title: Parental perceptions surrounding polio and self-reported non-participation in polio supplementary immunization activities in Karachi, Pakistan: a mixed methods study.
abstract: OBJECTIVE
  To assess parent's knowledge and perceptions surrounding polio and polio vaccination, self-reported participation in polio supplementary immunization activities (SIAs) targeting children aged < 5 years, and reasons for non-participation.
  
  
  METHODS
  The mixed methods study began with a cross-sectional survey in Karachi, Pakistan. A structured questionnaire was administered to assess parental knowledge of polio and participation in polio SIAs conducted in September and October 2011. Additionally, 30 parents of Pashtun ethnicity (a high-risk group) who refused to vaccinate their children were interviewed in depth to determine why. Descriptive and bivariate analyses by ethnic and socioeconomic group were performed for quantitative data; thematic analysis was conducted for qualitative interviews with Pashtun parents.
  
  
  RESULTS
  Of 1017 parents surveyed, 412 (41%) had never heard of polio; 132 (13%) did not participate in one SIA and 157 (15.4%) did not participate in either SIA. Among non-participants, 34 (21.6%) reported not having been contacted by a vaccinator; 116 (73.9%) reported having refused to participate, and 7 (4.5%) reported that the child was absent from home when the vaccinator visited. Refusals clustered in low-income Pashtun (43/441; 9.8%) and high-income families of any ethnic background (71/153; 46.4%). Low-income Pashtuns were more likely to not have participated in polio SIAs than low-income non-Pashtuns (odds ratio, OR: 7.1; 95% confidence interval, CI: 3.47-14.5). Reasons commonly cited among Pashtuns for refusing vaccination included fear of sterility; lack of faith in the polio vaccine; scepticism about the vaccination programme, and fear that the vaccine might contain religiously forbidden ingredients.
  
  
  CONCLUSIONS
  In Karachi, interruption of polio transmission requires integrated and participatory community interventions targeting high-risk populations.
authors.affiliation: Aga Khan University, Karachi, Pakistan.
authors.forename: Asif Raza
authors.initials: AR
authors.lastname: Khowaja
authors.forename: Sher Ali
authors.initials: SA
authors.lastname: Khan
authors.forename: Naveeda
authors.initials: N
authors.lastname: Nizam
authors.forename: Saad Bin
authors.initials: SB
authors.lastname: Omer
authors.forename: Anita
authors.initials: A
authors.lastname: Zaidi
mesh_terms: D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003657:Decision Making; D060740:Disease Eradication / Q000379:methods / Q000592:standards*; D005220:Fathers / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration / Q000706:statistics & numerical data; D007223:Infant; D007407:Interviews as Topic; D008297:Male; D009035:Mothers / Q000523:psychology* / Q000706:statistics & numerical data; D010154:Pakistan / Q000453:epidemiology; D011051:Poliomyelitis / Q000208:ethnology / Q000276:immunology / Q000517:prevention & control*; D023321:Poliovirus Vaccines / Q000008:administration & dosage*; D036301:Qualitative Research; D018570:Risk Assessment; D057566:Self Report; D011795:Surveys and Questionnaires; D014944:World Health Organization
chemical_list: D023321:Poliovirus Vaccines