Vaccine Hesitancy and Perceptions of the Community about Polio in High-Risk Areas of Karachi, Sindh, Pakistan.
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SUBMITTER: Abbasi FH
PROVIDER: S-EPMC9866813 | biostudies-literature | 2022 Dec
REPOSITORIES: biostudies-literature
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Vaccine Hesitancy and Perceptions of the Community about Polio in High-Risk Areas of Karachi, Sindh, Pakistan.
Abbasi Fayaz Hussain FH Shaikh Ahmed Ali AA Mehraj Jaishri J Raza Syed Musa SM Rasool Shumaila S Bullo Umar Farooq UF Mehraj Sandeep S Phul Zamir Ali ZA Sahitia Sundeep S Zardari Asif Ali AA Chandio Shoukat Ali SA
Vaccines 20221228 1
The study aimed to determine the reasons for polio vaccine hesitancy among parents of persistently missed children (PMCs) in the high-risk areas of Karachi, Pakistan. A cross-sectional survey of parents of PMCs was conducted in April 2019 in 34 high-risk union councils of Karachi. PMCs were randomly selected from the polio program database, and further information was collected on a questionnaire by trained staff using face-to-face interviews with parents of PMCs. A total of 325 participants wer ...[more]
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Project description:IntroductionHealth camps are organized to provide basic health services in underprivileged communities. This study was conducted to determine community acceptance and effectiveness of health camps in the high-risk areas for the polio program in Karachi, Pakistan.MethodsThis cross-sectional survey was conducted at the health campsites in high-risk union councils (HRUCs) of four districts of Karachi, Sindh. The survey was carried out in three rounds after a polio vaccination campaign in June, August, and October 2021. In June and August, health camps were organized in eight HRUCs; in October, the scope was extended to 33 union councils. All health camps provided basic health services, maternal and child health services, and routine immunization.ResultsIn June 877, August 367, and October 383 respondents participated in the survey. The main services availed include consultation with a doctor (64% in June, 79% in August, 78% in October), followed by childhood vaccination (58% in June, 55% in August, 69% in October), and nutrition support (34% in June, 17% in August, 17% in October). Children's immunization increased from 80% in June to 86% in August and 96% in October health camp rounds. Among parents who do not allow oral polio vaccine from polio teams at their doorstep, also vaccinated children at the health camps 48 (81%) in June, eight (80%) in August, and 13 (87%) in October.ConclusionHealth camps played a crucial role in building the reputation of the polio program among underserved communities in Karachi's high-risk areas. Alongside routine immunization vaccination services, the provision of public health services such as permanent healthcare facilities, access to safe drinking water, proper waste disposal, and mother and child healthcare services, are crucial steps toward improving immunization and overall health outcomes and strengthening community trust.
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Project description:BackgroundThe Government of Pakistan is facing difficulty to contain the surge of COVID-19 due to the country's social, political, economical and cultural context. Experiences from the previous epidemic suggest that community perceptions, social norms and cultural practices can impede COVID-19 containment. To understand social responses towards COVID-19, the study aims to explore the understanding of COVID-19 and the acceptance of control measures among community members.MethodsWe conducted an exploratory qualitative study using a purposive sampling approach, at two communities of Karachi, Pakistan. In-depth interviews were conducted with community members including, young, middle-aged and older adults of both genders. Study data were analysed manually using the conventional content analysis technique.ResultsA total of 27 in-depth virtual interviews were conducted, between May and June 2020. Six overarching themes were identified: (1) community knowledge and perceptions around COVID-19; (2) trusted and preferred sources of health information; (3) initial thoughts and feeling towards COVID-19 pandemic; (4) community practices to prevent exposure from COVID-19; (5) perceived risks associated with poor adherence to infection control practices; and (6) future preparedness of community to avoid the second wave of the outbreak. Generally, community members had good knowledge about COVID-19, and positive behaviour and attitude towards using standard precautions. The knowledge is mainly acquired through electronic, print and social media platforms, which have pros and cons. However, some community members including younger individuals had poor adherence to safety measures. This may necessitate concentrated efforts to raise awareness through community mobilisation and sensitisation activities.ConclusionThis study provides an initial evidence base of communities' perceptions, and attitudes towards COVID-19 in an early stage of pandemic. The study emphasises that sufficient knowledge and awareness about COVID-19, adequate training and drills, and adherence to safety measures, are necessary to better prepare for the second wave of COVID-19.
