IDENTIFYING BARRIERS TO EFFECTIVE IMMUNIZATION AND MISSED OPPORTUNITIES IN RURAL AREAS OF PAKISTAN.
Main Article Content
Keywords
Immunization, Rural Health, Barriers, Vaccination, Qualitative
Abstract
Introduction: The vaccination process is necessary for the public health system to prevent the development of infectious diseases. Rural populations are more likely to face various difficulties than urban populations, such as accessing centers to receive life-saving vaccines. Due to this neglect, the vaccination rate is lower. This article will examine the challenges of vaccination in rural areas of District Poonch Pakistan and distill the obstacles and missed opportunities.
Objectives: The goal of the study is to get a better understanding of barriers to effective immunization to enhance immunization rates and achieve improved public health in the area from an emic perspective. To document the obstacles and opportunities lost related to immunization in remote areas of District Poonch, AJK.
Methods: The article conducted a study among parents and healthcare providers living in rural areas through in-depth interviews. The qualitative research method and a grounded theoretical approach were used. The interview results were analyzed using thematic analysis techniques to identify common themes and patterns present in the data.
Results: The study reported five meta themes and several sub-themes on important issues related to vaccine uptake. Several important issues were revealed by the data, which were related to access and transportation issues, lack of knowledge and awareness gap, socioeconomic barriers, health infrastructure issues, and most importantly, community support for the vaccination program shows room for improvement.
Conclusion: This study focuses on the challenges of vaccinating people living in remote areas. Policymakers and healthcare professionals can use information from this study to improve vaccination rates in underserved communities. Additional research and initiatives are needed to address the challenges and ensure equal access to vaccines for everyone.
References
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60. Rutherford, M. E., Dockerty, J. D., Jasseh, M., Howie, S. R., Herbison, P., Jeffries, D. J., . . . Hill, P. C. (2009). Preventive measures in infancy to reduce under‐five mortality: a case–control study in The Gambia. Tropical Medicine & International Health, 14(2), 149-155.
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63. Yazdani, A. T., Muhammad, A., Nisar, M. I., Khan, U., & Shafiq, Y. (2021). Unveiling and addressing implementation barriers to routine immunization in the peri-urban slums of Karachi, Pakistan: a mixed methods study. Health Research Policy and Systems, 19, 1-9
2. Ahmed, V. &. (2014). Poverty and social impact analysis of expanded program on immunization in Pakistan.
3. Deal, A. C. (2023). Defining drivers of underimmunization and vaccine hesitancy in refugee and migrant populations. Journal of Travel Medicine, , 30(5), taad084.
4. Fadl, N. A. (2024). Routine childhood immunization in Sub-Saharan Africa: addressing parental vaccine hesitancy. . Public Health,, 226, 66-73.
5. Gul, S. &. (2016). Immunisation knowledge and practices among mothers attending a paediatric clinic in Karachi, Pakistan. International Journal of Advances in Medicine,, 3(3), 656-61.
6. Habib, S. S. (2024). Social determinants of low uptake of childhood vaccination in highrisk squatter settlements in Karachi, Pakistan–A step towards addressing vaccine inequity in urban slums. Vaccine: X,, 17, 100427.
7. Holon, I. Q. (2024). Health Innovation & Technology in Latin America & the Caribbean.
8. Hossain, I. M. (2021). Rethinking Strategies to Address Inequity in Immunization Services towards Achieving Universal Immunization Coverage (UIC) in
9. Karachi, Pakistan.
10. Hu, Y. W. (2018). Measles vaccination coverage, determinants of delayed vaccination and reasons for non-vaccination among children aged 24–35 months in Zhejiang province, China. BMC public health,, 18, 1-8.
11. Husain, S. &. (2016). Routine immunization services in Pakistan: seeing beyond the numbers. EMHJ-Eastern Mediterranean Health Journal, , 22(3), 201-211.
12. Jammeh, A. M. (2023). Comparing full immunisation status of children (0–23 months) between slums of Kampala City and the rural setting of Iganga District in Uganda: a cross-sectional study. . BMC Health Services Research, 23(1), 856.
