Improvements in Polio Vaccination Status and Knowledge about Polio Vaccination in the CORE Group Polio Project Implementation Areas in Pastoralist and Semi-Pastoralist Regions in Ethiopia

"The CGPP has leveraged community networks and partnerships in the most hard-to-reach, highest risk areas of the country. These efforts have made it possible to increase polio vaccination coverage rates and to decrease dropout rates."

This article examines the population coverage of oral polio vaccine (OPV) in CORE Group Polio Project (CGPP) programme areas and the influences on coverage, with a focus on pastoral and semi-pastoral regions in Ethiopia. Implementing its programmes through a network of international and national non-governmental organisations (NGOs) coordinated by a national secretariat, the CGPP has trained more than 12,000 community volunteers (CVs) to promote immunisations and conduct surveillance, as described elsewhere in a series of articles detailing the work of the United States Agency for International Development (USAID)-funded CGPP (accessible through Related Summaries, below).

The analysis included vaccination-related data for children aged 12-23 months from the 2011 Ethiopian Demographic and Health Survey (EDHS) and from surveys carried out by the CGPP in 2013, 2015, and 2017. The EDHS data were from the entire regions (states) of Somali; Oromia; Southern Nations, Nationalities, and Peoples (SNNP); Benshangul-Gumuz; and Gambella, whereas the CGPP data were for portions of these states where the CGPP was working and consisted entirely of pastoralist or semi-pastoralist populations.

The overall polio immunisation coverage rate showed upward trend from 39.6% in the 2011 EDHS to 72.6% for 2017 survey of children in the CGPP intervention areas. Full OPV coverage, based on appropriate dosing intervals, is substantially higher in the CGPP intervention areas than in the regional states as a whole (66-73% versus 40%). The evidence also suggests that the CGPP was able to achieve increasing levels of coverage in the hardest-to-reach areas of these states.

Based on the data shared, the researchers assert that the strategies used by the CGPP/Ethiopia to increase coverage appear to have been effective. Other characteristics associated with full polio immunisation included mother's religion and education, whether the mother had heard about polio, knowledge on the effect of many polio vaccine doses, and age at first polio immunisation. These findings point, for example, to the importance of educating young girls and women and ensuring access to primary and secondary schooling.

Overall, almost all (85%) mothers in the CGPP surveys had heard of polio. However, more than a quarter had misconceptions about the benefits of more polio doses, and 48% wrongly stated the starting age for polio vaccine. Thus, say the researchers, education should focus on increasing knowledge of vaccine benefits and the importance of timeliness in dosing.

In addition, this study found that Christian mothers had children with a higher rate of OPV 3 vaccination (odds ratio (OR) = 2.67) compared with Muslim mothers. "It is important to understand the factors that underlie this finding. The CGPP should continue to work with religious leaders, both Muslim and Christian, to dispel any misconceptions linked to religious teachings and strengthen accurate knowledge among Muslim mothers."

The results from this study indicate that a substantial percentage of children are not receiving OPV doses with the prescribed spacing or at the prescribed age. Thus, say the researchers, improving the timeliness of polio immunisation administration requires continued emphasis.

Survey data also indicated that many caregivers did not have vaccination cards accessible or that they were possibly inaccurately filled out. The researchers suggest that the CGPP continue to support parents in obtaining and retaining vaccination cards, also calling for training and refresher training for health workers and immunisation providers in order to improve quality and accuracy of recording. "This is necessary to ensure that children are given needed vaccines and that they are given in a timely manner."

In conclusion: "Continuous polio awareness creation activities need to consider the local context and the involvement of local stakeholders, including community leaders and volunteers, and providing special training to CVs to provide birth dose OPV for home deliveries may be an area that might be put in place in hard-to-reach area in collaboration with community health workers. Polio-related education must include mothers with low or no education, as their children are at risk of incomplete vaccinations."