Urban–Rural Disparities in Polio Vaccination in South Punjab, Pakistan: The Role of Community Perceptions, Barriers, and Health System Factors
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Abstract
Background: Polio eradication in Pakistan remains challenged by persistent gaps in vaccine acceptance, access, trust, and community engagement, particularly in underserved rural populations. Urban–rural differences in vaccination determinants require localized evidence to guide equitable eradication strategies. Objective: To compare community perceptions, perceived barriers, and factors associated with polio vaccination uptake among urban and rural residents of South Punjab, Pakistan. Methods: An analytical cross-sectional study was conducted among 600 adults, including 300 urban and 300 rural respondents. Data were collected through a structured, pilot-tested questionnaire assessing socio-demographic characteristics, awareness, socio-cultural influences, accessibility, institutional trust, communication barriers, and vaccination practices. Descriptive statistics, urban–rural comparisons, and multivariable logistic regression were used to identify factors associated with vaccination uptake. Results: Rural respondents reported higher barriers across most domains, including lack of awareness (63.7% vs. 50.3%), religious or cultural opposition (31.0% vs. 16.3%), limited campaign access (29.7% vs. 10.7%), transportation barriers (20.7% vs. 6.3%), and lack of schedule awareness (41.0% vs. 23.7%). Rural residence was independently associated with lower vaccination uptake (AOR=0.62, 95% CI: 0.45–0.85; p=0.003). Low awareness (AOR=0.48), poor access (AOR=0.55), transportation issues (AOR=0.58), low trust in government programmes (AOR=0.60), and religious influence (AOR=0.67) were also significant predictors. Conclusion: Polio vaccination disparities in South Punjab are driven by intersecting informational, socio-cultural, infrastructural, logistical, and institutional barriers. Rural-focused outreach, improved schedule communication, mobile vaccination services, and engagement of trusted community and religious leaders are essential to improve equitable vaccine uptake
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