Immunization

Summary of 2007 KAP survey

Difficult terrain and conservative cultural views combine to pose formidable challenges to immunizing all eligible children across Pakistan’s rural areas. The country has made great progress over the past 15 years, reducing the number of polio infections from 15 – 20,000 per year in 1994 to 90 by 2002.  But completely eradicating the disease requires responsive communication support for all immunization rounds. Constructing that communication system depends upon having quality information about and understanding of local knowledge and attitudes towards polio. 

UNICEF set out to gain that knowledge by conducting a three-phase survey of households in selected districts in each of Pakistan’s four provinces. The multi-round survey, concluded in 2006, identified the networks and channels through which caretakers attain health information as well as the gaps in current knowledge. The survey also defined the constraints and challenges facing healthcare providers and caretakers and the impact on achieving the eradication of polio. 

Distribution of respondents

The survey results were then used to design and implement distinct communication and administrative strategies for each province.  In 2007, UNICEF undertook a Knowledge, Attitudes and Practices (KAP) study to evaluate the impact of the resulting communication efforts on the caretakers in the targeted districts. This fourth round of survey was spread evenly across the four provinces and included many of the same families and participants from rounds II and III. 

The KAP survey selected twelve at-risk districts and interviewed a total of 2,096 households. The respondents were overwhelmingly child caregivers, with the majority being mothers, including 97.3% in NWFP/FATA province. Respondents reported that the most common sources of polio-related information were television, lady health workers (LHW) and healthcare providers. The same sources were also identified as the most trusted. 94.5% of respondents trusted information that came from their doctors, followed closely by television (94.2%), other health providers (88.7%) and elder persons (82.9%).

Noticeably, vaccinators were rarely described as sources of information.  Newspaper and radio were rarely listed as information sources and did not garner much trust from respondents.

The survey delved deeper into the respondents’ knowledge in an attempt to ascertain their level of understanding about the spread and prevention of polio. Overall 94% knew that polio is a serious health problem, a significant improvement from 76% in phase III and only 60% in phase II.  But twenty nine respondents (1.4%) had not heard of polio (24 of them were from NWFP/FATA province). Interviewees were also asked how polio is transmitted and prevented. 44.5% of respondents gave appropriate answers for how polio is spread, an improvement over the 21.2% from Phase II. But many people also provided inappropriate answers and 38% had no idea how poliomyelitis spreads.

There was demonstrated improvement in the knowledge of respondents about how to prevent the spread of poliomyelitis.  However, there is still a considerable knowledge gap in understanding the role of vaccination in prevention and inappropriate responses, such as proper care and keeping away from sick children, remain prevalent. 

The survey revealed that the awareness of polio and how to prevent it is improving in the targeted districts. But refusals remain a challenge suggesting that communication and social mobilization efforts should continue. The survey results also suggest that the public sector should focus on television as a means to communicate to caregivers and LHWs, for it is both widely consumed and highly trusted. 

Healthcare workers should be trained to use polio-focused IPC techniques and these efforts should be supported with consumer-friendly materials, such as brochures, pamphlets and posters. This training should target the knowledge gaps of caretakers including the dangers of poliomyelitis, how it spreads and the best method of prevention.  

Return to Communication for Polio Eradication Pakistan page