Analyzing Polio Eradication Strategies and Vaccination Efforts

The assignment provided is a compilation of research papers and articles related to global health, specifically focusing on polio eradication efforts in Nigeria. It includes studies on the use of mobile phones to improve vaccination uptake, environmental and human surveillance of polioviruses, and cost-effectiveness of interventions for reproductive, maternal, neonatal, and child health. The assignment also covers strategies for targeting the last polio sanctuaries with directly observed oral polio vaccination in northern Nigeria, and the use of satellite imagery analysis to guide immunization responses. It provides a comprehensive overview of various approaches to addressing potential polio reservoir areas and improving childhood immunization uptake.

PUBLIC HEALTH
REPORT

Table of Contents
INTRODUCTION...........................................................................................................................1
1. Identification and critical discussion of four cultural practices in England that act as help
and hindrance to intervention.................................................................................................1
2. Qualitative and quantitative evaluation for this intervention.............................................5
3. Ethical consideration arising from delivery of intervention and ways in which intervention
is of benefit to global health...................................................................................................7
4. Manner in which effectiveness and efficiency of the intervention will be determined......8
Planning Intervention Design: Intervention Mapping......................................................8
CONCLUSION................................................................................................................................9
REFERENCES..............................................................................................................................10
REFERENCES..............................................................................................................................10

INTRODUCTION
Public Health Report or more commonly referred to as PHR can be said to be a peer
reviewed public health journal that was published for United States Public Health Service as well
as Association of Schools and Programs of Public Health by SAGE Publishers in the year 1878.
The frequency of publication as well as the title of this journal has varied with the passage of
time, however, it is presently being released once in every two months. The Editor in Chief of
this journal is ascertained to be Frederic Shaw. Herein, articles are first released under the status
of ‘delayed open access’ but later with the passage of an annum from date of publication, it
transforms into ‘fully open access.’ Such articles can be access by way of PubMed Central.
The present report is based on a public health intervention prevailing in England, namely,
polio vaccination. This has been chosen because it is regarded as vaccination is found to be one
of the most significant and relevant aspect of public health which prevents millions of demises
across the globe every annum. Immunisation of childhood takes place dependent upon attitude of
parents, especially mothers, towards vaccination. This report consists of cultural practices that
foster and hinder the intervention along with quantitative and qualitative evaluation. Also, it
comprises of ethical considerations together with effectiveness as well as efficiency of
intervention
1. Identification and critical discussion of four cultural practices in England that act as help and
hindrance to intervention
Vaccination is a very important intervention of public health as this provides
immunisation to children against preventable diseases. In this regard, it has been found that polio
is a widespread disease that generally develops in people under 5 years of age. Although the
number of people stricken by Polio have gradually decreased within England in last century, yet
the need to raise awareness and take measures for this health issues is necessary. This gains
importance because of the serious and negative consequences that it is found to have for people.
In this relation, it is ascertained that many issues arise for people having polio (Poliomyelitis).
Some of the short term consequences associated with this disease are stiffened back as well as
neck without or with paralysis, immense pain in muscles, breathing along with swallowing issues
etc. Further, one of the biggest long term consequences of this disease is found to be long term
disability owing to paralysis of muscles.
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Polio is a severely contagious disease which takes place owing to a virus which is
ascertained to attack the nervous systems of individuals. In this regard, it is often seen that
children under 5 years of age are more probable to come in contact with this virus that any other
kind of group. As per the reports of WHO (World Health Organisation), it is acknowledged that
1 out of every 200 polio infections ultimately leads to permanent paralysis taking place. The
Global Polio Eradication Initiative began in the year 1988 owing to which the extent of this
disease has reduced a lot over last century. Yet there are cases that are reported of poliomyelitis
across the globe, especially England. Till the time even one child is getting infected by the virus
of Polio, the effort to raise awareness for this cause and to take measures to eradicate it across
the globe is significant and relevant. The vaccine for this disease was made in the year 1953 and
was made accessible only from the year 1957. Elimination of polio holds relevance and
significance for a nation as its eradication would be benefitting the globe in the form of a
stronger economy and enhanced quality of health. The purge of Poliomyelitis has the potential to
significantly save not less than $40-50 billion people in a time span of upcoming 20 yrs.
