Abstract
Background The World Health Organization’s Global Polio Eradication Initiative (GPEI) has succeeded in reducing the cases of Polio by 99%. The persistence of the remaining 1% in Pakistan, Afghanistan and Nigeria has continued to pose threats to polio-free neighbouring countries. This systematic review aims to contribute to ongoing efforts to eradicate polio by exploring factors that influence the successful implementation of the GPEI in low- and middle-income countries. Methods We reviewed qualitative research or mixed methods study reports published between 2012-2018 from studies conducted in low- and middle-income countries. We extracted qualitative research data using a standardised data extraction form and assessed study quality using the Critical Appraisal Skills Programme (CASP) qualitative checklist. We then conducted best-fit framework synthesis to organise, and explore patterns in, the data relating to new and existing themes. We report data on factors influencing the implementation of polio eradication efforts organised by theme. Results We included 11 studies published between 2012 and 2017. Most of the studies were conducted in Pakistan and Nigeria with other countries (Ethiopia, Cameroon, Angola) also represented. The ten themes included structural factors (the development of capacity, through infrastructure and training) and attitudinal factors (including cultural and religious beliefs), were particularly important given the characteristics of included low- and middle-income countries. Common factors emerged across the included studies and generally these mapped well to the underpinning “best fit” framework. Conclusions This qualitative evidence synthesis offers a useful expanded framework by which policymakers can explore factors specific to their geographical and population-based context although it should be recognised that individual factors relating to personal values and belief systems may moderate any community response to a polio vaccination programme.
Highlights
The World Health Organization’s Global Polio Eradication Initiative (GPEI) has succeeded in reducing the cases of Polio by 99%
The Wild Polio Virus Type 1 (WPV1) is the serotype of the poliovirus that is yet to be eradicated while circulating Vaccine-Derived Poliovirus type 2 is caused by the Oral Polio Vaccine (OPV), the vaccine used for polio eradication
The development of circulating Vaccine-Derived Poliovirus type 2 (cVDPV2) caused by Oral Polio Vaccine (OPV) has led to outbreaks in non-endemic areas following routine immunisation
Summary
We reviewed qualitative research or mixed methods study reports published between 2012-2018 from studies conducted in low- and middle-income countries. We report data on factors influencing the implementation of polio eradication efforts organised by theme. Only qualitative studies or mixed methods studies that reported qualitative findings published between 2012 and 2018 were considered eligible. 2 Unpublished papers were considered provided they reported qualitative findings to minimise publication bias. Searching electronic databases for qualitative studies can be challenging as subject indexing for qualitative papers is poorly developed in some databases. The “pearl growing” strategy was used by identifying a key article on polio eradication from a preliminary database search and using relevant terms to “grow” a list of candidate MeSH headings and free text terms. Terms like “barriers” and “facilitators” were not used as search terms, given that they could be implicit in many relevant abstracts, and greatly increase the number of articles retrieved, without an accompanying increase in accuracy
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