Author: El-Zanaty & Associate
In Egypt, the number of reported polio cases has dropped dramatically, from hundreds at the beginning of the 1990s, to only five 5 cases last year. Although there are few polio cases, the Ministry of Health and Population’s goal is to announce Egypt as free of polio at the end of 2003. In this regard, UNICEF, in collaboration with the Ministry of Health, initiated a strong national communication campaign to support the National Immunisation Days (NIDs), with the aim of immunising all children under five. These three NIDs were conducted in September, October and December 2002. Accordingly, a Baseline Survey was conducted to highlight the design and implementation of communication strategies and the social mobilisation campaign, and to assess its outcomes. Thereafter, a Snapshot Survey was conducted to provide a quick assessment of the outcome of the immunisation of children in the first NID, as well as the results of a polio campaign on knowledge, attitudes, and practices regarding routine and NID polio immunisation. Finally, a Post Survey was conducted to evaluate the changes in public awareness, knowledge, attitudes and practices regarding public participation in the National Immunisation Days.
The goal of this Post Survey is to evaluate the changes in the public awareness, knowledge, attitudes and practices regarding public participation in the NID. Thus, the Post Survey objective was to assess the impact of the NID that could have resulted from direct exposure to the communication campaign. The impact will be measured based on comparing the main indicators that were calculated in the Baseline Survey to that of the Post Survey.
The same sample design and selection methodology of the Baseline Survey were also applied for the Post Survey. The same methodology was employed for the two surveys to allow for a comparison between the Baseline and Post Survey results. The ten governorates that were selected for the Baseline Survey were also selected for the Post Survey. The number of households in each governorate was determined in proportion to the size of the selected governorate (self-weighted sample). Using the household listing in these segments, a systematic random sample of about 20 households was chosen from each segment (98 PSU). Overall, two urban governorates, four governorates from Lower Egypt and four governorates from Upper Egypt were selected for the Post Survey. The Post Survey study included interviews with 2,021 households and 792 caretakers.
Findings and Conclusions:
The results indicate that 98 per cent of caretakers from those who watch TV reported that they saw one of the spots that talk about polio immunisation. 73 per cent of caretakers recalled that "immunisation protects children from polio," and 61 per cent recalled "polio is a dangerous disease" as key messages they remember as a result of watching TV spots. Meanwhile, around 40 per cent of caretakers reported both "there are 3 NID campaigns" and "NID campaign comes to the home".
Around one third of caretakers who listen to the radio, heard a spot about the NID Polio campaign. 63% per cent mentioned that the radio spots talked about "immunisation is important to protect children from polio" and 52 per cent remember that "polio is a dangerous disease". However, very few caretakers heard a radio programme or the song.
The data showed that 60 per cent of caretakers (who read newspapers/magazines) read something about NID polio immunisation in newspapers/magazines. Al-Akhbar newspaper was the main source for caretakers’ information about NID polio immunisation, followed by Al-Ahram.
Overall, more than two-fifths of caretakers saw printed materials, such as posters and balloons, about NID polio immunisation, with clear variation among urban/rural residence. In addition, around two-fifths of caretakers reported hearing megaphones talking about NID polio immunisation and around two thirds of them mentioned that “there are 3 NID campaigns” and “immunisation is important to protect children from polio” as the main messages.
Impact of Communication Campaign on Child Immunisation:
Data indicates a positive impact on practices as a result of exposure to the media campaign. 68 per cent and 56 per cent of caretakers went to immunise their children as a result of watching the “Dream Spot" and “El-Sahha Spot” respectively. 48 per cent immunised their children as a result of watching a television programme, with no differences between urban and rural residence. Regarding the radio spots, 55 per cent of caretakers who listen to radio mentioned that they were motivated by the spots, while 38 per cent of caretakers were motivated by the articles in the newspapers.
Knowledge of Polio Immunisation:
Slightly less than two-thirds of caretakers indicated that the number of polio doses is five, with clear differences between urban and rural areas. Data in Post Survey shows also that caretakers became more knowledgeable of the safety of the polio vaccine. Only 12 per cent mentioned that the vaccine has a side effect, with some differences between regions, while this figure in the Baseline Survey reached 27 per cent.
The data shows also the increase of correct information, where 91 per cent of caretakers mentioned that the polio vaccine administered during NIDs is the same as that used during routine immunisation, while this figure reached 82 per cent in the Baseline Survey. Around 85 per cent of caretakers in both Upper and Lower Egypt reported that NIDs cannot replace the main doses compared to 78 per cent in urban governorates. Highly-educated caretakers and those working for cash are more aware that the main doses cannot be replaced by NID doses, than less educated caretakers and those who are not working for cash.
83 per cent of all caretakers mentioned that extra doses will not harm the child compared to 64 per cent in the Baseline Survey. As a consequence of not receiving all doses of the polio vaccine, data shows that about 60 per cent mentioned that the child “surely will have polio,” with some differentials between regions. Data in Post Survey shows that slightly more than three quarters of caretakers mentioned that a child could be immunised while having fever, compared to 36 per cent only in the Baseline Survey.
Public Participation in the NIDs:
Coverage of NIDs was universal among children under five years. The results show that almost all children received a dose at the last NID (December, 2002), with slight differentials between urban and rural areas. Regarding the reasons for immunising children at the last NID, 62 per cent of caretakers mentioned that “we must immunise our children at the NID,” while 60 per cent mentioned “NID is important”. 85 per cent mentioned that the last NID campaign came to their home, 8 per cent took the vaccine at the health facility, and 3 per cent took the vaccine at the Mobile NID units. Similar results were observed for the participation of the public in the second NID of October 2002.
In the meantime, 96 per cent of the children under five were immunised in the first NID (September 2002). 82 per cent of the children under five were immunised at the first NID at their homes, 9 per cent mentioned that immunisation took place at the health unit and 4 per cent mentioned the mobile NID units.
A strong and integrated media campaign should continue to maintain the momentum achieved in the 2002 NIDs.
TV spots should be aired frequently at different times throughout the day to reach all audiences to support the coming NID rounds, since this has proven to be a key, successful medium.
NID teams should be better organized to reach all households with children under five to validate media messages.
Community-level awareness activities are also important to maintain, particularly, microphones since they easily reach various target populations in rural and urban areas.
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Ministry of Health, USAID, WHO, Rotary International