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A peer-reviewed article of this preprint also exists.
Submitted:
11 April 2023
Posted:
12 April 2023
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"Grandmothers guide our daughters-in-laws' about child-rearing and caring, counsel what to feed if the child has fever or pain, what type is food is good in hot and cold weather to keep the child healthy."
"Polio workers give knowledge and guide us about health and vaccine, we are thankful to them that they visit repeatedly to our doorstep for the sake of community health."
"The health of my grandchild is good because his height and weight are perfect."
"Mostly children are weak because they live and play in a dirty environment, and where there are open sewerage lines."
"Health of our children is not good, as most children don't get the vaccination, they don't get proper nutrition and live in unhygienic conditions. Nowadays diet of mothers is also not good that's why children are weak."
"Community people don't care about their children's health. I think to feed balanced diet to my child, but I can't buy fruit and chicken for them"
"People believe that these vaccines are for family planning, cause infertility to decrease their generation."
"People think that because of vaccines child get a reaction and if one child dies so they do protest and refuse to give the vaccination."
"Only legs are not affected by polio disease it may cause many other problems like weakness, low immunity, heart problem, indigestion, weakens of an arm or leg and it can also lead to death."
"Polio disease spreads through our breath, sewerage, and air."
"One of my grandchildren was healthy at the time of his birth. However, three days later he got fever, fits and his leg was affected. After consulting, the doctor diagnosed that the child has Polio."
"In our neighbors, the boy is born. After two or three days after his birth, he started trembling, got a fever, and was later affected by Polio. Same symptoms were seen in a couple of children here and nearby hospitals also confirm polio disease."
"My niece gets affected by polio disease because her mother never gives her polio drops, when she took her to the doctor, he told them she got attacked by Polio. Now she is 18 years old but disabled. After this incident, my sister gives polio drops to every child to prevent them from Polio."
"Water testing from drainage was done to identify the poliovirus in our area and it has been proven that this is one of the main reasons for spreading this disease. Unfortunately, no vaccine and medicine can save children, until and unless the environment can be cleaned."
"After giving vaccines there is a chance that child can get polio disease, but this vaccine improves the immunity to fight against polio disease."
"I have seen that there was one girl who was 18 months old and she got polio attack and she became disabled. So her family took her to the Syed's and within 5 days she becomes normal. another child was in the last stage and they took the child to the Molvi and then the child becomes normal."
"Science is so advanced these days that there is the treatment of every disease, there are so many laboratories, people can be treated through medicine."