As per the estimates, it can be said that 95-99% of persons who contract the virus of polio
are asymptomatic. This phenomenon is referred to as subclinical polio. However, it has been
seen that personnel who are infected with Poliomyelitis virus could spread this virus and create
infection amidst other people even where they gained polio without any type of symptoms.
Non paralytic poliomyelitis shows its symptoms and signs for 1 to 10 days. Such signs
may include headache, fever, vomiting, fatigue, sore throat, meningitis etc. Such kind of
poliomyelitis is also referred to as abortive polio. On the contrary, paralytic polio is the one
which results in paralysis taking place of brainstem or spinal cord or both. Full paralysis is least
likely to take place as a result of polio. Only in 7-10% cases of paralytic polio, the virus of this
disease can be so severe that it may hold the capability to attack those muscles which cause
breathing in individuals and thereby ultimately result in death of the person. Further, there are
probabilities that polio can return even whereby an individual had recovered from it totally. This
is referred to as Post Polio Syndrome. This may take place after 15-40 years.
From the above discussion, it can be ascertained that the impact of contracting poliovirus
is so severe that there is a dire need for the initiative undertaken to eradicate global polio
continue to exist. The people of a country and their attitudes towards such diseases are of the
utmost importance while dealing with them. Uptake of vaccination against seasonal influenza is
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suboptimal in most countries and campaigns to promote vaccination may be weakened by
clustering of opinions and decisions not to vaccinate. This clustering can occur at myriad
interacting levels: within households, social circles, and schools. Given that influenza is more
likely to be transmitted to a household contact than any other contact, clustering of vaccination
decisions is arguably most problematic at the household level. Thus, there are always some
people who support a cause while others who restrain it. In this regard, there are a number of
cultural factors or aspects that foster or hinder the vaccination intervention to eradicate polio
from the confines of England totally. Such factors are necessary to ascertain so that the
favourable aspects can be taken advantage of and the unfavourable factors can be tackled in an
effective manner. The cultural practices of England which serve as help and hindrance for polio
vaccination are briefly explained below:-
CULTURAL PRACTICES HELPING INTERVENTION
There are several cultural practices prevailing within England which aid governments and
local bodies of medical care in their aim of spreading awareness and undertaking measures to
eliminate polio across the national boundaries. Such cultural practices helping polio vaccination
to successfully take place in confines of England are explained below:-
Spatial Clustering: This is a technique through which integration of opinions as well as
decisions take place to support a healthcare cause. In this regard, spatial clustering of opinions
and ideologies is a cultural practice existing within the confines of England that aims to decide
whether to vaccinate when overlaid with epidemiological dynamics may reduce vaccine
effectiveness in the entire population. Generally, the outcome of such thinking within the
respective country is found to be in favour of health care intervention. Such clustering of
opinions can take place by way of 3 types of mechanisms. The first and foremost of these is the
induction which can be said to be the direct and indirect influence of others' opinions and
behaviours. The second one is homophile which is a practice of associating with individuals
because of their similar opinions or behaviours. The last and third one is confounders who are
the environmental determinants of similar opinions or behaviours. Quantifying vaccine opinion
clustering within households and understanding the associated cultural factors help to foster the
healthcare intervention of polio vaccination, thereby, leading to improvements within public
health messages to mitigate future influenza epidemics.
