PDF(Pubmed)
Abstract：
Pakistan is one of two countries globally still endemic for poliovirus. While increasing immunization coverage is a concern, providing equitable access to care is also a priority, especially for conflict-affected populations. Recognizing these challenges, Naunehal, an integrated model of maternal, newborn, and child health (MNCH), immunization, and nutrition services delivered through community mobilization, mobile outreach, and private-sector engagement was implemented in conflict-affected union councils (UCs) with high poliovirus transmission, including Kharotabad 1(Quetta, Balochistan) and Bakhmal Ahmedzai (Lakki Marwat, Khyber Pakhtunkhwa). A quasi-experimental pre-post-design was used to assess the impact of the interventions implemented between April 2021 and April 2022, with a baseline and an endline survey. For each of the intervention UCs, a separate, matched-control UC was identified. At endline, the proportion of fully immunized children increased significantly from 27.5% to 51.0% in intervention UCs with a difference-in-difference (DiD) estimate of 13.6%. The proportion of zero-dose children and non-recipients of routine immunization (NR-RI) children decreased from 31.6% to 0.9% and from 31.9% to 3.4%, respectively, with a significant decrease in the latter group. Scaling up and assessing the adoption and feasibility of integrated interventions to improve immunization coverage can inform policymakers of the viability of such services in such contexts.
摘要：
巴基斯坦是全球仍然流行脊髓灰质炎病毒的两个国家之一。虽然增加免疫覆盖率是一个令人担忧的问题，提供公平的护理机会也是一个优先事项，特别是受冲突影响的人口。认识到这些挑战，Naunehal,母亲的综合模式，新生,儿童健康（MNCH）免疫接种,以及通过社区动员提供的营养服务，移动外展，私营部门的参与在脊髓灰质炎病毒传播程度较高的受冲突影响的工会理事会(UC)中实施，包括哈罗塔巴德1号(奎达，Bal路支省）和BakhmalAhmedzai（LakkiMarwat，开伯尔·普赫图赫瓦）。使用准实验性的前后设计评估2021年4月至2022年4月实施的干预措施的影响，并进行基线和终线调查。对于每个干预UC，一个单独的，确定了匹配的对照UC。在终点处，在干预性UC中,完全免疫儿童的比例从27.5%显著上升至51.0%,差异差异(DiD)估计值为13.6%.零剂量儿童和常规免疫（NR-RI）儿童的非接受者比例从31.6％下降到0.9％，从31.9％下降到3.4％，分别,后一组显着减少。扩大和评估综合干预措施的采用和可行性，以提高免疫覆盖率，可以使决策者了解这种服务在这种情况下的可行性。