13. Levin, A. B. (2023). Cost-effectiveness of measles and rubella elimination in lowincome and middle-income countries. . BMJ Global Health, 8(7), e011526.
14. Masud, T. &. (2012). The expanded program on immunization in Pakistan: recommendations for improving performance.
15. Minta, A. A. (2023). Progress toward measles elimination—Worldwide, 2000–2022. India: Morbidity and Mortality Weekly Report.
16. Muhammad, A. A. (2023). Barriers to childhood vaccination in urban slums of Pakistan.
17. Eastern Mediterranean Health Journal,, 29(5), 371-379.
18. Murtaza, F. M. (2016). Determinants of nonimmunization of children under 5 years of age in Pakistan. Journal of Family and Community Medicine,, 23(1), 32-37.
19. Pickering, L. K. (2009). Immunization programs for infants, children, adolescents, and adults: clinical practice guidelines by the Infectious Diseases Society of America. Clinical Infectious Diseases, 49(6), 817840.
20. Qayyum, K. R. (2021). Addressing community barriers to immunization in Rajanpur district, Pakistan: an implementation research. . Journal of Global Health Reports, 5, e2021088.
21. Rutten, L. (2023). Barriers to HPV Screening and Prevention in Latin America:. A systematic Review.
22. Ryman, T. K. (2008). Too little but not too late: results of a literature review to improve routine immunization programs in developing countries. BMC Health Services Research, , 8, 1-11.
23. Saman, S. C. (2023). Vaccines: an important tool for infectious disease. Recent Advances in Anti-Infective Drug Discovery Formerly Recent Patents on Anti- Infective Drug Discovery,, 18(2), 88-109.
24. Shaikh, B. T. (2012). Strengthening health system with key strategies in the post devolution times in Pakistan.
25. Shen, A. K. (2014). The future of routine immunization in the developing world: challenges and opportunities. . Global Health: Science and Practice,, 2(4), 381394.
26. Singh, S. S. (2019). Barriers and opportunities for improving childhood immunization coverage in slums: A qualitative study. Preventive medicine reports, , 14, 100858.
27. Sodha, S. V. (2015). Strengthening routine immunization systems to improve global vaccination coverage. British medical bulletin,, 113(1), 5.
28. Stein, R. A. (2011). Vaccination: A public health intervention that changed history & is changing with history. The american biology Teacher,, 73(9), 513-519.
29. Tampi, M. C.-L.-G.-P. (2023). Systematic review on reducing missed opportunities for vaccinations in Latin America. Revista Panamericana de Salud Pública,, 46, e65.
30. Tampi, M. C.-L.-G.-P. (2023). Systematic review on reducing missed opportunities for vaccinations in Latin America. Revista Panamericana de Salud Pública, 46, e65.
31. Tang, X. Y. (2021). Multi-level determinants of failure to receive timely and complete measles vaccinations in Southwest China: a mixed methods study. Infectious Diseases of Poverty, , 10, 1-14.
32. Van Pelt, A. E.-N. (2023). Recommendations for empowering partners to conduct implementation research in Latin America to advance global health. Global Implementation Research and Applications,, 3(4), 390-399.
33. Wagner, A. L. (2014). Timely measles vaccination in Tianjin, China: a crosssectional study of immunization records and mothers. BMC public health,, 14, 1-7.
34. Abdulraheem, I., Onajole, A., Jimoh, A., & Oladipo, A. (2011). Reasons for incomplete vaccination and factors for missed opportunities among rural Nigerian children. J Public Health Epidemiol, 3(4), 194-203.
35. Barman, D., & Dutta, A. (2013). Access and barriers to immunization in West Bengal, India: quality matters. Journal of health, population, and nutrition, 31(4), 510.
36. Carter, A., Msemburi, W., Sim, S. Y., Gaythorpe, K. A., Lambach, P., Lindstrand, A., & Hutubessy, R. (2023). Modeling the impact of vaccination for the immunization Agenda 2030: Deaths averted due to vaccination against 14 pathogens in 194 countries from 2021 to 2030. Vaccine.