"Pakhtoon community wants a large family and like to have more children. That's why they fear giving polio drops as it might stop their generations."
"This vaccine may cause infertility and can affect the lungs and kidneys of the children. So it is suspicious that why the Government is doing it free of cost."
"Mostly people refuse to give polio drops to their male child. When asked about the reason for refusal during the polio campaign, they say that we have an only male child in our home and these drops cause impotence."
Karachi (18 UCs ~ 210 HH/UC ) | Bajaur (6 UCs ~ 210 HH/UC) | Pishin (10 UCs ~ 210 HH/UC) |
---|---|---|
Gujro, Songal, Maymarabad, Yousaf Goth, Mangopir, Godhra, Gulshan-e-Ghazi, Itehad Town, Islam Nagar, Nai Abbadi, Saeedabad, Muslim Mujahid Colony, Muhajir Camp, Islamia Colony, Pehlwan Goth, Metrovile Colony, Hijrat Colony, Baloch Goth, | Khar, Mamund, Salarzai, Nawagai, Uttamkhel, Barang | Bazar Kona, Muchan, Bazar Pishin, Karbala, Batazai, Khanozai, Bostan, Dilsora, Malikyar, Kaza Villa, |
Karachi | Bajaur | Pishin | ||||
---|---|---|---|---|---|---|
FGDs | IDIs | FGDs | IDIs | FGDs | IDIs | |
Mothers | 4 | - | 2 | - | 2 | - |
Fathers | 4 | - | 2 | - | 2 | - |
Mothers in Law | 4 | - | 2 | - | 2 | - |
Community influencers | - | 8 | - | 4 | - | 4 |
Health Care Providers | - | 8 | - | 4 | - | 4 |
12 | 16 | 6 | 8 | 6 | 8 |
Karachi | Bajaur | Pishin | |
---|---|---|---|
Indicators | |||
Union councils | 18 | 6 | 10 |
Households surveyed | 3780 | 1258 | 2099 |
HH density | 7.8 | 9.1 | 12.5 |
Total population | 29381 | 11507 | 26223 |
Male (%) | 50.8 | 51 | 49.8 |
Total children under 5 years of age | 6181 | 2144 | 4774 |
Male (%) | 51.73 | 53.26 | 49.79 |
Illiteracy rate (among respondents) | 44.1 | 74.7 | 84.2 |
Ownership of household (owned households) | 61.3 | 92.6 | 81.6 |
Hand-washing practice (after defecation) | 99.7 | 96.5 | 92.3 |
Water treatment practices (% treats water) | 45.3 | 31.2 | 42.3 |
Karachi | Bajaur | Pishin | |
---|---|---|---|
Indicators | (n=3766) | (n=1258) | (n=2099) |
Knowledge about Polio | n (%) | n (%) | n (%) |
Yes | 3748 (99.5) | 1229 (97.7) | 2036 (97) |
No | 18 (0.5) | 29 (2.3) | 63 (3) |
Source of knowledge about Polio | |||
TV | 2199 (47.1) | 199 (15.8) | 822 (39.2) |
Radio | 23 (0.5) | 905 (71.9) | 561 (26.7) |
Newspaper | 49 (1.1) | 31 (2.5) | 139 (6.6) |
Posters | 388 (8.3) | 49 (3.9) | 416 (19.8) |
Masjid Imam | 10 (0.2) | 64 (5.1) | 274 (13.1) |
Local leaders | 24 (0.5) | 79 (6.3) | 19 (0.9) |
Elders | 1231 (26.4) | 330 (26.2) | 526 (25.1) |
Neighbours | 368 (7.9) | 169 (13.4) | 445 (21.2) |
Friends | 131 (2.8) | 66 (5.3) | 264 (12.6) |
Relatives | 682 (14.6) | 235 (18.7) | 348 (16.6) |
Doctor | 592 (12.7) | 629 (50) | 451 (21.5) |
Hakeem | 0 (0) | 1 (0.1) | 29 (1.4) |
Homeopathic doctor | 0 (0) | 0 (0) | 14 (0.7) |
Quack | 0 (0) | 0 (0) | 16 (0.8) |
LHV | 13 (0.3) | 28 (2.2) | 26 (1.2) |
Nurse | 0 (0) | 2 (0.2) | 27 (1.3) |
Traditional healer | 0 (0) | 0 (0) | 8 (0.4) |
LHWs | 58 (1.2) | 339 (27) | 822 (39.2) |
Vaccinators | 36 (0.8) | 364 (28.9) | 83 (4) |
Others | 37 (0.8) | 8 (0.6) | 29 (1.4) |
Consider Polio as a health problem | |||
Yes | 3482 (92.5) | 1088 (86.5) | 1267 (60.4) |
No | 90 (2.4) | 69 (5.5) | 231 (11) |
Don't know | 194 (5.2) | 101 (8) | 601 (28.6) |
Knowledge about preventing a child from Polio | |||
By proper disposal of waste/sewage | 487 (10.4) | 245 (19.5) | 607 (28.9) |
