Impact Examples: Polio Communication Programming

Polio Outbreak Ukraine 2015-2016

A nationwide communication for behaviour change campaign was designed to raise the urgency of the need for multiple vaccination rounds to contain the summer 2015 outbreak of circulating vaccine-derived poliovirus (cVDPV) in Western Ukraine.

Results from 3 post-campaign monitoring reports indicate:

More than 95% of Ukrainians were aware of the polio vaccination rounds and were reached through at least one medium of a diverse media mix. Levels of knowledge and acceptance of vaccines have increased among parents and the medical community: The percentage of parents who know that polio causes paralysis, for example, more than doubled, and awareness of polio among caregivers and parents increased from 68% before the outbreak to 89% during Round 1, 91% during Round 2, and 96% during Round 3. The percentage of vaccine refusals due to fear of side effects or complications decreased from 67% before the outbreak to 38% by the third round. Crucially, vaccine coverage increased significantly: from below 17% (three doses in children under one year of age) in 2015, to 65% in Round 1 and 75% in Round 2 (age two months to six years), and 82% in Round 2 (age two months to 10 years).

Youth Group Engagement in Noncompliant Communities During Supplemental Immunization Activities in Kaduna, Nigeria, in 2014

Noting that one of the major challenges being faced in the Global Polio Eradication Initiative (GPEI) programme is persistent refusal of oral polio vaccine (OPV) and harassment of vaccination team members by youth, an intervention was designed to collaborate with recognised youth groups in Kaduna State, Nigeria during supplementary immunisation activity (SIA) campaigns. The leadership of the youth groups worked in collaboration with security agents and traditional leaders. During the polio vaccination campaign, the sensitised youth were deployed to areas of documented noncompliance and vaccination team harassment.

The researchers found, in part, that:

During the 8 rounds assessed, in Igabi LGA, the 4,126 noncompliant households in round 3 decreased to 778 after the intervention. For Zaria LGA, the proportion of missed children decreased in all the rounds after the intervention, compared with before the intervention. Statistical analysis of monitoring data (percentage of missed children) indicate that the mean percentage (±SD) was 11.6% ± 5.0% before the intervention and 7.9% ± 5.6% after the intervention. The P value was .002, indicating a significant decline in the percentage of missed children. Team harassment per round decreased from >10 incidents to 5 incidences in the ward. In addition, there was a positive outcome in terms of reduced poliovirus detection in the affected settlements.

Community Engagement, Routine Immunization, and the Polio Legacy in Northern Nigeria

The community engagement (CE) component of the Partnership for Reviving Routine Immunization in Northern Nigeria; Maternal, Newborn, and Child Health Initiative (PRRINN-MNCH) aimed to empower communities, work with volunteers, and develop solutions to overcome barriers to health. For instance, community volunteers used Say and Do interactive communications and narrative mimes to help participants remember key health messages.

Baseline and endline population-based random household surveys conducted in 2009 and 2013 showed improved community knowledge, increased use of antenatal care (ANC) and immunisation services, and a decrease in maternal, infant, and under-5 mortality. For example:

• The effect of the discussion groups led by community volunteers can be seen in the large increase in the proportion of women's knowing of maternal danger signs, from 16.8% to 52.3%, and in the proportion of women with children under 2 years of age who knew the number of routine immunisation (RI) visits, which increased from 57.3% to 82.7%.
• From 2009 to 2013, women receiving ANC increased from 25% to 51%, and the use of skilled birth attendants increased from 11% to 27%. Women who participated in community dialogue or group discussions were more likely to use ANC services.
• The proportion of women with standing permission to take a child to a health facility increased from 42.7% to 86.3%, showing that husbands and other family decision makers shifted their behaviour to give higher priority to support women's and children's health.
• In the project areas, the maternal mortality ratio fell from 1,270 to 1,057; under-5 mortality decreased from 160 to 90.1 per 1,000 live births; and infant mortality decreased from 90 to 46.9 per 1,000 live births.
• The overall coverage of fully immunised children rose from 2.2% to 19.3%.

Eyi Megh Eyi Roudro - Bangladesh

With the message "come with your family for health care," this 26-episode television series was developed to create more interest in and awareness about health and family planning services. The aim of Eyi Megh Eyi Roudro ("Now Cloud, Now Sunshine") was to encourage Bangladesh people to take advantage of available health services like the Essential Services Package (ESP) that are provided by these clinics as well as to instill the habit of visiting health services clinics. The TV drama featured many popular performers, revolved around stories in both urban and rural areas, and included "Health Talk" - a segment focusing on health topics that introduced quizzes to stimulate reflection among viewers.

2003 evaluation showed:

• Viewers are more aware about the sources of information regarding different diseases and problems among children, and are more aware of the symptoms of pneumonia and polio.
• 43% of viewers stated that they had learned something from the quiz sessions, such as how to take care of pregnant mothers (28%), health-related information (26%), child immunisation (26%), proper care of children (16%), family planning (15%), and Smiling Sun clinics (6%).
• 93% of viewers and 86% of the non-viewers had given the polio vaccine to their children.

Immunization Promotion Activities: Are They Effective in Encouraging Mothers to Immunize Their Children?

This study was conducted to evaluate the effectiveness of the Mexican National Vaccination Council (CONAVA)'s communication activities for the Second National Health Week (SNHW) in Mexico City. The study sought to determine whether the messages communicated were effective in providing information to mothers and in motivating them to have their children vaccinated.

Key findings (1999):

Overall, 83% were aware of the campaign, and 63% were impacted by its messages. The net increase in immunisation between the "aware" and "unaware" groups was 14.8%, though it must be recognised that a relatively large proportion of the "unaware" mothers also took their children for vaccinations, a feature the authors attribute to long-term momentum gained by successive vaccination campaigns.

1995 National Immunisation Days (NIDs) - Bangladesh

The goal of this campaign was to administer 2 doses of the oral polio vaccine (OPV) to all children under the age of 5 years, irrespective of their previous immunisation status. Among the vehicles used to spread the word about the campaign were radio, television, mobile loudspeakers, printed materials (newspapers, posters, and leaflets), community meetings, and house-to-house contact (female field workers and volunteers promoted the NIDs during visits to women's houses).

1997 evaluation showed:

• After NID2 (April 16), 81% of all women interviewed spontaneously mentioned that polio is a vaccine-preventable disease, increasing from 63% before NID1. The increase was more pronounced among slum dwellers, where the awareness rose to 74% (having been 52% before the first NID). By the end of the campaign, there was "a significant and substantial increase in knowledge about the method of administration of OPV for both groups, with a significant difference in increase among slum mothers, as compared to non-slum mothers."
• 88% of children under 5 years received at least one dose of OPV during the NIDs; 67% received 2 stipulated doses, with no significant differences between slum (65%) and non-slum (69%) groups. In addition, 68% of the children contacted during the NIDs were given vitamin A supplementation. In addition, the nutritional surveillance reports indicate a dramatic improvement in vitamin A coverage from 42% to 87% of the children living in the rural areas serving as sentinel sites (NID efforts were combined with other services - a strategy that was found to be very effective).