37. Cheng, M., Lan, T., Geater, A., Deng, Q.-Y., Lin, Y.-D., Jiang, L.-Y., . . . Tang, X.-Y. (2023). Health system barriers to timely routine measles vaccinations in rural southwest China: a qualitative study on the perspectives of township vaccination professionals and village doctors. BMJ open, 13(11), e072990.
38. Duclos, P., Okwo-Bele, J.-M., Gacic-Dobo, M., & Cherian, T. (2009). Global immunization: status, progress, challenges and future. BMC international health and human rights, 9, 1-11.
39. Garchitorena, A., Ihantamalala, F. A., Révillion, C., Cordier, L. F., Randriamihaja, M., Razafinjato, B., . . . Rakotonirina, J. (2021). Geographic barriers to achieving universal health coverage: evidence from rural Madagascar. Health Policy and Planning, 36(10), 1659-1670.
40. Guzman-Holst, A., DeAntonio, R., Prado-Cohrs, D., & Juliao, P. (2020). Barriers to vaccination in Latin America: A systematic literature review. Vaccine, 38(3), 470-481.
41. Hussain, S., Farooq, M., Nadeem, M., Siddiq, S., Ahmed, R. I., & Javed, I. (2020).
42. Immunization Status of Children: A Study at Shaikh Khalifa Bin Zayed AlNahyan Hospital Rawalakot Azad Kashmir. Journal of Islamic International Medical College (JIIMC), 15(3), 159-162.
43. Khaliq, A., Sayed, S. A., Hussaini, S. A., Azam, K., & Qamar, M. (2017). Missed immunization opportunities among children under 5 years of age dwelling in Karachi city. Journal of Ayub Medical College, Abbottabad: JAMC, 29(4), 645.
44. Landoh, D. E., Ouro-Kavalah, F., Yaya, I., Kahn, A.-L., Wasswa, P., Lacle, A., . . . Soura, A. B. (2016). Predictors of incomplete immunization coverage among one to five years old children in Togo. BMC Public Health, 16, 1-7.
45. Li, X., Mukandavire, C., Cucunubá, Z. M., Londono, S. E., Abbas, K., Clapham, H. E., . . . Vynnycky, E. (2021). Estimating the health impact of vaccination against ten pathogens in 98 low-income and middle-income countries from 2000 to 2030: a modelling study. The Lancet, 397(10272), 398-408.
46. Lindstrand, A., Cherian, T., Chang-Blanc, D., Feikin, D., & O’Brien, K. L. (2021). The world of immunization: achievements, challenges, and strategic vision for the next decade. The Journal of Infectious Diseases, 224(Supplement_4), S452S467.
47. Machado, A. A., Edwards, S. A., Mueller, M., & Saini, V. (2021). Effective interventions to increase routine childhood immunization coverage in low socioeconomic status communities in developed countries: A systematic review and critical appraisal of peerreviewed literature. Vaccine, 39(22), 2938-2964.
48. Maurice, J. M., & Davey, S. (2009). State of the World's Vaccines and Immunization: World Health Organization.
49. Nagata, J. M., Epstein, A., Ganson, K. T., Benmarhnia, T., & Weiser, S. D. (2021). Drought and child vaccination coverage in 22 countries in sub-Saharan Africa: A retrospective analysis of national survey data from 2011 to 2019. PLoS Medicine, 18(9), e1003678.
50. Najda-Janoszka, M., & Kopera, S. (2014). Exploring barriers to innovation in tourism industry–the case of southern region of Poland. Procedia-Social and Behavioral Sciences, 110, 190-201.
51. Orenstein, W. A., & Ahmed, R. (2017). Simply put: Vaccination saves lives. In (Vol. 114, pp. 4031-4033): National Acad Sciences.
52. Orenstein, W. A., Seib, K., Graham-Rowe, D., & Berkley, S. (2014). Contemporary vaccine challenges: improving global health one shot at a time. Science Translational Medicine, 6(253), 253ps211-253ps211.