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Parental education: This is the key to encouragement and facilitation of healthcare
interventions. In this regard, polio vaccination is of vital importance owing to the long term
impact that it may have for some individuals (long term disability in terms of paralysis) as well
as the Post Polio Syndrome. When parents of children are educated, they seem to possess the
knowledge about the reasons behind getting their kids vaccinated on time before they reach the
age of 5 years. Further, they are more likely to get persuaded and encouraged by the awareness
programmes developed and organised by government and local healthcare bodies. The couple
who is educated is more likely to see only the positive outcomes of vaccination in terms of
immunisation from the illness caused due to disease as well as its long term effects. They do not
pay attention to the rumours or misbelieves held by people regarding the ill consequences of
getting their children vaccinated. Thus, they render aid and support to this intervention and even
intend to create awareness among such people who are not equipped with knowledge regarding
the importance of immunisation against polio.
CULTURAL PRACTICES RESTRAINING INTERVENTION
While there are many cultural practices prevailing within the boundaries of England
which support the selected healthcare intervention, namely, polio vaccination, there are also
some practices and beliefs which restrain people supporting this cause. The attitudes, beliefs,
practices, philosophies and cultural insights of nation have a great role to play in supporting such
important and relevant healthcare interventions such as polio vaccination. However, there are
some practices and ideologies of people of England which abstain from effective spread of the
selected intervention. These are explained in detailed manner below:-
Individualistic Culture: England is found to be having an individualistic Hofstede
culture which indicates a high degree of individual decision making persisting within the
country. In countries where individualistic culture prevails, the government as well as local
bodies providing vaccination for polio face difficulties. This is so because such type of culture
indicates that every household and individual takes decision for themselves. In this regard, there
are many people who are against uptake of vaccination as they think there are a lot of issues
associated with the vaccine such as speech issues or autism. The hysterical thinking of such
people restrains the polio vaccination intervention as they do not let their children get the vaccine
on time. Only rational individuals within the country intend to minimise the risks linked to
illness and aim to seek vaccination for their children if they recognise a higher risk of
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contagiousness of disease and a lower threat post vaccination. In contrast to this, places where
collectivism persists is found to be more open to polio vaccination as there, the decisions are
taken on a collaborative basis which illustrates that if the decision to encourage uptake of
vaccination has been taken then a small percentage of people deviate from such course of action.
Thus, it has been found that individualistic culture acts as a hindrance for the present
intervention.
Attitudes of Mothers: The attitudes of mothers towards a healthcare intervention shape in
a great manner the fact that such strategy would be facilitated or restrained. In this regard, the
mothers that consider that immunisation hold a lot of consequences for the child do not let the
child get vaccinated. It is well known that vaccination do not have any kind of major
consequences for the one being polio vaccinated. It is only in some children that it is observed to
cause swelling at the injection site or slight fever. The females who think that such vaccines have
negative aspects related to them prevent their kids from getting immunisation thus hindering the
intervention in a large and significant manner. What these mothers do not know is that all kinds
of vaccines, even the ones for polio, undergo full testing before being approved for usage by
FDA. It is well regarded that vaccines comprise of weakened toxins which makes the body of kid
create antibodies for protection of child from polio. Irrespective of massive awareness
programmes and initiatives being taken up by government and local health care bodies, mothers
possessing such negative and wrong thinking restrain the positive outcomes of polio vaccination.
Their attitudes towards preschool immunisation lead to increase in the probability of their
children contracting poliovirus. There is a strong emotional aspect associated with such decision
making, characterised by fear as well as mistrust in vaccinators. Risk perception is fostered by
the social networks of mothers, their knowledgebase as well as understanding of the relative
risks of polio infection versus polio vaccination, along with their own experiences.
