Knowledge, Attitude and Perception towards Polio Immunization

Introduction

Poliomyelitis is an acute communicable disease of humans caused by 3 poliovirus serotypes (types 1, 2 or 3). Where sanitation is poor, these viruses are believed to spread mainly by fecal-to-oral transmission, whereas the oral-to-oral mode of transmission probably dominates in settings with a high standard of sanitation. In the pre-vaccine era, virtually all children were infected by polioviruses, and on average 1:200 susceptible individuals developed paralytic poliomyelitis [1].

Poliomyelitis is a highly contagious and incurable disease, which mainly affects children under five years of age leading to irreversible paralysis and possibly death [2]. The virus is transmitted by person-to-person and is spread mainly through the fecal-oral route [3]. Polio can be easily transmitted when someone infected with the poliovirus has close contact with many other people, such as in day care centres and family homes. Thereafter, the virus multiplies in the intestine, from where it can invade the nervous system and cause paralysis.

The disease was controlled using the formalin- inactivated Salk polio vaccine (IPV) and the Sabin oral polio vaccine (OPV). Global poliomyelitis eradication was proposed in 1988 by the World Health Organization to its member states. OPV is the vaccine of choice for the poliomyelitis eradication program because it induces both a systemic and mucosal immune response. The supplementary immunization with monovalent strains of OPV type 1 or type 3 or with a new bivalent oral polio vaccine bOPV (containing type 1 and type 3 PV) has been introduced in those regions where the virus has been difficult to control.

Medin first reported the epidemic form of this disease in 1890, after an epidemic of 44 cases in Stockholm in the summer of 1887. He recognized a systemic phase of the disease which often failed to progress to neurological paresis and developed the classification of that. Pakistan is one of three remaining polio-endemic countries in the world, along with Afghanistan and Nigeria. However, since the launch of the Pakistan’s Polio Eradication Programme in 1994, there has been a massive decline in polio cases in Pakistan from approximately 20,000 every year in the early 1990s to only eight cases in 2017. Polio has been circulating in the Pakistani regions of Karachi, Northern Sindh, Quetta, and areas in Federally Administrative Tribal Areas (FATA.

A survey conducted by Harvard Opinion Research Program in collaboration with UNICEF reported low OPV coverage in higher conflict areas of Pakistan (eg FATA), parents’ misperceptions about polio virus and OPV, and lack of parental trust on local healthcare workers [4].

Globally various studies have been reported on knowledge, attitude and perception of general public regarding polio immunization and showed that success of immunization depends on positive attitude and knowledge of public. Many studies identified that positive attitude and adequate knowledge about immunization increased the immunization rate up to 90% [5]. There is no cure for poliovirus infection. Treatment focuses on managing the consequences of severe muscle weakness. This may include admission to intensive care to assist with breathing, and physiotherapy or medicines to reduce muscle spasm [4]. Polio virus can be prevented by excluding people with polio from childcare, preschool, school and work  until a public health doctor has given a clearance to return. In addition to proper hygiene and hand washing techniques, the best way to prevent polio is by being vaccinated. The polio vaccine, or IPV (Inactivated polio vaccine), is recommended four times, when child is 2 months old, 4 months old, between 6 and 18 months old and between 4 and 6 years old (children 7 to 18 years old may catch up as needed) [6].

Two types of polio vaccines are available which include; a live attenuated or weakened oral polio vaccine (OPV) commonly called the Sabin vaccine which is administered orally, and an inactivated (killed) polio vaccine (IPV) commonly called the Salk vaccine which is administered via injection [7]. Present study was conducted to determine the Knowledge, Attitude and Perception of polio immunization among the people of Lahore Pakistan. Questionnaires were distributed among people in hospitals and community.

Discussion

Study was conducted to asses’ knowledge, attitude and perception among people regarding polio immunization in Lahore Pakistan. Polio cases have decreased by over 99% since 1988, from an estimated 350, 000 cases in more than 125 endemic countries, to 650 reported cases in 2011. In 2012, only parts of three countries in the world remained endemic for the disease.

The results of this study revealed that people have adequate knowledge about polio and wanted to eradicate it from Pakistan by participating in vaccination activities but still there are few people who believe that Polio vaccine cannot prevent disease resulting in failure to get vaccine for their children. All these gaps in vaccination can be addressed by improving literacy rate and use of print and electronic media for creating awareness of the disease.

Participants were aware of the terminology of polio and the fact that it is caused by virus. A large proportion of participants wrongly believed that polio vaccines should not be given to children with mild illnesses. Respondents’ knowledge about symptoms was also not very encouraging as only few correctly answered that most patients do not develop sub-clinical symptoms.

The main reasons for routine immunization failure were unawareness of need for immunization. This study also revealed that most people knew about the schedule of the vaccination. Most participants knew that polio could be prevented through routine immunization, but they lack accurate knowledge about transmission and spread of poliovirus. Participants with low income, no formal education and residents of rural locality are also less likely to be knowledgeable about polio. Data on refusals of oral polio vaccine indicated that most participants did so because they believed inaccurate information propagated by religious preachers. For instance, parents believed that the oral polio either causes infertility in children or is not Halal; both are consistent with a recent study in Pakistan.

It is noteworthy to mention that the study highlighted the significant association of knowledge with the age of the participants. Youngsters appeared to be more knowledgeable than older ones. Religious and social beliefs appeared to be the major barrier preventing the disease from tipping over into complete eradication. These findings clearly support recommendations that for polio eradication, different modes of information, education, and communication strategies must be adopted.

Conclusion

Most of the participants had adequate knowledge & wanted the complete elimination of polio from Pakistan but there are still few people who have improper knowledge & they don’t believe in these campaigns which lead to failure of eradicating polio. It is recommended that these gaps in knowledge should be addressed by use of print and electronic media for creating awareness of the disease.