Abstract
BackgroundThe success of the Global Polio Eradication Initiative was remarkable, but four countries - Afghanistan, Pakistan, India and Nigeria - never interrupted polio transmission. Pakistan reportedly achieved all milestones except interrupting virus transmission. The aim of the study was to establish valid and reliable estimate for: routine oral polio vaccine (OPV) coverage, logistics management and the quality of monitoring systems in health facilities, NIDs OPV coverage, the quality of NIDs service delivery in static centers and mobile teams, and to ultimately provide scientific evidence for tailoring future interventions.MethodsA cross-sectional study using lot quality assessment sampling was conducted in the District Nankana Sahib of Pakistan's Punjab province. Twenty primary health centers and their catchment areas were selected randomly as 'lots'. The study involved the evaluation of 1080 children aged 12-23 months for routine OPV coverage, 20 health centers for logistics management and quality of monitoring systems, 420 households for NIDs OPV coverage, 20 static centers and 20 mobile teams for quality of NIDs service delivery. Study instruments were designed according to WHO guidelines.ResultsFive out of twenty lots were rejected for unacceptably low routine immunization coverage. The validity of coverage was questionable to extent that all lots were rejected. Among the 54.1% who were able to present immunization cards, only 74.0% had valid immunization. Routine coverage was significantly associated with card availability and socioeconomic factors. The main reasons for routine immunization failure were absence of a vaccinator and unawareness of need for immunization. Health workers (96.9%) were a major source of information. All of the 20 lots were rejected for poor compliance in logistics management and quality of monitoring systems. Mean compliance score and compliance percentage for logistics management were 5.4 ± 2.0 (scale 0-9) and 59.4% while those for quality of monitoring systems were 3.3 ± 1.2 (scale 0-6) and 54.2%. The 15 out of 20 lots were rejected for unacceptably low NIDs coverage by finger-mark. All of the 20 lots were rejected for poor NIDs service delivery (mean compliance score = 11.7 ± 2.1 [scale 0-16]; compliance percentage = 72.8%).ConclusionLow coverage, both routine and during NIDs, and poor quality of logistics management, monitoring systems and NIDs service delivery were highlighted as major constraints in polio eradication and these should be considered in prioritizing future strategies.
Highlights
The success of the Global Polio Eradication Initiative was remarkable, but four countries Afghanistan, Pakistan, India and Nigeria - never interrupted polio transmission
Pakistan reportedly achieved all targets set in the Global Polio Eradication Initiative (GPEI) strategic plan but failed to interrupt virus transmission [5,9,10,11], probably due to sub-district coverage gaps, low routine coverage, operational weaknesses in the quality of services and large numbers of children missed during National Immunization Days (NIDs)/SNIDs
For random selection of the lots of the catchment areas of primary health centers, primary health centers, static centers and mobile teams; a line listing of all the respective areas/facilities was obtained from the District Department of Health and the sample was randomly selected by using two-digit random number table generated by Epi Info 6. [Additional file 3]
Summary
The success of the Global Polio Eradication Initiative was remarkable, but four countries Afghanistan, Pakistan, India and Nigeria - never interrupted polio transmission. Pakistan adopted the Polio Eradication Initiative (PEI) within the Expanded Program on Immunization (EPI) in 1994 remarkably decreasing the number of cases to 32 by 2007 including 19 WPV type 1 and 13 WPV type 3 cases with virus found in 18 of 120 districts [2,6,7,8]. Pakistan reportedly achieved all targets set in the GPEI strategic plan but failed to interrupt virus transmission [5,9,10,11], probably due to sub-district coverage gaps, low routine coverage, operational weaknesses in the quality of services and large numbers of children missed during NIDs/SNIDs. The scenario calls for immediate action
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