Forecasting the continued challenges in Polio eradication the Centre of Excellence for Women and Child Health at Aga Khan University with its partners, Trust for Vaccines and Immunization and Peshawar Medical College designed and implemented a Polio Demonstration project in Polio high risk areas of Karachi, Kashmore and Bajaur agency in 2013-2014. The Key components included Community engagement and buy in through utilization of Community support groups and women’s groups, Improved coverage through engagement of the private sector (Physicians and NGO vaccinators), Improved messaging and integration of vaccination strategies with nutrition interventions (esp. vitamin A supplementation) and Offering an OPV/IPV combination to enhance coverage and boost individual and population level immunity
A three cell community based cluster randomized trial was conducted on a population of about 75000 under five children. This is the largest cluster RCT for polio immunization in population settings to-date. The interventions were well accepted and community mobilization strategies were found to be effective. The health camps were accessed by over 58000 under five children for routine immunization and 29,300 children for IPV receipt alongside OPV. The strategy of delivering IPV through low cost MNCH health camps resulted in overall IPV coverage of about 80% with an excellent safety profile. Further a signifant increase of about 10% in coverage of OPV (p-value <0.005) was observed. And for routine immunization a significant reduction in un-immunized children and significant increment in fully immunized children was observed in intervention clusters compared to control clusters (p-value <0.001). The strategy of low cost health camps for the delivery of interventions such as education and counseling, scaling up routine immunization and delivery of IPV has been successfully demonstrated and provided critical programmatic learning.