By vaccinating a child/person/polio drops | 2643 (56.6) | 811 (64.5) | 1066 (50.8) |
Avoiding contact with an infected child/ person | 86 (1.8) | 96 (7.6) | 305 (14.5) |
Washing hands with soap and water | 204 (4.4) | 69 (5.5) | 196 (9.3) |
Others | 997 (21.4) | 6 (0.5) | 9 (0.4) |
Don't know | 426 (9.1) | 139 (11.1) | 438 (20.9) |
Knowledge about how a child gets polio disease | |||
By drinking dirty water | 602 (12.9) | 246 (19.6) | 701 (33.4) |
By eating dirty food | 624 (13.4) | 318 (25.3) | 543 (25.9) |
Through sewage contamination of food/water | 372 (8) | 300 (23.9) | 441 (21) |
By air/breath | 34 (0.7) | 117 (9.3) | 452 (21.5) |
By evil eye | 48 (1) | 212 (16.9) | 442 (21.1) |
Don't know | 1626 (34.8) | 73 (5.8) | 367 (17.5) |
Allah's will | 793 (17) | 452 (35.9) | 842 (40.1) |
Others | 403 (8.6) | 4 (0.3) | 3 (0.1) |
Knowledge about polio transmission | |||
By air/breath | 262 (5.6) | 596 (47.4) | 855 (40.7) |
By evil eye | 28 (0.6) | 152 (12.1) | 359 (17.1) |
By contaminated water | 389 (8.3) | 183 (14.6) | 496 (23.6) |
By sewage contamination | 707 (15.2) | 191 (15.2) | 697 (33.2) |
Through polio vaccines | 43 (0.9) | 258 (20.5) | 160 (7.6) |
Don't know | 2543 (54.5) | 334 (26.6) | 773 (36.8) |
Others | 228 (4.9) | 0 (0) | 8 (0.4) |
Knowledge about preventive measures for Polio | |||
Completing routine EPI immunization | 2485 (53.3) | 900 (71.5) | 1365 (65) |
Completing routine EPI immunization plus getting your child vaccinated in NIDs | 1327 (28.4) | 248 (19.7) | 473 (22.5) |
Proper nutrition of child | 847 (18.2) | 116 (9.2) | 561 (26.7) |
Proper hygiene | 1331 (28.5) | 288 (22.9) | 226 (10.8) |
Proper care | 510 (10.9) | 138 (11) | 138 (6.6) |
Keeping child away from the sick child | 147 (3.2) | 302 (24) | 651 (31) |
Proper sewage disposal and sanitation | 99 (2.1) | 75 (6) | 178 (8.5) |
Others | 429 (9.2) | 0 (0) | 7 (0.3) |
Do not know | 282 (6) | 57 (4.5) | 247 (11.8) |
Karachi | Bajaur | Pishin | |
---|---|---|---|
Indicators | (n=3766) | (n=1258) | (n=2099) |
Knowledge about oral polio vaccine | n (%) | n (%) | n (%) |
Yes | 3759 (99.8) | 1253 (99.6) | 2044 (97.4) |
No | 7 (0.2) | 5 (0.4) | 55 (2.6) |
Knowledge about OPV protects from Polio | |||
Yes | 3347 (88.9) | 1186 (94.3) | 1445 (68.8) |
No | 55 (1.5) | 21 (1.7) | 25 (1.2) |
Don't know | 71 (1.9) | 30 (2.4) | 342 (16.3) |
Not sure | 293 (7.8) | 21 (1.7) | 287 (13.7) |
Knowledge about the consequences of not giving OPV | |||
Child gets Polio | 2419 (64.2) | 669 (53.2) | 1208 (57.6) |
The child will not get Polio | 919 (24.4) | 359 (28.5) | 492 (23.4) |
Polio would not be eradicated from Pakistan | 172 (4.6) | 111 (8.8) | 191 (9.1) |
Don't know | 256 (6.8) | 119 (9.5) | 208 (9.9) |
Perceptions about the safety of OPV | |||
Completely safe | 2891 (76.8) | 791 (62.9) | 880 (41.9) |
Reasonably safe | 517 (13.7) | 353 (28.1) | 405 (19.3) |
Not safe at all | 179 (4.8) | 16 (1.3) | 199 (9.5) |
Others | 4 (0.1) | 0 (0) | 0 (0) |
Don't Know | 175 (4.7) | 97 (7.7) | 615 (29.3) |
Ever refused to give polio drops to your child? | |||
Never | 2897 (76.9) | 943 (75) | 1689 (80.5) |
Once | 294 (7.8) | 209 (16.6) | 111 (5.3) |
More than once | 420 (11.2) | 92 (7.3) | 290 (13.8) |
Always | 137 (3.6) | 14 (1.1) | 5 (0.2) |
Other | 18 (0.5) | 0 (0) | 4 (0.2) |
Are all your children immunized with OPV? | |||
