THE LAST FRONTIER OF RESISTANCE: REFUSALS TO ORAL POLIO VACCINATION IN SIX DISTRICTS OF KANDAHAR PROVINCE OF AFGHANISTAN.

Background: Refusal to the Oral Polio Vaccine (Henceforth referred to as OPV) is a difficulty faced by the Polio Eradication Initiative (PEI) in the most dangerous and highly endemic areas, in Kandahar, Afghanistan. Through our survey during the period of 2015-2016, we investigated community perceptions of the OPV and estimated the prevalence of OPV refusal in 6 Very high risk districts (VHRDs) of polio-endemic areas in the province of Kandahar. Methods: Cross-sectional survey was conducted among the caregivers of refusal families with children aged <5 years. The study was conducted at the community level of 6 very high risk districts of Kandahar province. For the first section of the study, multistage cluster sampling technique was adopted. The primary sampling units were families obtained by the Polio vaccination team. At the first stage, a total of 400 households were randomly selected from 4000 refusal families in 6 districts, using Probability Proportion to Size (PPS) technique. The sample consisted of 400 households selected for the survey. All target houses were interviewed in the survey. Discussion: The survey identified the reasons behind refusals to OPV. There are numerous reasons given by the respondents, where some had only one reason for refusing OPV whilst others had multiple misconceptions. These misconceptions include, vaccines will cause impotence because it is a western conspiracy, and that the vaccine is not safe. Others did not even believe in the effectiveness of the vaccine provided. Some were against it for cultural reasons such as the prohibition of bringing out a new-born outside of the house. While others thought it was not allowed by the religion. Other reasons included too many campaigns, political differences with the government and males members of the family not at home at the time of immunization. In the 6 districts, the rate of refusal ranged from 20% up to 60% (WHO, 2009). Recommendations: The approach has to be modified by the PEI to reflect ground realities considering the local value system in the path to polio eradication in the surveyed districts. During this article we have established that the awareness level of the caregivers is high. Almost 80% of the residents know about the campaigns. Even though the caregivers know about the timing of immunization there is a lack of knowledge of potential risk associated with retracting the virus. The program has to work harder to make people realize the dangers of not vaccinating their children not only for their children but all the children of the vicinity.