Review Article

Socioecological Challenges of Polio Supplementary Immunization Activities (SIAs) in the Asia-Pacific Region: A Systematic Review

Table 1

Summary of study findings.

No.Author (year), countryTitleStudy designVaccination coverageChallengesImprovement strategies

1Habib et al. (2017), Pakistan [20]Community engagement and integrated health and polio immunization campaigns in conflict-affected areas of Pakistan: a cluster randomised controlled trialExperimental (randomized control trial)The estimated OPV coverage: before intervention (via routine vaccination: the coverage for children younger than 24 months of age was 43% in arm A, 52% arm B and 54% in arm C; post intervention: coverage was 75% in arm A compared with 82% in arm B and 84% in arm C significant increment in all arms with package of interventionN/AArm A (control): intervention received the routine immunization and additional SIA.
Arm B: received additional interventions with community outreach and mobilization using an enhanced communication package (community engagement) and provision of maternal and child. Health immunization services.
Arm C: similar as above + IPV arm C shown greater increments after received combination of SIA + community outreach + IPV

2Voorman and lyons (2016), LIC [21]Measuring polio immunity to plan immunization activitiesObservationalN/AThe numbers of SIA showed no effect on the dose coverage in several nonendemic MIC-LIC. Due to poor Polio surveillance system which used as surrogate indicators to determine the appropriate immunization activities as it done based on:
(i) Caregiver self-report
(ii) Lack of validated indicator (based on routine immunization)
N/A
3Kazi et al. (2014), Pakistan [22]Monitoring polio supplementary immunization activities using an automated short text messaging system in Karachi, PakistanObservationalPolio vaccination coverage reported as relationship between the numbers of campaigns per polio vaccination dose coverageThe monitoring system for SIA coverage done manually. Limitation:
(i) Resource-intensive
(ii) Utilizes convenience sampling and the 3rd party is prone to misreporting bias
(iii) Exposes HCW to the risk of violence, especially in certain locations with poor security
Short message service (SMS) texts found to be an effective tool to measure the coverage of SIA activities in polio SIA in Karachi, Pakistan, showed that the coverages estimated using the SMS system were also like those recorded using lot QA sampling by WHO. For the monitoring of coverage in SIA, automated SMS-based systems appear to be an attractive and relatively inexpensive option

4Helleringer et al. (2014), Indonesia, Bangladesh, Pakistan [8]Polio supplementary immunization activities and equity in access to vaccination: evidence from the demographic and health surveysObservational (cross sectional)Indonesia 2007 (69.9%), Bangladesh 2011 (93.4%), Pakistan 2006 (81.9%).N/ATo improve operational innovations in SIA implementation may have further improved the effectiveness of SIAs in reaching the poorest children, e.g., improved mapping of settlements and intensified activities of social mobilization and communication. Corroborate the idea that the SIA approach to health service delivery may be an important tool in promoting health equity

5Khowaja et al. (2012), Pakistan [23]Parental perceptions surrounding polio and self-reported nonparticipation in polio supplementary immunization activities in Karachi, Pakistan: a mixed methods studyObservational (mixed method study)N/AQuantitative 13% did not participate in one SIA:
(i) 73.9% refused to participate
(ii) 4.5% reported that the child was absent from home when the vaccinator visited
(iii) 21.6% reported not having been contacted by a vaccinator qualitative
(iv) Fear of sterility
(v) Lack of faith in the polio vaccine
(vi) Scepticism about the vaccination programme
(vii) Fear that the vaccine might contain religiously forbidden ingredients
N/A
6Choudhary et al. (2021), India [24]Effectiveness of a community-level social mobilisation intervention in achieving the outcomes of polio vaccination campaigns during the post-polio-endemic period: evidence from CORE group polio project in Uttar Pradesh, IndiaExperimental (quasi-experimental)SIA coverage post-polio-endemic period had insignificant change over time in both intervention group (community level social mobilisation) and nonintervention areasBelief, fearVaccination campaign using community level social mobilisation

7Podder et al. (2019), India [25]Community perception toward intensified pulse polio immunization in post certification era: a mixed-method study in a high-risk area of Kolkata, West Bengal, IndiaObservational (cross-sectional)N/ASocial behaviour is one of the barriers of polio SIA (IPPI-intensified pulse polio immunization) in Kolkata, West Bengal, India. It is statistically significant associated with respondent’s attitude which directly link to gender, religion, and education. Result study showed the following:
(i) Inadequate knowledge (32%)
(ii) Unfavourable attitude (45%)
(iii) Safety concern (5.7%)
(iv) Spouse/elderly pressure (4.8%)
(v) Sterility issues (1.9%)
(vi) Hesitancy (16.2%)
N/A
8Jiee et al. (2021), Malaysia [26]Polio supplementary immunization activities during COVID-19 pandemic: experience from Penampang district, Sabah, MalaysiaObservational (case report)OPV coverage has achieved more than 90% for both bOPV and mOPVMovement control order enforcement causing the on-site activities involving the preschools and primary school student temporarily haltedMultiple vaccination strategies were utilized: static posts, mobile posts, house to house visits, school visits, mobile clinics and drive through. Schools’ authorities were one of the most important partners in Polio SIAs since more than half of the targeted population were preschool and primary school children. Community health volunteers (KOSPEN), the health advisory panel, religious leaders, and government retirees were also involved as community mobilizers and recorder

9Wallace et al. (2018), India [27]Impact of an intervention to use a measles, rubella, and polio mass vaccination campaign to strengthen routine immunization services in NepalExperimentalN/AN/ANewly introduced or modified key activities in intervention package: SIA training, social mobilization, supervision, and monitoring were modified with RI messaging for healthcare providers from randomly selected 100 health care providers significant positive changes in terms of knowledge of adverse events post immunization (11% increase)