2. Qualitative and quantitative evaluation for this intervention
It is essential for government as well as local bodies to constantly evaluate the results of
interventions in order to gain comprehensive knowledge about its effectiveness within the
society and environment. In this regard, polio vaccination is a public health care intervention that
is aimed at eradication of polio from the confines of globe with a view to reduce the illness and
after effects caused by this disease. For carrying out the evaluation of this public health
intervention two types of methods are taken into use, namely, quantitative and qualitative. Both
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of these are conducted in a manner such that they can depict the outcomes of polio vaccination as
being favourable or unfavourable in terms of gaining support from general public and spreading
the cause to save children from contracting this disease by way of poliovirus. These methods are
briefly explained as follows:-
Qualitative method of evaluation: This is a method which takes into account the views,
opinions, ideologies and perceptions of humans with respect to any kind of matter or issue in
concern. This does not quantify the data or it can be said that here data is not presented in the
form of number or statistical information. In this regard, polio vaccination is a cause that is
fostered by government and local health care bodies which together integrate in order to ensure
better results for the company. Thus, for evaluating the outcomes, government and HSC bodies
will conduct survey, questionnaire or one on one interview with people to gain knowledge of
their views regarding the results of intervention in terms of eradication of polio in the confines of
England. With the help of questionnaire and/or survey, data regarding its effectiveness can be
duly collected and studied in order to enhance the existing manner of executing this intervention.
Quantitative method of evaluation: This is a type of evaluation which comprises of
examination of outcomes of a matter or topic in concern in terms of number, statistical figures or
numerical data. In this relation, England is a very big country where collecting information
regarding the views of people about results of this public intervention can be cumbersome and
tiring. Thus, to deal with the large population and collect views from them in order to carry out
evaluation, the views and opinions of total population is taken into account by making use of a
number of mathematical and statistical methods such as SPSS test. Further, sampling methods
such as systematic random sampling, random sampling, multistage sampling, cluster sampling
and stratified sampling are taken into use for carrying out survey over a last base of audience and
gaining knowledge of their opinion over polio vaccination so that improvements can be brought
in the measures taken to deal with Poliomyelitis.
With the help of above mentioned two types of evaluation methods, government as well
as health care local bodies aim at ascertainment of effectiveness of public health intervention and
gaining knowledge of the ways in which improvements can be incorporated within its scope to
ensure betterment and welfare for people. Where the results of evaluation of polio vaccination
are determined to be positive, this reflects that the intervention has to a great extent been
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successful in eradication of polio across the globe, especially, within England which is the
specific country under study.
3. Ethical consideration arising from delivery of intervention and ways in which intervention is
of benefit to global health
In public health care, intervention is meant to raise benefits or policy for the treatment of
public health or mental care. Interventions such as health care department as well as supporting
units are best solution of any issues raise from ethical issues of the health care problems. Use of
an ethical consideration such as values, moral ethics and vision for an effective treatment of
mental or physical health based problems. From intervention such as medical support system,
mental health care units and clinic etc. ethical consideration such as issues to lack of health
awareness and still less medical support to an individual are some of the ethical consideration
from public health. In the public health, consideration such as lack of vision, values and moral
consideration are suffering with its own weakness or problems. In making right strategy for
mental and physical health care this is to be reveals that ethics ethical consideration such as
making of the health care program, skill and use of the funds are required to planned or consider
in less point of time. In the global platform, intervention in health is in demand in order to raise
productive outcomes from health and mental considerations. Consideration such as effective
moral tools or techniques can be used in mental or health care to bring harmony against social
and cultural development at the proactive side of treatment or development. Providers of the
intervention such as clinics, health care service as well as hospital can be covered as part of
provider of the health and considered as part of support system or services.
Ethical consideration needs to have right consideration with help of which health care
providers such as clinic, health care and treatments centre will be able to treatments or act as
guidance in minimum point of time. This was realised that treatment is need to be consider a
level of an effective regulation which will be done in the right point of time. Also, ethical issues
is required to be solve out to make clear focus on making physical and health. Service provider
should have to makes is its clear focus on providing intervention to the health and support with
support of the health care units to ensure about clear delivery of intervention units.
