Barriers to Childhood Immunization in Rural and Remote Areas: A Qualitative Exploration From the Perspectives of Community Leaders in Sindh, Pakistan.

Despite overall improvements observed at the national level, there is a significant disparity in childhood vaccination coverage rates between urban and rural regions, particularly within tribal and remote areas in Pakistan. Our study aimed to explore the views of community/tribal leaders concerning barriers and their local solutions for improving vaccine uptake, with a specific focus on remote settings. An exploratory qualitative research study was conducted from July to September 2019 in Shikarpur, Sindh, Pakistan. We interviewed 11 community leaders, after developing a semi-structured interview guide based on the health belief model. Following validation, the collected data was transcribed and subsequently translated into the English language. A stepwise process of manual familiarization, coding, theme generation, and theme review using an inductive approach was followed. While most of the rural community leaders expressed a willingness to support vaccinations, numerous unexplored barriers were identified. These barriers included an unsustainable communication system heavily dependent on polio mobile teams, discourteous behavior of healthcare personnel, cultural restrictions that limited women's involvement, economic hardships, limited transportation options, insufficient collaboration with the education sector, poor knowledge among community leaders, and security concerns. Additionally, they proposed some innovative solutions of information dissemination methods through the Ottaque system, ethics-based training, subsidized transportation services or voucher system, and addressing security concerns in collaboration with community leaders. Our findings suggest policymakers take both community leaders and members for an inclusive policy-making process to redraft the special policy for these remote and rural areas.

Vaccine Hesitancy and Perceptions of the Community about Polio in High-Risk Areas of Karachi, Sindh, Pakistan.

The study aimed to determine the reasons for polio vaccine hesitancy among parents of persistently missed children (PMCs) in the high-risk areas of Karachi, Pakistan. A cross-sectional survey of parents of PMCs was conducted in April 2019 in 34 high-risk union councils of Karachi. PMCs were randomly selected from the polio program database, and further information was collected on a questionnaire by trained staff using face-to-face interviews with parents of PMCs. A total of 325 participants were included in the study. Among refusals, 112 (37.3%) had no trust in vaccine quality, followed by 45 (15.0%) who were afraid of side effects, 42 (14.0%) whose elders did not allow polio vaccination, 39 (13.0%) who refused due to the influence of negative social media videos, and 20 (6.7%) who had no trust in polio teams. We concluded that misconception is still a big challenge, and the program needs to strive for community acceptance. Low levels of trust in vaccines and teams as well as fear of OPV side effects were among the main reason for vaccine hesitancy. The participant communities recommended involving famous medical doctors, religious influencers, and TV or sports stars to enhance knowledge and acceptance of polio vaccination.