Role of rotavirus vaccine in reducing diarrheal episodes in infants visiting private primary health care clinics in Karachi, Pakistan: A mixed-methods study

Sehrish Karim; Amna Rehana Siddiqui; Nurose Karim; Nousheen Akber Pradhan; Iqbal Azam; Muhammad Farrukh Qazi

doi:10.1016/j.vaccine.2024.05.012

Role of rotavirus vaccine in reducing diarrheal episodes in infants visiting private primary health care clinics in Karachi, Pakistan: A mixed-methods study

Vaccine. 2024 May 13:S0264-410X(24)00558-9. doi: 10.1016/j.vaccine.2024.05.012. Online ahead of print.

Authors

Sehrish Karim¹, Amna Rehana Siddiqui², Nurose Karim³, Nousheen Akber Pradhan⁴, Iqbal Azam⁵, Muhammad Farrukh Qazi⁶

Affiliations

¹ Department of Medicine, The Aga Khan University, Karachi, Pakistan; Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan. Electronic address: Sehrishkarim93@gmail.com.
² APPNA Institute of Public Health Jinnah Sindh Medical University, Karachi, Pakistan; Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan.
³ Department of Neurology, ECU Health Medical Center, Greenville, NC, USA.
⁴ Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan; University of Toronto, Doctoral Student, Canada.
⁵ Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan.
⁶ Department of Pediatrics & Child Health, The Aga Khan University, Karachi, Pakistan.

PMID: 38744597
DOI: 10.1016/j.vaccine.2024.05.012

Abstract

Background: 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.

Objectives: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Diarrhea; HMIS; Private Primary Healthcare clinics; Rotavirus vaccine.