Nomadic and Rural Population of Balochistan: Exploring the Pockets of Poor Childhood Immunization in the Most Under-Vaccinated Province of Pakistan

Abstract

Objective: To assess the immunization coverage of children less than 2 years of age in rural and nomadic population of Balochistan. To assess the knowledge of parents about EPI immunization and find reasons of poor vaccination. Material and methods:The cross-sectional survey was conducted in rural population and nomadic tribes located in suburbs of district Zhob, Balochistan. One hundred families of rural areas and 100 families of nomadic tribes were interviewed. Information regarding the vaccination status of children, parents' knowledge of EPI vaccinationand reasons of not vaccinating children or skipping vaccines were asked and noted. Education status of parents and socioeconomic status was also noted. Results: There were 295 children under 2 year age in the study population with 146 (49.5%) males and 149 (50.5%) females. Among rural population, 25 (16.4%) children were completely vaccinated, 106 (69.7%) children were partially vaccinated and 21 (13.8%) children never received any vaccination. In nomadic population, 10 (7%) children were completely vaccinated, 88 (61.5%) were partially vaccinated and 45 (31.5%) were unvaccinated. There was significant difference between vaccination status of families belonging to rural population versus those of nomadic population (P=0.002). Most common reason of skipping one or more vaccines was lack of knowledge and awareness in 28.8% cases. There was significant association between education status of fathers and mothers with vaccination status of families. Conclusion: Routine immunization of children in rural and nomadic population of Balochistan is dismal. Main culprits are lack of knowledge and awareness, compounded by illiteracy and poor education status of parents.

Tetanus; a dreadful complication of ear piercing, ear instrumentation and chronic otorrhea in children of Southern Punjab Pakistan.

“…This destitute state of tetanus vaccination/immunization is attributed to lack of awareness, illiteracy, decreased uptake by people, false beliefs, religious refusals, fears of injections/syringes, side effects, etc. 3,4 Clinicians should advise tetanus toxoids to all the patients of chronic otitis media with discharging ears and those who present to them with any complication of either ear piercing or instrumentation to reduce the chances of developing tetanus. Government must take actions to curb quackery practices so that people take to physicians for their otologic conditions.…”

“…Owing to these reasons, it is not unusual to face vaccine preventable diseases in developing countries. 3,4 Tetanus leads to 80,0000 to one million deaths per year and 80% of these deaths occur in South East Asia and Africa. 5 Tetanus has been reported after deep penetrating wounds, postpartum, nonsterile intramuscular and intravenous injections, ear piercing, ear instrumentation, chronic ear infections, acupuncture, tattooing, toothpicks, etc.…”