53. Organization, W. H. (2000). Maternal and neonatal tetanus elimination by 2005: strategies for achieving and maintaining elimination. Maternal and neonatal tetanus elimination by 2005: strategies for achieving and maintaining elimination.
54. Organization, W. H. (2001). Measles: mortality reduction and regional elimination: strategic plan 2001-2005. Retrieved from Organization, W. H. (2006). Challenges in global immunization and the global immunization vision and strategy 20062015. Weekly Epidemiological Record= Relevé épidémiologique hebdomadaire, 81(19), 190-195.
55. Organization, W. H. (2010). World health statistics 2010: World Health Organization.
56. Organization, W. H. (2013). Polio eradication and endgame strategic plan 2013–2018. Global Polio Eradication Initiative, working draft, 23, 1-99.
57. Piot, P., Larson, H. J., O’Brien, K. L., N’kengasong, J., Ng, E., Sow, S., & Kampmann, B. (2019). Immunization: vital progress, unfinished agenda.
58. Nature, 575(7781), 119-129.
59. Rehman, S. U., Siddiqui, A. R., Ahmed, J., Fatmi, Z., Shah, S. M., Rahman, A., & Yousafzai, M. T. (2017). Coverage and predictors of routine immunization among 12-23 months old children in disaster affected communities in Pakistan. International journal of health sciences, 11(1), 1.
60. Rutherford, M. E., Dockerty, J. D., Jasseh, M., Howie, S. R., Herbison, P., Jeffries, D. J., . . . Hill, P. C. (2009). Preventive measures in infancy to reduce under‐five mortality: a case–control study in The Gambia. Tropical Medicine & International Health, 14(2), 149-155.
61. Shaikh, B. T., Haq, Z. U., Tran, N., & Hafeez, A. (2018). Health system barriers and levers in implementation of the Expanded Program on Immunization (EPI) in Pakistan: an evidence informed situation analysis. Public health reviews, 39, 1-10.
62. Wolfson, L. J., Gasse, F., Lee-Martin, S.-P., Lydon, P., Magan, A., Tibouti, A., . . . Okwo-Bele, J.-M. (2008). Estimating the costs of achieving the WHO-UNICEF Global Immunization Vision and Strategy, 2006-2015. Bulletin of the World Health organization, 86, 27-39.
63. Yazdani, A. T., Muhammad, A., Nisar, M. I., Khan, U., & Shafiq, Y. (2021). Unveiling and addressing implementation barriers to routine immunization in the peri-urban slums of Karachi, Pakistan: a mixed methods study. Health Research Policy and Systems, 19, 1-9
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Jun 24, 2024
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Eliza Shahid, Mansoor ulHaque Nohri, Aisha Sahoowal, Naeema Asghar, Usama Javed, & Ruqia Jamali. (2024). IDENTIFYING BARRIERS TO EFFECTIVE IMMUNIZATION AND MISSED OPPORTUNITIES IN RURAL AREAS OF PAKISTAN. Journal of Population Therapeutics and Clinical Pharmacology, 31(6), 2255–2274. https://doi.org/10.53555/jptcp.v31i6.6871
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Author Biographies
Eliza Shahid
Eliza Shahid, Pharmacist MSPH, Health Services Academy Islamabad, Pakistan. email:
Mansoor ulHaque Nohri
Lecturer, People's Nursing School LUMHS Jamshoro Pakistan.
Aisha Sahoowal
Principal BSN MSN, Rising Star Institute of Nursing Hyderabad Pakistan. email:
Naeema Asghar
Assistant Professor Community Medicine, Shaheed Mohtarma Benazir Bhutto Medical College Lyari Karachi Pakistan.
Usama Javed
Manager Pharmacist, Al Rehaab Pharmacy/Zahid surgical Hospital Islamabad / Jampur Pakistan.
Ruqia Jamali
Consultant Gynaecologist, Premier Diagnostic Center Saddar Hyderabad / Senior Medical officer, Social security Hospital hyderabad Pakistan