(1) The Ages at which Children were Immunised

Table 32 shows the percentages of immunised children who had been immunised at different ages.

It was noted in the introduction that the sample might be to a small extent biased in favour of children under the age of five. This might have some effect on the results given above. 58% of the immunised children in the sample had been immunised before reaching their fifth birthday. The possibility that this figure is rather too high should be noted.

It is clear that the two modal ages for immunisation are one or just under one, the age which is specially recommended by the Ministry of Health, and about five years old, the age at which most children begin their school life.

The Immunisation Campaign has been in progress since about 1940 and older children would be less likely to have been immunised at the age of one than younger children, since they would have passed their second birthday before the campaign was in full swing.

The percentages of immunised children aged under five at the time of the inquiry who were immunised at different ages are shown in Table 33. All these children would have been born since the campaign began.

The great majority of these children were immunised at the age of one or younger.

In the analyses given below the ages at which children were immunised have been grouped to make comparison easier.

Analysis by Type of Area

In small towns and in rural areas higher proportions of children had been immunised at the age of one or less than in large towns. It will be remembered that a higher proportion of mothers in small towns and rural areas than in large towns knew that the best age for children to be immunised was one year old. 62% compared with 48%.

Analysis by Region

In the Midlands and the South and East slightly higher proportions of children were immunised in the younger years, and mothers in these regions more frequently knew the best age to have children immunised.

Analysis by Economic Group

The highest economic group shows greater proportions of children immunised in their first and second year, than do the lower groups, and it was shown that more mothers in the highest group knew the best age to have children immunised. There is a similar difference between education groups.

(2) Who suggested that children should be immunised

The proportions of mothers who had noticed publicity about immunisation through different media, were shown in the last section. In the majority of cases children were not immunised as a direct result of general publicity but at the suggestion of a particular authority. The proportions of mothers whose children (the selected child) were immunised giving different replies are shown in Table 37. The proportions of those giving different answers from those of the whole sample are also shown.

About one third of immunised children were immunised as a result of a suggestion made by the school, and welfare clinics also have had a considerable influence in getting children immunised. A smaller part was played by health visitors and doctors.

35% of the mothers whose children were immunised said that it had been their own idea, as a result of seeing or hearing about immunisation through publicity, to have them immunised. These form 23% of all the mothers interviewed. It is clear from this that general publicity has played a very considerable part in the success of the scheme, and the analysis given below shows that it has been particularly important with respect to younger children.

Amongst the older children the school was by far the most important influence. 71% of immunised children aged five or over were immunised at the suggestion of the school. 31% of immunised children aged under five were immunised at the suggestion of the welfare clinic, and 47% as a result of the parents’ own initiative arising out of publicity. 19% of the older children were immunised as a result of the parents’ own idea.

Analysis by Type of Area

It was shown in Table 33 that there was a tendency for children to be immunised later in large towns than in small towns and rural areas. It is therefore to be expected that a higher proportion of children in large towns would be immunised at the suggestion of the school. A relatively high proportion of mothers living in small towns said that it had been their own idea to have their children immunised, and it has already been noted that mothers in small towns and in rural areas more frequently know the best age to have children immunised and were in general better informed than mothers in large towns.

In rural areas the health visitor is of slightly more and the welfare clinic of slightly less importance than elsewhere.

Analysis by Region

The school is relatively of less importance in the South and East than elsewhere, and in this region rather more children were immunised before they had reached school age. The proportion acting on their own initiative in getting their children immunised is high in this region.

Welfare clinics played a greater part in the Midlands and in London, than elsewhere, doctors and health visitors accounting for a higher proportion of immunisations in the North and the South and East.

Analysis by Economic Group

A relatively high proportion of mothers in the highest group said it was their own idea or that the doctor suggested it. (About the same proportions of mothers in the higher education group gave these answers).

Welfare clinics are mentioned more frequently by mothers in the lower, than by mothers in the middle and high economic groups.

(3) How long after it was suggested was the immunisation done?

This question was asked of mothers who had had their children immunised at the suggestion of the authorities mentioned in answer to the previous question, and did not apply to those who had had their children immunised on their own initiative.

The time counted was the time between the mother's filling in the form agreeing to immunisation, and the date at which the first injection was given.

25% of these mothers were unable to remember what time had elapsed between the suggestion being made to them and the immunisation being carried out. Interviewers were told not to press the point if mothers were at all doubtful, as their answers would be likely to be inaccurate.

It is, however, clear from these results that the majority of children were immunised within four weeks of the suggestion being made and accepted, and it does not seem therefore that delay is causing trouble.

Mothers were further asked whether they had had any difficulty in getting their children immunised, and the proportion experiencing difficulty was less than 1%.