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Project description:The COVID-19-related misinformation and vaccine hesitancy is a widespread global concern and a recognized public health problem in Pakistan. The current research sought to explore the beliefs and experiences with regard to COVID-19, including vaccine hesitancy and acceptance, in a slum of Karachi, Pakistan. This study used an interpretivist epistemological approach for data collection and employed in-depth interviews (IDIs) and focus group discussions (FGDs) to explore the themes of interest. IDIs and FDGs were conducted in the local language (Pashtu) and Urdu, using semi-structured interview guides. A hybrid thematic analysis approach (use of both inductive and deductive coding) was used to analyze the data. We identified two key themes: the first related to vaccine hesitancy and refusal and included the role of personal belief systems, vaccine mistrust and public perceptions in hesitancy; the second related to vaccine acceptance and included knowledge and awareness about the vaccine and trusted sources of information. Religious beliefs and cultural norms influenced attitudes toward COVID-19 and vaccination. This study also found that awareness about the COVID-19 vaccine in this sample was influenced by sex, educational status and socioeconomic status. Participants with good health literacy and those from healthcare backgrounds were more likely to share views that indicated vaccine acceptance. The findings of this study are being used to co-design a comprehensive intervention to dispel COVID-19 misinformation and vaccine hesitancy across a range of stakeholders such as youths, community leaders, family members, faith leaders, schools and community-based local organizations in Pakistan.
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Project description:Purpose The delay in acceptance or refusal to get vaccinated despite the availability of services is called vaccine hesitancy. The Global Polio Eradication Initiative in Pakistan faced consistent barriers preventing the eradication of the disease in the country. Similarly with the advent of the coronavirus disease 2019 (COVID-19) pandemic mass vaccination drives were initiated to a vaccine hesitant population. The aim of this study is to explore the prevalence and reasons for COVID-19 vaccine hesitancy in the Pakistani population. Materials and Methods Cross-sectional study conducted during July to September 2021 using a snowball sampling technique targeting the adult population of Pakistan. The modified version of the vaccine hesitancy questionnaire related to the Strategic Advisory Group of Experts on Immunization Vaccine Hesitancy matrix was distributed online. Results Out of 973 participants, 52.4% were immediately willing to take the vaccine and constituted the acceptance group whereas the remaining 47.6% who were still not sure formed the hesitant group. Support from leaders was found to be statistically significant for the difference between the hesitant and acceptance groups (p-value=0.027). Hesitant people were concerned about the effectiveness of the vaccine (60.9%) and potential side effects (57.9%) as it was not sufficiently tested prior to launch (44.7%). Age and education were significant factors affecting the acceptance of vaccination. The most trusted source of information regarding vaccination was health care workers (43.8%). Conclusion A moderately high prevalence of vaccine hesitancy was reported in Pakistan. To overcome it, policymakers need to address the reasons for it. Leaders, celebrities, and healthcare workers can play an instrumental role in dispelling conspiracy theories regarding vaccines and making the vaccination drive a success.
| S-EPMC10435776 | biostudies-literature
Project description:BackgroundMaternal mortality is of global public health concern and >99 % of maternal deaths occur in less developed countries. The common causes of direct maternal death are hemorrhage, sepsis and pre-eclampsia/eclampsia. In Pakistan, pre-eclampsia/eclampsia deaths represents one-third of maternal deaths reported at the tertiary care hospital settings. This study explored community perceptions, and traditional management practices about pre-eclampsia/eclampsia.MethodsA qualitative study was conducted in Sindh Province of Pakistan from February to July 2012. Twenty-six focus groups were conducted, 19 with women of reproductive age/mothers-in-law (N = 173); and 7 with husbands/fathers-in-law (N = 65). The data were transcribed verbatim in Sindhi and Urdu, then analyzed for emerging themes and sub-themes using NVivo version 10 software.ResultsPre-eclampsia in pregnancy was not recognized as a disease and there was no name in the local languages to describe this. Women however, knew about high blood pressure and were aware they can develop it during pregnancy. It was widely believed that stress and weakness caused high blood pressure in pregnancy and it caused symptoms of headache. The perception of high blood pressure was not based on measurement but on symptoms. Self-medication was often used for headaches associated with high blood pressure. They were also awareness that severely high blood pressure could result in death.ConclusionsCommunity-based participatory health education strategies are recommended to dispel myths and misperceptions regarding pre-eclampsia and eclampsia. The educational initiatives should include information on the presentation, progression of illness, danger signs associated with pregnancy, and appropriate treatment.
