Mothers' education and socio-economic status remain key aspects to reach full polio immunization coverage: Findings from Pakistan

Background: International spread of polio from Pakistan has been declared a “Public Health Emergency of International Concern” by WHO. Routine immunization coverage in high risk areas remains critically low, creating a... [ view full abstract ]

Background: International spread of polio from Pakistan has been declared a “Public Health Emergency of International Concern” by WHO. Routine immunization coverage in high risk areas remains critically low, creating a serious hindrance in halting polio transmission. Various household level social factors have been linked with low demand and care seeking for vaccination services. We aimed to explore the association of maternal education and socio-economic status with childhood polio immunization using nationally representative data of Pakistani mothers.
Methods: Pakistan Demographic and Health Survey 2012-13 data (n=6982) were used. Polio immunization coverage among children aged up to five years was categorized as full immunization (all four OPV doses), incomplete immunization, and no immunization (zero OPV dose received). Education was categorized as no education, primary, secondary, and higher. Results of Multinomial regression analyses were reported as OR, with 95% confidence interval, adjusted for age, wealth index, and urban/ rural residence.
Results: Only 56.4% (n=3936) of the children received complete polio immunization. Women with no education had significantly higher odds of not taking their child for any polio immunization (OR= 3.96, 95% CI= 1.80, 8.71; p-value <0.01); and incomplete immunization (OR= 1.58, 95% CI= 1.18, 2.12; p-value < 0.01). Further poorest dwellers women also had significantly higher odds of not taking their child for any polio immunization (OR= 3.89, 95% CI= 1.94, 7.79; p-value <0.01); and incomplete immunization (OR= 2.37, 95% CI= 1.70, 3.30; p-value < 0.01).
Conclusion: Illiterate and poorest women remain a high risk group not complying with routine polio immunization efforts, resulting in poor overall immunization coverage in the country.
Public Health Implications: Children of such women may be targeted in Supplementary immunization activities (SIAs) to achieve better immunization coverage, and achieve polio free country in the longer run. Further interventions may be planned for improving their healthcare seeking behaviors.