Low vaccination in rural Sindh, Pakistan: A case of refusal, ignorance or access?

Jamal, Durenaz; Zaidi, Shehla; Husain, Sara; Orr, David W.; Riaz, Atif; Farrukhi, Asif A.; Najmi, Rabia

doi:10.1016/j.vaccine.2020.05.018

Cited by 34 publications

(28 citation statements)

References 32 publications

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“…Several articles cited misbeliefs and misperceptions about polio vaccination as a barrier to increasing vaccination rates. The beliefs were of two different types; demographic, geopolitical, and religious concerns, and misbeliefs about when a child could be vaccinated [26,27,[31][32][33]36,[38][39][40][41][42]44,49,53,54,56,65]. Misbeliefs about when a child could be vaccinated were less common, and included caregivers who believed that they could not vaccinate their child if the child was unwell [33,42].…”

Section: Caregiver Beliefs Knowledge and Experiencesmentioning

confidence: 99%

“…Limited knowledge of immunization schedules and the need for multiple polio vaccinations was highlighted by several studies as leading to incomplete polio vaccination [32,33,42,45,52,54]. Conversely, caregiver's awareness of the benefits of polio vaccination for their children was a strong facilitator of vaccination [32,35,42,47,48,56].…”

Section: Caregiver Beliefs Knowledge and Experiencesmentioning

confidence: 99%

“…Frustrations with the lack of essential services such as poor water and sanitation also fostered mistrust in the Pakistani government and contributed to polio vaccine refusal [26,66]. Conversely, the literature highlighted how positive experiences through community outreach activities facilitated polio vaccinations [32,63,64]. The importance of communication strategies such as Sehat Muhafiz (health security) was highlighted by one study as shifting beliefs about polio activities and healthcare workers [63].…”

Section: Caregiver Beliefs Knowledge and Experiencesmentioning

confidence: 99%

“…The importance of communication strategies such as Sehat Muhafiz (health security) was highlighted by one study as shifting beliefs about polio activities and healthcare workers [63]. Several documents highlighted how trust in the healthcare workers delivering vaccination could also foster trust and acceptance of the services provided by these workers, particularly polio vaccines [32,64,65]. A few studies highlighted how caregivers only partially or entirely refused vaccinating their children because they had experienced negative treatment by healthcare workers [42,54].…”

Section: Caregiver Beliefs Knowledge and Experiencesmentioning

confidence: 99%

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Eradicating polio in Pakistan: a systematic review of programs and policies

Ataullahjan

Ahsan

Soofi

et al. 2021

Expert Review of Vaccines

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Introduction: Established in 1994, Pakistan's polio program demonstrated early success. However, despite over 120 supplementary immunization activities in the last decade, polio eradication efforts in Pakistan have been unable to achieve their objective of halting polio transmission. Variable governance, and inconsistent leadership and accountability have hindered the success of the polio program and the quality of the campaigns. Insecurity and terrorism has interrupted polio activities, and community fears and misbeliefs about polio vaccinations continue to persist. Areas covered: The article consists of a systematic review of the barriers and facilitators associated with the delivery of polio eradication activities in Pakistan. We also provide a comprehensive review of the policy and programmatic decisions made by the Pakistan Polio Programme since 1994. Searches were conducted on Embase and Medline databases and 25 gray literature sources. Expert opinion: Polio eradication efforts must be integrated with other preventive health services, particularly immunization services. Addressing the underlying causes of polio refusals including underdevelopment and social exclusion will help counteract resistance to polio vaccination. Achieving polio eradication will require building health systems that provide comprehensive community-centered care, and improving governance and systems of accountability.

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Section: Caregiver Beliefs Knowledge and Experiencesmentioning

confidence: 99%

Section: Caregiver Beliefs Knowledge and Experiencesmentioning

confidence: 99%

Section: Caregiver Beliefs Knowledge and Experiencesmentioning

confidence: 99%

Section: Caregiver Beliefs Knowledge and Experiencesmentioning

confidence: 99%

See 2 more Smart Citations

Eradicating polio in Pakistan: a systematic review of programs and policies

Ataullahjan

Ahsan

Soofi

et al. 2021

Expert Review of Vaccines

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“…These costs also make parents more fearful and susceptible to misinformation that frontline health workers are ill-equipped to counter (Jamal, Zaidi, Husain, Orr, Riaz, Farrukhi, & Najmi, 2020;Bhattacharjee & Dotto, 2020), further impacting trust in the state. Fear closely shadows immunization campaigns in Pakistan.…”

