KARACHI, Nov 10: While assessing the knowledge and perception of parents in Karachi about polio vaccine during two sub-national immunisation drives in Sept to Oct 2011, researchers found that the refusals were clustered in two groups. However, what came as a surprise was that it was not just the low-income group which eyed the polio vaccine with sceptism. Ironically, the highest percentage of refusals, 46.4 per cent, was gathered from people living in high-income areas.

The research was published last week in the WHO bulletin. It discussed the lack of knowledge about polio, mistrust about the effectiveness of polio vaccine and myths about its side-effects. The researchers, most of whom were from the Aga Khan University Hospital, gathered data across Karachi from the two sub-national immunisation drives in specific districts held in Sept and Oct 2011 and surveyed households in 18 towns and one cantonment in Karachi.

According to the study, the lowest percentage of refusals, zero per cent, was reported from Baldia, Lyari, Saddar, Shah Faisal and Gulberg, while the highest percentage of refusals, 71 per cent, were from people living in DHA and Clifton. The second cluster group from which emerged the second highest percentage of refusals, 9.8 per cent, were the Pashto-speaking people living in low-income areas.

According to the report, among the well-off parents who were interviewed in five big shopping malls across the city, in view of difficulties in previous field work in accessing households in affluent areas because of security measures.

Among the parents who were interviewed, 72 per cent of the parents believed that the polio vaccine was harmful while 8.5 per cent thought it was unnecessary. A lot of parents who were interviewed also believed that the vaccine caused sterility in adulthood — a concern shared by parents from the low-income Pakhtun community — and that it was a conspiracy against Muslims.

“The polio vaccine was prepared in the West and sent here,” said parents. “It is given to our children to destroy their ability to reproduce.”

Around one-third of the parents said that they did not believe that the vaccine would actually work against polio. “It is no good because one of my friends has polio even though he was vaccinated against it,” said another parent.

Some parents felt that since their children had been vaccinated before, they didn’t need to be vaccinated again through government’s immunisation drives while others doubted the government’s exhaustive efforts against polio. “Why does the government and health system give so much emphasis to polio vaccine?” they asked. “There are so many other diseases that should be addressed first.”

A few parents also mentioned the poor maintenance of the vaccine cold chain as a reason for not vaccinating their children vaccinated against polio. Other reasons included difficulty in communicating with the polio vaccinator because of a language barrier and fear of side-effects such as fever, bloating of skin, weakness, etc.

Low-income Pakhtun community

Meanwhile, the Pashto-speaking people living in low-income areas from where the second highest percentage of refusals was gathered, thought that the vaccine would make the children sterile and contained haram (forbidden in Islam) ingredients. They believed that the vaccine would be ineffective and were also sceptical of the vaccination programme.

In-depth interviews were conducted of around 30 Pashto-speaking parents who had refused to vaccinate their children. The study showed that it was seven times more likely that low-income Pashto-speaking children did not participate in the polio supplementary immunisation activities (SIA) as compared to low-income populations of other ethnic groups.

According to the report, the odds of not knowing about polio were 2.2 times higher among low-income Pashto-speaking parents as compared to other low-income ethnic groups. The Pashto-speaking parents were also six times more likely to have never heard about polio SIA in their area as compared to other low-income households.

The reason, according to Dr Anita Zaidi of Aga Khan University Hospital, who led the research, was that the Pashtun community had high rates of migration and displacement while low rates of polio vaccination.

A report published in earlier this year in February by the Independent Monitoring Board of the Global Polio Eradication Initiative had also highlighted this fact. The report had stated that the large nomadic and internally-displaced population combined with the refusal of some parents to have their children vaccinated, had made the goal of eliminating polio from Pakistan elusive. It had also been observed that significant differences in polio awareness and participation in SIAs between the low-income Pashtun community and other low-income groups.

Polio in Karachi

Explaining the reasons for conducting this research in Karachi, said that Karachi was chosen because it is the only megapolis in the world which has been unable to stop the spread of polio.

Dr Zaidi said that the risk of transmission of polio virus in Karachi was among the highest in the country. She said that very few studies, which evaluate the results of polio supplementary immunisation activities (SIA) in the city, have been published.

“Given Karachi’s cultural and ethnic diversity, we studied a large representative sample of individuals living in different areas to assess parents’ knowledge of polio, the rate of not participating in polio SIAs and their reasons for not doing so,” she said. “We ensured that the Pashtun community had adequate representation. They comprise an estimated 35 to 40 per cent of Karachi’s population and suffer from 90 per cent of the reported cases.”

For the gathering data, a structured questionnaire was distributed among parents. It emerged in the study that out of the 1,017 parents who participated in the research, 41 per cent (412) had never heard of polio. Around 13 per cent, (132) did not participate in one of the SIAs conducted from Sept to Oct 2011, and 15.4 per cent (157) did not participate in either.

Among those who did not participate in the vaccination programmes, 21.6 per cent (34) parents said that they hadn’t been contacted by a vaccinator, 73.9 per cent (116) said that refused to have their children vaccinated, and 4.5 per cent (7) parents said that the children hadn’t been home when the vaccinators visited.

The report said that the reasons cited above would make it highly probable that the transmission of the polio virus continues unless targeted action was not taken to promote vaccination, while recommending integrated efforts by government and communities, and community interventions for targeting high-risk populations to stop the spread of polio in Karachi.

In 2011, nine cases of polio were reported in Karachi, two cases each from Baldia, Gadap and SITE, and one case each from Saddar, Orangi and Gulshan-i-Iqbal. No cases have been reported this year so far.