Yes | 3543 (94.1) | 1162 (92.4) | 1996 (95.1) |
No | 95 (2.5) | 16 (1.3) | 33 (1.6) |
Partially | 99 (2.6) | 32 (2.5) | 42 (2) |
Not at all | 20 (0.5) | 3 (0.2) | 2 (0.1) |
Don't know | 9 (0.2) | 45 (3.6) | 26 (1.2) |
Did your child/children receive OPV during the recent campaign | |||
Yes | 3526 (93.6) | 1241 (98.7) | 2067 (98.5) |
No | 238 (6.3) | 14 (1.1) | 18 (0.9) |
Don't know | 2 (0.1) | 3 (0.2) | 14 (0.7) |
Decision-maker regarding the health matters of the children? | |||
Mother-in-law | 419 (9) | 353 (28.1) | 769 (36.6) |
Father-in-law | 136 (2.9) | 359 (28.5) | 633 (30.2) |
Husband | 2304 (49.4) | 763 (60.7) | 1812 (86.3) |
Mother my self | 2212 (47.4) | 259 (20.6) | 363 (17.3) |
Other | 65 (1.4) | 0 (0) | 1 (0.1) |
Decision-maker regarding the immunization of the children? | |||
Mother-in-law | 336 (8.9) | 158 (12.6) | 201 (9.6) |
Father-in-law | 92 (2.4) | 256 (20.4) | 244 (11.6) |
Husband | 1562 (41.5) | 703 (55.9) | 1593 (75.9) |
Mother/my self | 1717 (45.6) | 139 (11.1) | 59 (2.8) |
Others | 59 (1.6) | 2 (0.2) | 1 (0.1) |
Karachi | Bajaur | Pishin | |
---|---|---|---|
Reasons | |||
Reasons for refusing Polio drops to child? | n (%) | n (%) | n (%) |
Vaccine is not halal | 21 (2.4) | 10 (3.2) | 187 (45.6) |
Vaccine can cause sterility | 163 (18.8) | 62 (19.7) | 280 (68.3) |
Vaccine is not safe | 162 (18.6) | 11 (3.5) | 161 (39.3) |
Child has got Polio drops too many time | 31 (3.6) | 67 (21.3) | 93 (22.7) |
Community/local leader prohibited | 0 (0) | 0 (0) | 4 (1) |
Against my religious belief | 6 (0.7) | 0 (0) | 19 (4.6) |
Others | 227 (26.1) | 42 (13.3) | 13 (3.2) |
Total | 869 | 315 | 410 |
Reasons for not giving OPV in the last polio campaign | |||
Polio team did not visit the houses | 86 (26.5) | 90 (86.5) | 92 (83.6) |
Did not know about OPV | 53 (16.3) | 6 (5.8) | 5 (4.6) |
Went, but distribution point had run out of OPV | 3 (0.9) | 1 (1) | 4 (3.6) |
Child was not at home at time of visit | 2 (0.6) | 0 (0) | 1 (0.9) |
Child was sick | 13 (4) | 2 (1.9) | 1 (0.9) |
Distribution site is far away | 24 (7.4) | 0 (0) | 1 (0.9) |
Family members/elders did not allow the child to get OPV | 99 (30.5) | 5 (4.8) | 5 (4.6) |
Others | 45 (13.9) | 0 (0) | 1 (0.9) |
Don't Know | 86 (26.5) | 90 (86.5) | 92 (83.6) |
Total | 223 | 96 | 103 |
Karachi | Bajaur | Pishin | ||||
---|---|---|---|---|---|---|
Indicators | 2012 | 2020 | 2012 | 2020 | 2012 | 2020 |
Respondent's knowledge about Polio | 94.1 | 99.5* | 97.5 | 97.7 | 98.4 | 97.0 |
Respondent considers Polio as a health problem | 92.2 | 92.5 | 85.6 | 86.5 | 77.6 | 60.4* |
Respondents having Knowledge about OPV | 99.3 | 99.8 | 96.8 | 99.6 | 97.8 | 97.4 |
Perceptions about the safety of OPV completely safe | ||||||
Completely safe | 76.5 | 76.8 | 61.6 | 62.9 | 49.7 | 41.9 |
Reasonably safe | 11.2 | 13.7 | 11 | 28.1 | 28.9 | 19.3 |
Not safe at all | 1.1 | 4.8 | 2.7 | 1.3 | 1.4 | 9.5 |
Don't Know | 11.2 | 4.7 | 24.7 | 7.7 | 19.7 | 29.3 |
Ever refused for OPV | 5.0 | 23.1* | 17.4 | 25.0* | 20.0 | 19.5 |
Immunization card available | 26.4 | 47.7 | 12.9 | 78.1 | 6.9 | 44.5 |
Immunization status | ||||||
Fully immunized | 52.3 | 55.5* | 28.3 | 67.8* | 56.5 | 68.6* |
Partially immunized | 27.9 | 35.1 | 35.4 | 27.3 | 17.2 | 18.0 |
Un immunized | 19.8 | 9.4* | 35.1 | 5.0* | 25.6* | 13.4 |
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