Section: Learning Psychological and Compliance Costs: State Neglect And Citizen Trustmentioning

confidence: 99%

Citizen trust, administrative capacity and administrative burden in Pakistan’s immunization program

Ali

Altaf

2021

JBPA

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Pakistan has the highest infant mortality rate in South Asia, is one of two countries where wild polio is still endemic, and is ranked third for un- or under-immunized children. Why is this the case when considerable donor and government funds have been spent on Pakistan’s Expanded Program for Immunization (EPI)? Based on a year of mixed methods research in district Kasur in Punjab, Pakistan, we focus on vaccination as a site of interaction between citizens and the state and apply the concept of administrative burden to explain vaccine hesitancy in Pakistan. As immunization is a non-means tested program where the state approaches citizens expecting full compliance, we argue that learning, psychological, and compliance costs are exacerbated by the context in which parents interact with frontline bureaucrats. Citizens’ distrust of an often absent or coercive state and low administrative capacity (specifically overburdened staff, inadequate facilities, and rushed digitization) have a multiplier effect on administrative burdens imposed on parents of young children in accessing immunization programs. Therefore, attempts by the state to vaccinate citizens often exacerbate distrust, and limited capacity hinders the state’s ability to reduce the burdens experienced by citizens.

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Factors that influence parents' and informal caregivers' views and practices regarding routine childhood vaccination: a qualitative evidence synthesis

Cooper

Schmidt

Sambala

et al. 2021

Cochrane Database of Systematic Reviews

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Background Childhood vaccination is one of the most effective ways to prevent serious illnesses and deaths in children. However, worldwide, many children do not receive all recommended vaccinations, for several potential reasons. Vaccines might be unavailable, or parents may experience difficulties in accessing vaccination services; for instance, because of poor quality health services, distance from a health facility, or lack of money. Some parents may not accept available vaccines and vaccination services. Our understanding of what influences parents’ views and practices around childhood vaccination, and why some parents may not accept vaccines for their children, is still limited. This synthesis links to Cochrane Reviews of the effectiveness of interventions to improve coverage or uptake of childhood vaccination. Objectives ‐ Explore parents’ and informal caregivers’ views and practices regarding routine childhood vaccination, and the factors influencing acceptance, hesitancy, or nonacceptance of routine childhood vaccination. ‐ Develop a conceptual understanding of what and how different factors reduce parental acceptance of routine childhood vaccination. ‐ Explore how the findings of this review can enhance our understanding of the related Cochrane Reviews of intervention effectiveness. Search methods We searched MEDLINE, Embase, CINAHL, and three other databases for eligible studies from 1974 to June 2020. Selection criteria We included studies that: utilised qualitative methods for data collection and analysis; focused on parents’ or caregivers’ views, practices, acceptance, hesitancy, or refusal of routine vaccination for children aged up to six years; and were from any setting globally where childhood vaccination is provided. Data collection and analysis We used a pre‐specified sampling frame to sample from eligible studies, aiming to capture studies that were conceptually rich, relevant to the review's phenomenon of interest, from diverse geographical settings, and from a range of income‐level settings. We extracted contextual and methodological data from each sampled study. We used a meta‐ethnographic approach to analyse and synthesise the evidence. We assessed methodological limitations using a list of criteria used in previous Cochrane Reviews and originally based on the Critical Appraisal Skills Programme quality assessment tool for qualitative studies. We used the GRADE‐CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each finding. We integrated the findings of this review with those from relevant Cochrane Reviews of intervention effectiveness. We did this by mapping whether the underlying theories or components of trial interventions included in those reviews related to or targeted the overarching factors influencing parental views and...

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Low vaccination in rural Sindh, Pakistan: A case of refusal, ignorance or access?

Cited by 34 publications

References 32 publications

Eradicating polio in Pakistan: a systematic review of programs and policies

Eradicating polio in Pakistan: a systematic review of programs and policies

Citizen trust, administrative capacity and administrative burden in Pakistan’s immunization program

Factors that influence parents' and informal caregivers' views and practices regarding routine childhood vaccination: a qualitative evidence synthesis

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