear and gives a way to rumors that affect the immunization campaign run by the government.
A few years back, rumors regarding polio vaccines made people, especially in Muslim communities, believe that it makes the male child impotent. It led to vaccine hesitance among parents which posed a potential risk to the infant’s life. Since deliveries at home are still rampant in poor and inaccessible areas in Bihar, there is a high chance that newborns miss the at-birth vaccines, which are administered within 24 hours of a child being born.
“Immunization is a proven tool for controlling and eliminating life-threatening infectious diseases and is estimated to avert between 2 and 3 million deaths each year.”- World Health Organization
A survey was conducted by Innovators In Health (IIH), a public health organization in Bihar, to find out the knowledge, attitude and practice regarding at-birth vaccines within communities. The survey was done with 638 families in Dalsinghsarai. While 52% of the respondents said that according to them, the major benefit of immunization is ‘protection from diseases’, they couldn’t relate which vaccine protects from which disease.
TB incidence in these areas is high and is one of the leading causes of mortality and morbidity. Regarding Hepatitis B vaccine, the knowledge is abysmal with 67% of respondents saying they don’t know about it. Hepatitis B causes serious liver infection and cancer which can be easily prevented by a vaccine. The knowledge regarding the at-birth Polio vaccine was comparatively higher, with 64% of respondents saying that they have heard about it. Most people used the terms ‘teeka’ (vaccine) and ‘sui’ (injection) interchangeably, indicating the lack of awareness regarding immunization here.
Since 2014, the Indian government, through its Mission Indradhanush Program has aimed for complete immunization of children, but has seldom focused on educating parents about the importance of vaccination. The project hugely depends on the community health workers such as ASHA, Anganwadi worker and ANM who hold the responsibility of bringing the child to the anganwadi centre on the routine Immunization days. But what happens if a family is completely against getting their child getting vaccinated? Manju, an ASHA says,
“In such cases, we try to explain to them the importance of the vaccine and the disease it prevents. If the family still doesn’t listen, we don’t force. What if something happens to the child? They will put the entire blame on us.”
Addressing the unmet need for information on vaccines and its side effects among parents is fundamental for building trust. When IIH got a grant from the Gates Foundation to ‘Increase Demand for Immunization through Gameplay’, they had a simple idea in mind. They took the communal game of Snakes & Ladders and gave it an interesting twist to give the required information. In this modified version, the boxes with snakes depict diseases such as Polio, TB and Hepatitis B and the boxes with a ladder had a vaccine which would protect the child from the respective disease and hence make them immune to snakebite.
Keeping in mind the local context, the board has different pathways such as delivery at home, in a private hospital and at a government hospital, to depict delays in getting the child vaccinated if he/she is not taken to the right place. For example, there is a box which says ‘Chatthi‘, a ritual followed in rural Bihar where the mother and newborn are not allowed to leave the house until six days of delivery. In case of a home-delivery, people usually don’t take the child for the at-birth vaccine due to this ritual.
Through the game, such real life situations which act as hindrance to timely immunization, are discussed. To ensure participation from the audience and considering the role of external parties, there are audience choice cards such as ASHA, family member, car and money, to be used at different points in the game. The community finds the game familiar and easy to understand. Through this game, IIH has also tried to increase male participation in such meetings, since immunization of a child should not solely be the responsibility of the mother.
The response from the community for the game has been encouraging so far. Both adults and children enjoy playing it with unexpected twists bearing new information for them. Since literary levels among adults are low in these areas, the children also help in reading out the messages printed on the board. Kiran Kumari, a mother who attended one of the games said,
“I thought both my children are fully vaccinated as I only knew about the BCG vaccine. I was in an assumption that this vaccine prevented all the diseases. Because of this game, an uneducated woman like me got to learn the name of vaccines. I will now share this information with my neighbours as well.”