Karim Sehrish, Rehana Siddiqui Amna, Karim Nurose, Pradhan Nousheen Akber, Azam Iqbal, Farrukh Qazi Muhammad
Department of Medicine, The Aga Khan University, Karachi, Pakistan; Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan.
APPNA Institute of Public Health Jinnah Sindh Medical University, Karachi, Pakistan; Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan.
Vaccine. 2024 Jul 25;42(19):4022-4029. doi: 10.1016/j.vaccine.2024.05.012. Epub 2024 May 13.
Rotavirus (RV) induced diarrhea led to hospitalization and mortality prior to the introduction of the rotavirus vaccine (RVV). The estimated RVV coverage was 86% in children less than one year of age in Pakistan.
To determine the difference in the number of diarrheal episodes among children who received and who did not receive RVV, along with the parental and physician's perspectives on the barriers toward RV immunization in children aged less than 1 year in Karachi, Pakistan.
A mixed-methods study design was conducted in three Primary Healthcare (PHC) private clinics located in different districts of Karachi, Pakistan. Data for RVV status and diarrheal episodes were collected, from medical records in June 2020 for children born between October 2019 to March 2020. Three In-depth Interviews (IDIs) with physicians and three focus group discussions (FGDs) with mothers were conducted for information on awareness and approach towards diarrhea, knowledge, and acceptance of RVV, and barriers towards RV immunization.
A total of 430 infants visited the three PHC centres coded as A (n = 144), B (n = 146), and C (n = 140). The mean age of infants was 2.6 ± 0.2 months, 49.5 % were males and 87 (20.2 %) were partial/not vaccinated for RV. Reported diarrheal episodes were 104 (24.2 %), and of these 76 (73.1 %) were partially or not vaccinated, and 83 (79.8 %) were stunted. Recorded diarrhea was significantly associated with partial/not vaccinated status (p < 0.001), stunting (p < 0.001), and by PHC centre location (p < 0.001). PHC-C had the lowest percentage of reported diarrhea, stunting, and non/partially vaccinated status. Qualitative study (FGDs) showed that mothers had lack of awareness and knowledge on the prevention of diarrhea by RVV. Physicians' IDIs pointed towards a lack of sufficient training on RVV.
Diarrheal episodes in infants were associated with partial or unvaccinated for RVV, low nutritional status, and areas of residence. Low levels of knowledge and awareness in caretakers and lack of training for RVV in PHC physicians were perceived as barriers in controlling diarrheal diseases.
在轮状病毒疫苗（RVV）引入之前，轮状病毒（RV）引起的腹泻导致住院和死亡。在巴基斯坦，估计1岁以下儿童的RVV覆盖率为86%。
确定接受和未接受RVV的儿童腹泻发作次数的差异，以及巴基斯坦卡拉奇1岁以下儿童的父母和医生对RV免疫障碍的看法。
在巴基斯坦卡拉奇不同地区的三家初级医疗保健（PHC）私人诊所进行了一项混合方法研究设计。收集了2019年10月至2020年3月出生儿童的RVV状况和腹泻发作数据，数据来自2020年6月的医疗记录。对医生进行了三次深入访谈（IDI），对母亲进行了三次焦点小组讨论（FGD），以获取有关腹泻的认识和应对方法、对RVV的了解和接受程度以及RV免疫障碍的信息。
共有430名婴儿前往编码为A（n = 144）、B（n = 146）和C（n = 140）的三家PHC中心。婴儿的平均年龄为2.6±0.2个月，49.5%为男性，87名（20.2%）未完全接种或未接种RV。报告的腹泻发作次数为104次（24.2%），其中76名（73.1%）未完全接种或未接种，83名（79.8%）发育迟缓。记录的腹泻与未完全接种/未接种状态（p < 0.001）、发育迟缓（p < 0.001）以及PHC中心位置（p < 0.001）显著相关。PHC-C报告的腹泻、发育迟缓和未接种/未完全接种状态的比例最低。定性研究（FGD）表明，母亲们对RVV预防腹泻缺乏认识和了解。医生的IDI指出对RVV缺乏足够的培训。
婴儿腹泻发作与未完全接种或未接种RVV、低营养状况和居住地区有关。照顾者的知识和意识水平低以及PHC医生对RVV缺乏培训被视为控制腹泻疾病的障碍。
