People’s Perception Towards Polio and Pulse Polio Immunization in an Underprivileged Area in Bengaluru- A Cross Sectional Study

Introduction

Poliomyelitis is a highly infectious viral disease that chiefly affects children under five years of age. The virus is transmitted by person-to-person spread mainly through the feco-oral route or by contaminated water and food and multiplies in the intestine, from where it can invade the nervous system and cause paralysis.¹

The Government of India launched the pulse polio immunization (PPI) program in 1995² intending to eradicate poliomyelitis by the end of 2000. National Immunization Day (NID), commonly known as the Pulse Polio Immunization program is conducted twice in the early part of each year. Oral polio drops are being provided to all children up to two years of age in a routine immunization program. It is supplemented by the PPI up to five years which amounts to about 14 doses of Oral Polio Vaccine (OPV) in five years. India’s success in stopping polio is demonstrated by polio-free certification of the entire WHO Southeast Asia Region in March 2014.² Despite the extensive PPI introduced by the government, we are still not out of the woods but at the edge as until all the children in the country are vaccinated with Inactivated Polio Vaccine (IPV) and OPV, the risk of polio resurgence either due to importations from other countries or from vaccinederived poliovirus (VDPV) will be there.

Even after 27 years of initiation of this programme, the awareness among common man regarding poliomyelitis is inadequate. As the polio disease is in its eradication phase in India, the general awareness about the features of polio and the reason for PPI is diminishing as it has become a routine process of the immunization. Our study aimed to assess the perception of people to better inform the future implementation of this program.

Objectives

1. To assess the people’s perception towards Polio and Pulse Polio Immunization (PPI).

Materials and Methods

A cross-sectional study was conducted during early January prior to the PPI round of February- March 2022 in underprivileged field practice area of Bangalore Medical College. Only houses with children under five years of age were included in the study. A total of 162 such households were covered by convenience sampling during the study period. Data was collected by interviewing any adult member of the household using a pre-tested, semi-structured questionnaire after obtaining informed consent.

Participants were asked about signs and symptoms of poliomyelitis, the age groups most susceptible to this disease, the mode of disease transmission, the sources of information, the number of and seasons in which the PPI rounds are held, the benefits of PPI, their preferences in PPI and reasons for non-immunization during PPI rounds.³

All data collected was entered in MS Excel and subjected to statistical analysis. Results were interpreted using various charts and tables and conclusion was drawn about perception towards PPI.

Results

In this study, out of 162 participants, 54 (33.33%) were males and 108 (66.67%) were females. Mean age of the participants was 35.3 years.

Discussion

This study found that there was lack of awareness about Polio and PPI among the underprivileged population of Bengaluru. A similar trend of lack of awareness was reported in a previous study conducted in semi urban areas.³ This study revealed that most people heard about polio but were unaware about the characteristics of poliomyelitis. Participants in this study revealed that they were unaware of symptoms of poliomyelitis, as India is free from poliomyelitis since 2014. This is in contrast with the findings of study conducted in Delhi in 2004 during the early phase of PPI where majority of the people were aware of the disease.⁴ Majority of the people were unaware of the high-risk groups and mode of transmission of polio and were uncertain whether it is curable or preventable.

The primary source of information about PPI in this study was from the television and health workers. In several other studies too, television was found to be the commonest source of information for participants.^3-4 This indicates that television is a key resource to use to disseminate information of public health.⁴ The role of health workers as providers of primary information about PPI was also evident in our study. This was similar to the results of studies done in West Bengal and Agra where health workers were the main source of information for about 70% of the participants.^5-6

This study revealed that almost 3/4^th of the participants were unaware of the purpose of PPI. Only a few participants understood the necessity to immunize their children during all the PPI rounds along with the routine immunization. This is in contrast to the study conducted in Delhi in 2004 during the early phase of PPI where 62% of the individuals were aware of the role of OPV.³

This study further revealed that participants were unaware whether children can have hot food after PPI until 30 minutes of administration due to the lack of instructions to be provided by the vaccinator of PPI.

This study further revealed lack of awareness on the number of rounds of PPI that are held in a year and also the months when it is given, because of absence of PPI in the last two years due to COVID-19 pandemic.

A few of the participants were found to be preferring PPI at home over booths in spite of booths being placed conveniently within city limits indicate that they misunderstood the true purpose of house-to-house immunization initiative of government.⁵

This study overall gives us an insight that there is lack of awareness about PPI in the underprivileged area due to illiteracy, ignorance, lack of information provided by health workers and many more. This study also further revealed that participants were taking PPI as a part of the routine process but were unaware of the role of OPV in the eradication of polio. These issues need to be addressed to improve the success of this programme.⁵

Conclusion

The critical need for immunization against polio in the underprivileged field practice area of Bangalore Medical College cannot be over-emphasized. The awareness on polio vaccination in underprivileged population is due to the involvement of health care workers, NGOs and publicity in multimedia outlets such as television. Coordinated efforts are necessary for complete eradication of polio by all concerned institutions. There was lack of awareness among general public about the features of polio disease and the purpose of immunization which should be addressed. Moreover, the support and supervision of the immunization service providers should be improved to ensure adequate and efficient service provisions at the health centre and hospitals. Additionally, logistics such as transport, equipment and materials should be enhanced to ensure adequate and quality provision of immunization services. The most common primary reason for non-vaccination is lack of knowledge, which indicates that the ongoing advertisement campaigns have partially failed to achieve the success desired. Hence, there is a dire need to promote awareness among the masses in collaboration with NGOs and major religious and social organizations.

Conflict of Interest

None.