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Project description:Heat waves are the second leading cause of weather-related morbidity and mortality affecting millions of individuals globally, every year. The aim of this study was to understand the perceptions and practices of community residents and healthcare professionals with respect to identification and treatment of heat emergencies. A qualitative study was conducted using focus group discussions and in-depth interviews, with the residents of an urban squatter settlement, community health workers, and physicians and nurses working in the emergency departments of three local hospitals in Karachi. Data was analyzed using content analysis. The themes that emerged were (1) perceptions of the community on heat emergencies; (2) recognition and early treatment at home; (3) access and quality of care in the hospital; (4) recognition and treatment at the health facility; (5) facility level plan; (6) training. Community members were able to recognize dehydration as a heat emergency. Males, elderly, and school-going children were considered at high risk for heat emergencies. The timely treatment of heat emergencies was widely linked with availability of financial resources. Limited availability of water, electricity, and open public spaces were identified as risk factors for heat emergencies. Home based remedies were reported as the preferred practice for treatment by community members. Both community members and healthcare professionals were cognizant of recognizing heat related emergencies.
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Project description:IntroductionMental health problems are pervasive nowadays. Adolescents are often expected to balance academic performance with familial obligations and work to support the family financially if they belong to low-socio-economic areas. These pressures can lead to Anxiety, stress, and even depression.ObjectiveThe study's main objective is to assess the association of gender, parenting style, eating habit, and screen timing with the level of Anxiety among school-going adolescents in three peri-urban areas of Karachi, Pakistan.MethodologyA school-based cross-sectional study was conducted among adolescents of age group 10-19 years using the Generalized Anxiety Disorder-7 (GAD-7) scale in two months in, three populated peri-urban areas of Karachi, Pakistan. Collected Data was analyzed by statistical software SPSS version with 80% response rate.FindingIn our collected data, 544 students participated; 313 (57%) were female, and 231(42%) were male. Among them 173(33%) participants showed moderate to severe level of anxiety out of which 140(26%) were female and 33(7%) were male. As per our study, strict Parenting style plays a significant role in developing moderate to severe 108(20%) levels of Anxiety, shown among adolescents in the studied population. In addition to this, those who do not take tuition 115 (21%), do not use transport to school 91(16%), spend significant time in games on mobile and computer 101 (18%), and have no involvement in physical activities 172 (31%) show more moderate to severe level anxiety than others factors. A significant multivariate association between level of anxiety with gender, school commute, type of lunch Intake, smoker family member at home, physical activity, video game, tuition and strict parent.ConclusionThis study concluded that there are various factors which have great association with anxiety and can affect adolescents' mental health badly. The factors were parental strictness, video game playing, a sedentary lifestyle, and the smoking habits of family members. Children and adolescents must be evaluated as soon as possible while they are still young to prevent mental health issues.