Analysis by type of area does not show any significant differences in the proportions mentioning different times. There are, however, some differences between different regions.

Analysis by Region

It appears that the interval is rather longer in the Midlands and Wales than elsewhere. In the North a relatively high proportion of children were immunised within a week of the suggestion being made and agreed to.

An analysis made of answers to this question by the authority suggesting that the child should be immunised reveals no significant differences except in the case of children immunised at the suggestion of a doctor. A higher proportion of these children than of others were immunised within a week of the suggestion being made.

(4) The Proportions of Children Immunised under the Immunisation Scheme and by private Doctors

Mothers who had had their children immunised were asked whether they had taken advantage of the Immunisation Scheme or whether the immunisation had been carried out by a doctor at their own expense.

It will be seen that in the great majority of cases children were immunised under the Immunisation Scheme.

An analysis was made of the answers to this question by the authority suggesting that immunisation should be carried out. The most interesting result coming from this analysis is that 70% of the mothers who decided to have their children immunised on their own inititative, after seeing publicity, made use of the Immunisation Scheme, only 30% having the imunisation done by their own doctor. This suggests that the publicity has succeeded not only in making mothers aware of the desirability of having their children imunised, but in bringing the existence of the free Immunisation Scheme to their notice.

88% of the children in large towns who had been immunised were immunised under the Scheme, the corresponding proportions in small towns and rural areas being 82% and 80% respectively.

The proportions of immunised children using the Scheme in different regions were, North 83%, Midlands and Wales 86%, South and East 78% and London 91%. In the South a relatively high, and in London a relatively low proportion of mothers had the immunisation done by their own doctors.

As might be expected a higher proportion of the mothers of immunised children in the highest economic group, 45%, than of those in the middle and lower economic groups, 11% and 9%, had their children immunised at their own expense by their own doctors. The corresponding proportions for the higher and lower education groups were 44% and 9% respectively.

(5) Was the Immunisation Completed?

The immunisation was counted as completed if two injections had been given, and mothers were asked how many injections the child had had before their answers were classified.

In the great majority of cases immunisation had been completed. It might be expected that in a few cases it would not be completed as some children would have had the first injection shortly before their mothers were interviewed, and would be waiting to have the second at the time of the interview. The percentage of children whose immunisation is not ultimately completed is likely to be very small.

There are no statistically significant differences between the proportions of children immunised at different ages whose immunisation had not been completed.

5% of immuinsed children in the North and in the Midlands as compared with 2% in London, had not received a second injection. (S.E. of difference = 1%)

Other analyses do not know significant differences between groups.

(6) Was the arm painful afterwards?

About one fifth of the mothers said that the children had had some pain after immunisation.

There is no difference between the proportions of boys and of girls who were said to have had trouble in this way.

Analysis by Age of Child

A lower proportion of children immunised at the age of one or less than of older children were said to have experienced pain. There is no difference in this proportion as regards the other age groups. It is perhaps possible that the difference shown between the babies and the older children is not a real one. If children of two or over felt a pain in the arm they would probably say so. Younger children, though perhaps able to express the fact just as forcibly, might or might not choose to according to their temperaments.

It is of interest that a cross analysis of answers to the question “Was the immunisation completed” and the answers to this question shows no difference. Thus although about a fifth of the children immunised are said to have experienced some pain in the arm after the injection, mothers are not deterred by this from letting them have the second injection.

Summary

(1) The majority of immunised children were immunised before reaching their sixth birthday, the most popular ages being one and five years old.

A relatively high proportion of the children of mothers with higher education and in the higher economic groups, were immunised when they were babies. A relatively high proportion of children living in small towns were immunised in their first or second year.

(2) 34% of immunised children were immunised at the suggestion of the school, and 19% at the suggestion of the welfare clinic. In the case of 35% the parents had acted on their own initiative after noticing publicity.

71% of children immunised between the ages of five and fifteen were immunised at the suggestion of the school. 47% of children immunised when they were younger than five were immunised as a result of their parents’ own initiative.

Relatively high proportions of mothers in the higher education and economic groups, and of mothers in small towns and in the South of England, had their children immunised without any suggestion being made to them personally.

(3) In the majority of cases, injections were carried out within four weeks of the suggestion being made and accepted. Less than 1% of mothers said they had had any difficulty in getting their children immunised.

The interval between the suggestion being accepted and the first injection being made, was somewhat longer in the Midlands than elsewhere.

(4) 84% of immunised children had been immunised under the free scheme, and 16% at their parents' own expense.

Fewer of the mothers in the high economic and education groups than of others, took advantage of the free scheme.

(5) In 95% of cases the immunisation had been completed.

(6) About one fifth of immunised children were said to have felt some pain in the arm after immunisation.