Treatment have to be ensure about the clear monitoring of support services which are they
are giving to led an effective treatment and solution of the patients problem. These services are
need to obtained using resources and treatment equipment which is necessary to obtained long
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life optimised outcomes out of the treatments as well as effective growth based regulation into
the health care sector. This was analysed that health and physical care sector is necessary to have
right treatments with help of which treatments of patients in clinic or medical centre would be
done with right purpose or aim.
4. Manner in which effectiveness and efficiency of the intervention will be determined
Effective intervention has been resulted from changes in kind of the perception,
behaviour, as well as broader factors for the patients or families. As such, it is necessary to
control these changes to illustrate either present current intervention is implementing a desired
change. The term used here is “progress monitoring” which is generally termed to as one major
patient’s level progress while in case of responding to an intervention. This is one stated that,
level of the progress monitoring is an effective kind of ongoing assessment which either helps to
ensure that problem behaviour must be changed, and if so, to what extent. The major idea or
status behind progress monitoring is to makes relatively simple understanding of the health and
also public care works: if the current intervention is not changing a problematic behaviour in a
timely fashion and/or improving QOL for the patient and family, then the intervention requires
revision.
Progress monitoring is one necessary, as a continuing of the improper intervention helps to
represents the complete cost. Resources & time allocates to an improper intervention has not
been regained, and will also results into the therapeutic relationship among the patients, family,
and clinician. Along with this, youth and their families will not have “do-over” for the weeks (or
months) that were spent engaged in an intervention that was not effective. Moreover, during
usage of the progress monitoring to do ranging or track and must be analyse youth’s
responsiveness to the selected intervention is also important, patients and families which have to
be objective markers of a change in behavioural and uses this kind of an information to enhances
an intervention accordingly. As part of the clinicians are involving the patients and their family
people and getting their feedback to change their intervention in given point of time. This level
of an activity has been revealed as a major strengthen to reach out the therapeutic relationship
(especially if the desired behavioural changes are achieved).
Planning Intervention Design: Intervention Mapping
Producing proper intervention is always depends on effective, with use of the careful,
using of the proper designs and wide range of necessary frameworks with use of which to guide
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planning are available. Here we focus on the IM approach because it provides a comprehensive
and practical guide to optimal design and evaluation procedure.
The targeted behaviour of patients is need to be tracked during an intervention process,
like following current change into the trends in the behaviour (increase or decrease in frequency)
will also be observed. Also, an effective manner to monitor progress in the individualized
manner for managing youth using support of the TD involves a target based assessment. In such
kind of an assessment, target behaviour is mentioned at the baseline and also frequency, intensity
and also impact are classified. This behaviour will be again re-assessed using each visit for range
of the frequency, intensity and impact of the health care business. This would allow the health
care support to perform objective assessment of either checking behaviour is decreasing or rising
from on each and every visit of the patients, and whether modification to the intervention is
warranted.
CONCLUSION
On the basis of analysis and examination of above mentioned discussion, it can be said
that public health interventions are aimed at welfare and betterment of society as well as people.
Further, it can be analysed that there are various aspects which foster or hinder a particular
public health intervention in accordance with the culture of people or nation. Also, it has been
assessed that the evaluation of such intervention becomes important as it helps in ascertaining
whether or not the particular public health intervention has been effective in delivering its
outcomes in terms of welfare of society and eradication of illness and health diseases across the
globe. In addition to this, it has been noted that there are two methods of carrying out evaluation
of such public health intervention and these are ascertained to be quantitative and qualitative.
Qualitative evaluation is done on the basis of surveys, questionnaire, face to face interviews etc.
On the other hand, quantitative evaluation is done with the help of mathematical and statistical
methods such as SPSS, cluster sampling, stratified sampling etc.
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REFERENCES
Books and Journals
Barton, H., and et. al., 2015. The Routledge handbook of planning for health and well-being:
Shaping a sustainable and healthy future. Routledge.
Bradshaw, J. ed., 2016. The Well-being of Children in the UK. Policy Press.
