Assessment of the Missed Children of the September 2004 National Immunization Day

Communication strategies and social mobilisation efforts have been identified as crucial for maintaining high immunisation coverage in countries, such as Egypt, that are striving to contribute to the global effort to eradicate polio. However, social mobilisation campaigns, including National Immunization Days (NIDs), may be compromised by negative attitudes and behavioural shortcomings such as public reluctance and ignorance of the importance of routine immunisation, as well as rumours and misconceptions about the after-effects of the vaccine.

At UNICEF's request, this study was conducted by El-Zanaty & Associates to support Egypt's Ministry of Health and Population (MOHP) national efforts to undertake a stronger communication and social mobilisation campaign that is directed by scientific evidence in order to reach its objective: a polio-free country by the end of 2005.

This 27-page report presents gaps in key knowledge, attitudes, and practices (KAP) indicators related to NIDs based on the 2002 and the 2003 data sets. It also provides a profile of missed children for the September 2004 NID, detailing misconceptions and refusal reasons. Since the percentage of missed children was lower than expected (1.5%) and the number of children missed too small to be analysed (64), researchers sampled 7,173 households, conducting some individual caretakers' interviews; results are detailed in this report and summarised in the material excerpted below.

Main conclusions of the 2004 survey:

"Knowledge about Polio Immunization

• Ninety two percent of the respondents indicated that the minimum age for a child to receive the polio vaccine was one day.
• Ninety four percent of the respondents indicated 5 years as the age up to which the child should receive the polio vaccination.
• Thirty two percent of the respondents mentioned that the child should be revaccinated if he/she had diarrhea, and 32 percent of the respondents indicated that the child cannot receive the polio vaccine while having fever.
• Quite a high number of caretakers (22 percent) are unaware whether or not there was no maximum number of polio doses.
• The wide majority of caretakers indicated that immunization against polio has no harmful effects (96 percent).
• Slightly more than one third of the caretakers indicated that the child might get Polio if the child did not receive any doses of Polio.
• An encouraging 99 percent of respondents indicated that the child must receive the NID doses if he had received all the routine doses.
• Most of the respondents (94 percent) indicated that NID doses do not replace routine doses.

Attitude towards the Polio Vaccine

• The attitude towards Polio immunization is extremely favorable as all the interviewed caretakers indicated that the routine polio vaccines are important (100 percent), however slightly less indicated that the NID doses are important (99 percent).
• Only 63 percent of the caretakers advised their neighbors to immunize their children in the last NID.

Immunization Practices

• One percent (64 children) of the children in the five governorates were not immunized in the last NID.
• Almost all of the caretakers immunized their children when the campaign came to their homes (94 percent), while 5 percent immunized their children at the health office.
• The most common reasons for not immunizing their children in the last NID were not refusal; this gives great hope that in the future there will be no missed children and no Polio cases. As the most common reason that was indicated by caretakers for not immunizing their children was because the mother was traveling/she did not hear about it/ she was busy (52 percent), followed by because the child was a new born /mother was pregnant with him (22 percent).

Profile of missed children

• The 64 children who were not immunized in the last NID were distributed as follows; 2 percent (18 children) in Cairo, 2 percent (8 children) in Giza, 1 percent (20 children) in Menya, 1 percent (2 children) in Kalyubia and 1 percent (16 children) in Assuit.
• Kism el Basateen displayed the highest percentage of non immunized children in Cairo (39 percent); Kism EL Omrania displayed the highest percentage of non immunized children in Giza (63 percent), Markz Bani Mazar displayed the highest percentage of non immunized children in Menya (35 percent), and Marakz EL Ghanaiem displayed the highest percentage of non immunized children in Assuit (19 percent).
• The caretaker who did not immunize his/her child in the last NID was mostly between 25-39 years of age, living in rural areas, had never been to school/primary incomplete or completed his/her secondary education, not working for cash, and was beyond the third quintile of the wealth index.
• Most of the children who were not immunized in the last NID were less than one year old (37 percent) and 4 years or more (30 percent)."

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Click here to access the accompanying household survey questions [PDF].