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

Abstract

Abstract Background: Globally rotavirus (RV) induced diarrhea was one of the major causes of childhood diarrhea, resulting in hospitalization and mortality prior to the introduction of the rotavirus vaccine (RVV). The estimated coverage of RVV in the year 2019 was 86% in children less than one year of age whereas the estimated diarrheal mortality was 67 deaths per 1,000 live births in Pakistan. This study aimed to determine the difference in the diarrheal episodes in children by RVV status and to identify barriers to RVV from the perspective of mothers visiting and physicians working in AKHS, P, primary healthcare (PHC) clinics in Karachi, located in the province of Sindh, Pakistan. Methods: A mixed-methods study design was conducted at three private PHC clinics located in three different districts of Karachi. Data for RVV status and diarrheal episodes were collected in June 2020 for children born between October 2019 to March 2020, from Health Management Information System (HMIS) and physician records respectively. In-depth Interviews (IDIs) with physicians and 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: Four hundred and thirty children more than one month and less than nine months of age visited the three private PHC clinics in Karachi for vaccination and clinical health care from October 2019 to June 2020. By June 2020, an overall of, 79.8% (343/430) eligible infants were fully vaccinated against RVV, and 24.2% (104/430) suffered diarrheal episodes. The mean age of infants at the time of the first dose of RVV was 2.6 ± 0.2 months. Among fully vaccinated, 8.2% (28/343) children had history of diarrheal episodes, while among non/partially vaccinated, 87.4% (76/87) children had history of diarrheal episodes and it found statistically significant with a p-value < 0.001. Qualitative study results (FGDs) showed that mothers showed a lack of awareness and knowledge on the prevention of diarrhea by RVV and the harmful effects of diarrhea. Physicians’ IDIs, pointed towards a lack of sufficient trainings on RVV. Conclusion: Diarrheal episodes were significantly greater in partially or unvaccinated children than in fully RVV vaccinated children. Low levels of awareness and knowledge in caretakers and lack of RVV training in PHC physicians are the obstacles in controlling diarrheal diseases.