Date of Award

12-2023

Degree Type

Thesis

Degree Name

MS in Epidemiology & Biostatistics

First Advisor

Mr. Syed Iqbal Azam

Second Advisor

Dr. Narjis Rizvi

Third Advisor

Dr. Nick Brown

Department

Community Health Sciences

Abstract

Introduction: The school-based immunization policy involves checking students' immunization status upon enrollment, administering routine vaccines at school, and having educational materials with the school to facilitate vaccination. School healthcare providers play a vital role in student health and communication with parents about their children's well-being. In 2022, the Government of Pakistan introduced the national school-based immunization policy, but the factors affecting policy compliance and the role of preschool healthcare providers in it are still unexplored. Thus, the study aims to assess the implementation of the school-based immunization policy in preschools, considering the presence of preschool healthcare providers and other factors that may influence policy compliance.
Methods The study employed an explanatory sequential mixed-method study which included all preschools in Karachi that met the defined eligibility criteria. Data regarding the preschool was obtained from the preschool administrator. Quantitative data was collected through a systematic sampling of preschools, while in-depth interviews were conducted with purposively selected preschool administrators. The final sample size was 212 preschools for the survey. Whereas in depth interviews were conducted until data saturation occurred. The school-based immunization policy compliance was measured using a self-developed structured questionnaire and a semi structured interview guide was used for the in-depth interviews. A t-test for two independent samples was used to compare the difference in mean compliance scores between preschools with and without healthcare providers. Multiple linear regression was applied to control other factors influencing the association between the presence of preschool healthcare providers and school based policy compliance at a statistically significant p-value of < 0.05 using STATA 15.0. Qualitative data were analyzed using thematic framework analysis, and the findings from both datasets were triangulated.
Results: A total of 223 preschools were surveyed and 9 in-depth interviews were conducted with preschool administrators. The survey revealed that 43.5% of the preschools relied on manual Page 7 of 91 vaccination record-keeping methods. Likewise, the qualitative data showed that some of the preschools (3 out of 9) were manually keeping vaccination records. Furthermore, the preschool administrators reported that 80.3% of parents were cooperative with school management in vaccinating their child(ren) at school, which was consistent with the qualitative findings. The survey indicated that 89.7% of the preschool administrators were unaware of the EPI. Similar findings were observed in in-depth interviews that most of the preschool administrators (7 out of 9) lacked knowledge about EPI. The results revealed a statistically significant mean difference of 3.91 (2.15 – 5.66) in compliance scores between preschools with healthcare providers and preschools without healthcare providers. The final model included the vaccination records storage method (β 5.05; 95% CI 3.47 – 6.63), parents’ cooperation (β 1.32; 95% CI 0.16 – 2.49), and a statistically significant interaction between the presence of preschool healthcare providers and awareness of EPI among preschool administrators at a p-value < 0.1.
Conclusion: The healthcare providers in preschools facilitate school-based immunization policy compliance, while the absence of staff training for vaccination record-keeping and supporting vaccination drives impedes compliance. Understanding and addressing these factors can optimize policy compliance.

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