Abstract

Introduction: Since the launch of the Global Polio Eradication Initiative (GPEI) in 1988, the number of annual polio cases has decreased by >99%. As of March 2013, circulation of indigenous wild poliovirus (WPV) continued in only three countries: Afghanistan, Nigeria and Pakistan. Pakistan is one of only three endemic countries in the world still struggling to interrupt poliovirus transmission and meet the target of global polio eradication by 2012. The failures to successfully immunize the population of Pakistan has impacted child mortality in the country and is an important area of research for the progression of child healthcare. Children who are under the age of five make up 15% of the population of Pakistan. Unfortunately, this demographic makes up 50% of the mortality rate in this country. Polio is an acute viral disease that is still endemic in Pakistan mainly due to failure of efforts to promote community participation. The polio vaccination program is facing many challenges that result in an increased number of new cases in the country. This research was conducted to find out the parents’ knowledge, attitudes and practices regarding polio vaccination. Pakistan is still not polio free and findings of this research reflect the mindset of parents regarding polio vaccination.

Objective: To determine the perceptions of parents regarding polio vaccination at National Institute of Child Health in Karachi.

Methodology: A Cross sectional study was conducted at the OPD of National Institute of Child Health in Karachi from April 2019 to August 2019. The participants were the parents of children under five years of age who had brought the latter for treatment at the hospital. The sample size was calculated to be 385. The sample was selected using non probability purposive sampling technique. A structured questionnaire with close ended questions was the data collection tool. It was translated into simple Urdu. It was handed out to our data collectors who after obtaining verbal consent, conducted personal interviews amongst the parents of children who had come to the OPD. Data collected was analyzed using the SPSS software version 20.0. Frequencies and percentages were taken out for categorical variables. The statistical analysis was conducted with a 95% confidence interval and a p-value of <0.05 as threshold of statistical significance. All ethical considerations were observed. Any research misconduct was avoided and rights and well-being of research participants were protected.

Results: Out of the 385 parents of children under five years, their frequencies and percentages with respect to their age ranges, 63.9% (n=246) were 18-22 years, 23.4% (n=90) were 23-26 years, 8.8% (n=34) were 27-30 years, 3.1% (n=12) were 31-40 years and 0.8% (n=3) were more than 40 years. Regarding the relationship status with the under five children the participants accompanying them, 51.4% (n=198) were fathers and 48.6% (n=187) were mothers. According to the literacy status, 43.4% (n=167) of the parents were educated and 56.6% (n=218) were uneducated. When asked what polio was, 68.1% (n=263) called it a disease, 18.7% (n=72) called it fate, 4.4% (n=17) termed it as a superstitious happening and 8.5% (n=33) did not know what it was. Stating their source of information about polio, 31.1% (n=120) learnt about it from TV, 11.4% (n=44) from the internet , 48.2% (n=186) through their surroundings and 9.1% (n=35) learnt about polio from polio workers. Describing polio severity, 110(28.5%) called polio severe, 56.6% (n=216) termed it extremely severe, 6% (n=23) regarded it as moderate and 9.3% (n=36) as mild. When asked about any relative of the parents who suffered from polio , 25.1% (n=97) said yes and 74.4% (n=287) said no. Responding to the question about mode of spread of polio, according to 30.3% (n=117) by food and water, 16.8% (n=65) airborne, 11.7% (n=45) by vector and 40.9% (n=158) did not know the mode of spread of polio. According to 65.8% (n=264) a vaccine existed for polio, 13.2% (n=51) denied existence of polio vaccine, 5.2% (n=20) were not sure and 15.5% (n=60) did not know about such a vaccine. About the mode of administration of polio vaccine, 74.1% (n=286) thought it was oral, 6.7% (n=26) thought it was parenteral and 68 (17.6%) did not know. When asked at what age should a child get polio vaccine, according to 33.4% (n=129) it was at birth, 51.8% (n=200) during childhood, 5.2% (n=20) during adulthood and according to 9.3% (n=36) parents a child could get polio vaccine at any age. Responding to the question regarding polio vaccine effectivity, 58% (n=224) termed it as good, 19.4% (n=75) called it normal, 11.9% (n=46) referred to it as not effective and 10.4% (n=40) had no idea.

When asked whether their child can become sterile after taking polio vaccine, 23.6% (n=91) said yes, 50.5% (n=195) said no, 12.7% ( n=49) said maybe and 13% (n=50) said that they did not know. Replying to question if polio can be caused by malnutrition, 23.6% (n=91) said yes, 39.1% (n=151) said no, 16.1% (n=62) said maybe and 21%(n=81) did not know. When asked whether polio vaccine was haraam or forbidden in religion, 72.5% (n=279) said no and 27.5% (n=106) said yes. Responding to the question whether there were proper preventive measures against polio in Karachi, 58% (n=224) said yes, 20.7% (n=80) said no, 7.5% (n=29) said maybe and 13.5% (n=52) did not know. Giving answers to how many times did polio workers had visited the parents’ houses, 9.6% (n=37) said monthly, 33.4% (n=129) said twice a year, 43.8% (n=169) said once a year and 12.4% (n=48) said that polio workers never visited their homes. When asked whether there were any preventive measure available against polio other than vaccination, 20.2% (n=78) said yes, 49% (n=189) said no and 28.2% (n=109 ) said maybe; replying to the question was polio a contagious disease, 28.2% (n=109) said yes, 69.7% (n=269) said no and 1% (n=4) said maybe. Giving answer to the question whether polio as a disease was treatable, 38.3% (n=148) said yes, 59.8% (n=231) said no and 1.6% (n=6) said maybe. When asked if any member of their family was suffering from polio, 22% (n=85) said yes and 76.9% (n=297) said no. When asked the question if those suffering from polio in their family received polio drops at the time of vaccination, 39.6% (n=153) said yes and 60.1% (n=232) said no.

Conclusion: Pakistan is among three countries in which polio is still endemic. Most of the cases sprouting up in the city are from slum areas where the majority of the population is uneducated. Several religious and fictional beliefs and misconceptions have been playing a pivotal role in keeping polio endemic in the area despite many sincere efforts of government. More efforts are needed to be done in this respect particularly in educating parents of children and carrying out social campaigns to spread awareness among every single parent and make them affirm that polio is preventable and by only vaccinating their children they can save them from this disease .

Key words: polio vaccination, endemic, parents, misconceptions