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Project description:BackgroundPakistan faces huge challenges in eradicating polio due to widespread poliovirus transmission and security challenges. Innovative interventions are urgently needed to strengthen community buy-in, to increase the coverage of oral polio vaccine (OPV) and other routine immunisations, and to enhance immunity through the introduction of inactivated polio vaccine (IPV) in combination with OPV. We aimed to evaluate the acceptability and effect on immunisation coverage of an integrated strategy for community engagement and maternal and child health immunisation campaigns in insecure and conflict-affected polio-endemic districts of Pakistan.MethodsWe did a community-based three-arm cluster randomised trial in healthy children aged 1 month to 5 years that resided within the study sites in three districts of Pakistan at high risk of polio. Clusters were randomly assigned by a computer algorithm using restricted randomisation in blocks of 20 by an external statistician (1:1:1) to receive routine polio programme activities (control, arm A), additional interventions with community outreach and mobilisation using an enhanced communication package and provision of short-term preventive maternal and child health services and routine immunisation (health camps), including OPV (arm B), or all interventions of arm B with additional provision of IPV delivered at the maternal and child health camps (arm C). An independent team conducted surveys at baseline, endline, and after each round of supplementary immunisation activity for acceptability and effect. The primary outcome measures for the study were coverage of OPV, IPV, and routine extended programme on immunisation vaccines and changes in the proportion of unvaccinated and fully vaccinated children. This trial is registered with ClinicalTrials.gov, number NCT01908114.FindingsBetween June 4, 2013, and May 31, 2014, 387 clusters were randomised (131 to arm A, 127 to arm B, and 129 to arm C). At baseline, 28 760 children younger than 5 years were recorded in arm A, 30 098 in arm B, and 29 126 in arm C. 359 clusters remained in the trial until the end (116 in arm A, 120 in arm B, and 123 in arm C; with 23 334 children younger than 5 years in arm A, 26 110 in arm B, and 25 745 in arm C). The estimated OPV coverage was 75% in arm A compared with 82% in arm B (difference vs arm A 6·6%; 95% CI 4·8-8·3) and 84% in arm C (8·5%, 6·8-10·1; overall p<0·0001). The mean proportion of routine vaccine doses received by children younger than 24 months of age was 43% in arm A, 52% in arm B (9%, 7-11) and 54% in arm C (11%, 9-13; overall p<0·0001). No serious adverse events requiring hospitalisation were reported after immunisation.InterpretationDespite the challenges associated with the polio end-game in high-risk, conflict-affected areas of Pakistan, a strategy of community mobilisation and targeted community-based health and immunisation camps during polio immunisation campaigns was successful in increasing vaccine coverage, including polio vaccine coverage.FundingBill & Melinda Gates Foundation.
| S-EPMC5439031 | biostudies-literature
Project description:BackgroundUnderstanding the spatial dynamics of oral polio vaccine (OPV) transmission will improve resource targeting. Mexico provides a natural laboratory, as it uses inactivated polio vaccine routinely as well as OPV bi-annually.MethodsUsing geospatial maps, we measured the distance and density of OPV vaccinees' shedding in the areas nearest to unvaccinated households in 3 Mexican villages. Comparison of transmission to unvaccinated households utilized a mixed effects logistic regression with random effects for household and time, adjusted for age, gender, area, and running water.ResultsThe median distance from an unvaccinated household to its nearest OPV-shedding household was 85 meters (interquartile range, 46-145) and the median number of vaccinees shedding OPV within 200 m was 3 (2-6). Transmission to unvaccinated households occurred by day 1. There was no association (odds ratio [OR] 1.04; 95% credible interval [CrI] 0.92-1.16) between the distance from OPV shedding and the odds of transmission. The number of OPV vaccinees shedding within 200 m came close to a significant association with unvaccinated transmission (OR 0.93; CrI 0.84-1.01), but this was not the case for households 100 or 500 m apart. Results were consistent across the 3 villages.ConclusionsGeospatial analysis did not predict community transmission from vaccinated to unvaccinated households, because OPV use resulted in rapid, low transmission levels. This finding supports the global cessation of OPV.
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Project description:Pakistan, along with Afghanistan, is one of two countries where wild poliovirus is still endemic. Frontline workers (FLWs) are the staff most intimately familiar with both implementation challenges and community context. Harnessing their expertise may be a way to improve the community-polio program interface, which has been a persistent and shifting challenge in polio-endemic areas of both countries. From 2020–2022, we engaged frontline workers in 18 Super High-Risk Union Councils (SHRUCs) in Pakistan through a Human-Centered Design ideas competition. In that competition, teams of polio FLWs identified the most significant barriers they faced in conducting their work, and suggested solutions to those problems—a window into the issues the program faces by the people who know it best. The suggestions of FLWs on how to eradicate polio fell into four main categories. First, there were suggestions to tackle community fatigue by reducing touchpoints, particularly visits solely for data collection. Second, there were calls to improve Primary Health Care in SHRUCs, as a way of addressing community frustrations over an intense focus on just one disease in the context of numerous acute needs. Third, there were suggested ways to increase community engagement through locally relevant channels. Finally, many workers suggested improvements to Human Resources processes and workplace dynamics. Across these ideas, one repeated concept is the need for balance between the intensity of polio activities required for eradication and the provision of other government services, including health services. FLWs engaged the process deeply, providing well thought out problem statements and ideas for change. It is our view that there is no one more qualified to speak to the issues on the ground than FLWs. There are critical insights available if we listen to people who are instrumental to the success of health programs, but not commonly involved with creating policy.
| S-EPMC10464965 | biostudies-literature