Role of rotavirus vaccine in reducing diarrheal episodes among children aged 6 months to 2 years at private PHC clinics in Karachi: A mixed method study

Date of Award


Document Type


Degree Name

Master of Science in Health Policy & Management (MSc Health Policy & Mgmt)

First Supervisor/Advisor

Dr Rehana Siddiqui

Second Supervisor/Advisor

Ms Nousheen Pradhan

Third Supervisor/Advisor

Syed Iqbal Azam


Community Health Sciences


Background: As per Global Burden of Diseases, injuries and risk factors2017, diarrheal diseases are the 3'd leading cause of mortality in children. Pakistan Demographic Health Survey 2017-18 showed the prevalence of diarrhea in children under 5 years of age as I9Yo. However, Multiple Indicator Cluster Survey (MICS) 2014 from Sindh province reported that t5.6yo children aged 4g-59 months and 37 .2yo children aged 0-11 months suffered from diarrhea. Rotavirus vaccines were incorporated in the National Immunization Program (NIP) of more than 70 countries by the year 2014. In Pakistan, this vaccine was introduced in the year 2017 and only 5g% of the children aged less than one year were vaccinated against rotavirus by the year 201g. Objectives: This study aims to determine the difference in the number of diarrheal episodes among children aged 6 months to 2 years who are vaccinated with those who are not vaccinated against rotavirus and to identify/explore barriers from the perspective of healthcare providers and mothers/caregivers in immunizing against rotavirus visiting Aga Khan Health service, Pakistan (AKHS, p) community centers in Karachi.
Methodology: It is a mixed-method (concurrent) study. A total of 430 children data (past 3 months records) were obtained from the Health Management Information System (HMIS) and Physician records. MICS questionnaire tool was used and data were analyzed using STATA-15. Three In-depth Interviews (IDIs) with physicians and frree Focus Group Discussions (FGDs) with mothers/caregivers were conducted and analyzed using content analysis.
Results: Of the 430 children TgYowere vaccinated appropriately for two doses of rotavirus and ZlYowere partially or not vaccinated. Complete vaccination status differed by the three centers ranging between 76.4-54.7%. There were a total of 104 diarrheal episodes that differed significantly by three centers (22.1%,38.4yo, and39.4%). Overall number of diarrheal episodes among children who were either partially vaccinated or not vaccinated against rotavirus were thrice more (n:77;74.03%) compared to those who were vaccinated against rotavirus (n:27;25.96%). Our qualitative results show that there is a lack of awareness and knowledge among mothers regarding the harmful effects of diarrhea and rotavirus vaccine as a preventive strategy for diarrhea as well as there is a need of training and refresher courses offered to the physicians to make their counselling better about the importance of rotavirus vaccination.
Conclusion: Raising awareness and knowledge among mothers/caregivers and communities is essentially important for the successful uptake of rotavirus vaccine and to improve its coverage. Organizing trainings/ refresher courses for Health Care providers (HCPs) at primary health care level about the significance of rotavirus vaccine will help in bringing the changes in diarrhea morbidity in this setting.

This document is available in the relevant AKU library