DIPHTHERIA IMMUNISATION ENQUIRY
Introduction

This enquiry was made at the request of the Ministry of Health, in association with the Department of Health for Scotland.

There is a great wastage of time and effort on the part of the medical and nurs­ing services and in expenditure of money in the curative treatment of Diphtheria. There are annually 30,000 cases of the disease in England and Wales, costing over £1,000,000 and causing the deaths of 3,000 children. Medical opinion is that this suffering and wastage of child life and expenditure of time and money could be avoided if 75% of children between the ages of 1 and 15 years could be immunised. At the time of the enquiry immunisation was much below this lowest effective rate of 75%.

The purpose of the enquiry was to find what objections or difficulties parents had in having their children immunised against Diphtheria, so that objections could be met and difficulties dealt with, if practicable. The enquiry was planned to find:

The extent of the knowledge among parents of the causes, dangers and prevention of Diphtheria.

How parents of immunised children had learned about the Diphtheria immunisation scheme, and what had decided them to immunise their children.

Whether those parents who had not had their children immunised had made any effort to get them immunised. If they had made the effort, to find what had prevented the immunisation from being carried out.

Whether parents who had not tried to have their children immunised knew of the arrangements for free immunisation, whether they had thought of the consequences of their children having Diphtheria, and why they did not have their children immunised.

In addition to the enquiry on Diphtheria, the opportunity was taken to obtain information on three other matters of interest to the Ministry of Health:

The use of Children's Welfare Centres by parents of children under the age of 5 years.

Whether parents kept their younger daughters' hair short. If no, whether there was any difficulty in keeping the hair clean.

The sleep of children.

These points were embodied in a questionnaire, following a pilot survey which enabled many of the questions to be pre-coded. A copy of the questionnaire is given at the end of this report.

The information was obtained by 30 trained investigators in interviews with 2,026 parents or guardians of children under the age of 14 years. All interviews were made during the period 22nd July to 15th August, 1942.

The English and Welsh districts in which the enquiry was made were nominated by the Ministry of Health, the Scottish districts by the Department of Health for Scotland. These districts are listed on page. They are divided into two kinds of districts. The “good” districts and those where there has been much local publicity for Diphtheria immunisation, or where the immunisation rate among children of pre-school age or of school age is above average. The “bad” districts are those where the immunisation rate for children is low, and/or where local publicity has been below average. By making the enquiry in this way it was hoped to obtain pointers from the “good” districts as to the best-way of popularising Diphtheria immunisation.

A strictly random sampling method was used. By the courtesy of the Ministry of Food the Wartime Social Survey was able to obtain names and addresses of children of the appropriate ages from the records of the Food Offices in the required districts. investigators made a random selection of children from these records and, keeping strictly to the list thus formed, interviewed the parents or guardians.

The enquiry was not meant to be national in scope but to cover some typically good and bad areas for Diphtheria immunisation. Consequently the composition of the sample obtained cannot be expected to agree with, the national composition. The sample does agree with various checks obtained from the particular districts surveyed. Its social class composition, for instance, is under-weighted for the A and B classes when compared with their national incidence, but having regard to the districts in which the survey was made, many of which are preponderantly working class districts such as Stepney, Bermondsey and Stafford; this is correct.

Again, the proportions of children under and over 5 years of age show satisfactory agreement with the known proportions as in 1939 for the district composing the sample, allowing for changes due to evacuation.

Since, however, the territory covered by the enquiry was extensive there is no reason to suspect that its findings would differ greatly from the findings of a nation-wide enquiry. The information it yields on the knowledge of Diphtheria shown by parents, how parents learned of the immunisation scheme and what had decided them to have their children immunised, the reasons given why immunisation was not carried out, can fairly be taken as indicative of the country as a whole.