KARACHI: Pakistan, like the rest of the world, can effectively address the challenges posed by polio, especially in its conflict-hit areas, by introducing community-based strategies and integrating campaigns aimed at eradicating polio with maternal health services and routine immunisation.

This is one of the key findings of a research published on Monday in The Lancet Global Health, an international online journal.

Titled “Community engagement and integrated health and polio immunisation campaigns in conflict-affected areas of Pakistan: a cluster randomised controlled trial”, the four-year study involved experts from the Aga Khan University (AKU), the Peshawar Medical College (PMC), the London School of Hygiene and Tropical Medicine, and Canada’s Centre for Global Child Health at the Hospital for Sick Children in Toronto.

Under the study, a range of health interventions were tested in 387 insecure areas in Bajaur, Karachi and Kashmore.

Community-based strategies, integrated campaigns key to success

The study showed that eight out of 10 families in these areas agreed that their child receive the inactivated polio vaccine (IPV) — a highly effective vaccine which is administered through an injection — when it was delivered as part of a comprehensive health package that provided vital hygiene, nutrition and antenatal services to mothers and children.

It also disproved the view that providing an anti-polio injection, alongside polio drops (the oral poliovirus vaccine), would result in opposition from the community.

Over 50,000 families benefitted from the interventions introduced during the study.

“Our package of interventions enabled us to boost coverage of the oral polio vaccine by 8.5 per cent in areas where there was previously fierce opposition to immunisation campaigns,” said Professor Zulfiqar A. Bhutta, senior author of the study and founding director of AKU’s Centre of Excellence in Women and Child Health.

“The step to organise temporary health camps providing broad-based health services ensured that the team reached two-thirds of targeted children and families and helped provide booster injections to ensure that every child stayed on track with the four-dose schedule needed to eradicate polio,” he added.

Barriers identified

During the study, researchers identified a range of problems leading to new cases of polio being reported in the country every year. These challenges included children not being present at home during immunisation drives, healthcare workers being denied access to particular areas or being unable to cover all homes in an area, and doubts among people over the vaccination activity.

Researchers were able to expand coverage of the polio vaccine in insecure areas by deploying a wide range of approaches.

These interventions included the introduction of pictorial health awareness campaigns, community mobilisation, engagement through local volunteers and running of holistic health camps after national immunisation drives that addressed the unmet need for mother and child health services in these areas.

“Ensuring that no child is missed in polio vaccination campaigns is especially challenging in Bajaur and parts of Karachi where the law and order situation limits access to vaccinators.

“There is also widespread suspicion over the immunisation activity in the country which is why one of the approaches we tested involved building trust within communities,” said Dr Sajid Soofi, an associate professor in paediatrics and child health at the AKU, who was also involved in the research.

Speaking about the value of these approaches, Dr Saeed Anwar, an associate professor in community health sciences at the PMC, said: “By winning the confidence of local stakeholders including community leaders, teachers and religious leaders, we were able to gain access to previously unreachable areas and thereby protect more children from this preventable disease, now prevailing only in Afghanistan, Nigeria and Pakistan.”

The research team worked closely with the World Health Organisation, Unicef, the Bill and Melinda Gates Foundation, as well as the provincial and federal governments to generate evidence that could help achieve the objectives of the National Emergency Plan and WHO’s polio eradication initiative.

“Importantly, the study’s findings also contribute to targets related to vaccine coverage and immunisation against communicable diseases under Goal 3 of the Sustainable Development Goals,” Prof Bhutta observed.

Previous research by the AKU, which was published in Science Direct in 2013, demonstrated that the use of booster IPV doses enhanced immunity in children.

This study also generated evidence and strengthened the case made by the WHO’s Strategic Advisory Group of Experts (SAGE) on Immunisation for booster doses of IPV to be made a part of routine immunisation programmes around the world.

The study was funded by the Bill and Melinda Gates Foundation.

Published in Dawn, May 9th, 2017