Jarrett, C. and et. al., 2015. Strategies for addressing vaccine hesitancy–A systematic
review. Vaccine, 33(34), pp.4180-4190.
Guirguis, S. and et. al., 2017. Placing human behavior at the center of the fight to eradicate polio:
lessons learned and their application to other life-saving interventions. The Journal of
infectious diseases, 216(suppl_1), pp.S331-S336.
Eskola, J. and et. al., 2015. How to deal with vaccine hesitancy?. Vaccine, 33(34), pp.4215-4217.
Church, J.A. and et. al., 2019. Interventions to improve oral vaccine performance: a systematic
review and meta-analysis. The Lancet Infectious Diseases, 19(2), pp.203-214.
Aaby, P. and et. al., 2016. Does oral polio vaccine have non-specific effects on all-cause
mortality? Natural experiments within a randomised controlled trial of early measles
vaccine. BMJ open, 6(12), p.e013335.
Bawa, S. and et. al., 2018. Achieving universal health coverage: implementation of a polio
eradication intervention to deliver integrated primary health services to hard-to-reach
and underserved communities in Nigeria Research. WHO Bulletin.
Sepúlveda, J., 2017. Global health: Towards polio eradication. Nature, 547(7664), p.411.
Joffret, M.L. and et. al., 2018. Environmental and Human Surveillance of Polioviruses and other
Enteroviruses in Madagascar. Impact of the trivalent to bivalent Oral Polio Vaccine
Switch. Инфекция и иммунитет, 8(4), p.527.
Fuchs, E.L., 2016. Self-reported prenatal influenza vaccination and early childhood vaccine
series completion. Preventive medicine, 88, pp.8-12.
Higgins, J. and et. al., 2019. Finding inhabited settlements and tracking vaccination progress: the
application of satellite imagery analysis to guide the immunization response to
confirmation of previously-undetected, ongoing endemic wild poliovirus transmission
in Borno State, Nigeria. International journal of health geographics, 18(1), p.11.
Korir, C. and et. al., 2018. Targeting the last polio sanctuaries with Directly Observed Oral Polio
Vaccination (DOPV) in northern Nigeria,(2014–2016). BMC public health, 18(4),
p.1314.
Oliver-Williams, C. and et. al., 2017. Using mobile phones to improve vaccination uptake in 21
low-and middle-income countries: systematic review. JMIR mHealth and
uHealth, 5(10), p.e148.
Kazi, A.M. and Jafri, L.A., 2016. The use of mobile phones in polio eradication. Bulletin of the
World Health Organization, 94(2), p.153.
Horton, S. and Levin, C., 2016. Cost-effectiveness of interventions for reproductive, maternal,
neonatal, and child health.
Bawa, S. and et. al., 2018. Conduct of vaccination in hard-to-reach areas to address potential
polio reservoir areas, 2014–2015. BMC public health, 18(4), p.1312.
Habib, M.A. and et. al., 2017. Community engagement and integrated health and polio
immunisation campaigns in conflict-affected areas of Pakistan: a cluster randomised
controlled trial. The Lancet Global Health, 5(6), pp.e593-e603.
10

Ozawa, S. and et. al., 2018. Parents’ preferences for interventions to improve childhood
immunization uptake in northern Nigeria. Vaccine, 36(20), pp.2833-2841.
Sack, D.A., 2019. Enhancing immune responses to oral vaccines: still an enigma. The Lancet
Infectious Diseases, 19(2), pp.122-123.
Basta, N.E. and Halloran, M.E., 2019. Evaluating the effectiveness of vaccines using a
regression discontinuity design. American Journal of Epidemiology.
Musa, A. and et. al., 2016. Enhancing transit polio vaccination in collaboration with targeted
stakeholders in Kaduna State, Nigeria: Lessons learnt: 2014–2015. Vaccine, 34(43),
pp.5159-5163.
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