{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T13:32:41Z","timestamp":1787319161566,"version":"build-2736575974"},"reference-count":17,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T00:00:00Z","timestamp":1759104000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>During January 2022\u2013June 2023, Pakistan reported 21 Wild Polio Virus 1 (WPV1) cases, all of which occurred within districts in the south Khyber Pakhtunkhwa (KP) province. In May 2023, a special immunization campaign was conducted to reach all children under 5\u202fyears of age within 69 high-risk union councils (UCs) in six districts of south KP. The campaign comprised of three rounds, each lasting 8\u202fdays, that provided bivalent oral poliovirus vaccine (bOPV) as well as other vaccines using a site-to-site delivery strategy. Rounds 1, 2, and 3 were conducted in July 2023, August 2023, and April 2024, respectively. We conducted a post-campaign evaluation (PCE) survey following the first two rounds, to assess OPV receipt, using a multistage sampling design. We analyzed PCE data for the two first rounds to provide UC-level estimates of the proportions of children who did not receive bOPV and assessed reasons for non-vaccination. The PCE survey included 8,125 children from 67 UCs during round 1 and 7,726 children from 47 UCs during round 2. The median number of villages by UC was 8 for both rounds. The median number of children by village was 16 for round 1 and 19 for round 2. Overall, 16% of children missed bOPV (95% CI\u202f=\u202f14\u201318%) for round 1 [estimated total of 39,983 children (95% CI\u202f= 34,775\u201345,808)]; and 15% (95% CI\u202f=\u202f13\u201317%) for round 2 [estimated total of 24,257 children (95% CI\u202f= 21,355\u201327,474)]. Percentages and numbers of missed children varied widely among UCs during both rounds. Six UCs in the first round and four UCs in the second had \u226540% missed children. Reasons for non-vaccination were similar for each round, with operational reasons leading by &amp;gt;60%, followed by refusals (\u226520%), and child not available (~10%). We found a high proportion of missed children during this special immunization intervention and identified the UCs with the greatest challenges. In these UCs, there is a need to design and implement comprehensive, tailored, and effective interventions for each reason why children missed vaccination.<\/jats:p>","DOI":"10.3389\/fpubh.2025.1591325","type":"journal-article","created":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T05:27:12Z","timestamp":1759123632000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Estimating proportions of missed children and reasons for non-vaccination following implementation of \u201creaching the unreached\u201d multiantigen immunization campaign\u2014south Khyber Pakhtunkhwa, Pakistan, July\u2013August 2023"],"prefix":"10.3389","volume":"13","author":[{"given":"Amen","family":"Ben 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Nawaz","family":"Sherani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hafizullah","family":"Khan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akerele","family":"Adekunle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdinoor","family":"Mohamed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chukwuma","family":"Mbaeyi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Franka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdul","family":"Basit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rana","family":"Safdar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,29]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"880","DOI":"10.15585\/mmwr.mm7233a1","article-title":"Progress toward poliomyelitis eradication\u2014Pakistan, January 2022\u2013June 2023","volume":"72","author":"Mbaeyi","year":"2023","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12992-016-0195-3","article-title":"Eradicating polio in Pakistan: an analysis of the challenges and solutions to this security and health issue","volume":"12","author":"Hussain","year":"2016","journal-title":"Glob Health"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"661","DOI":"10.1080\/14760584.2021.1915139","article-title":"Eradicating polio in Pakistan: a systematic review of programs and policies","volume":"20","author":"Ataullahjan","year":"2021","journal-title":"Expert Rev Vaccines"},{"key":"ref4","year":"2022"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"781","DOI":"10.3390\/vaccines11040781","article-title":"Why reaching zero-dose children holds the key to achieving the sustainable development goals","volume":"11","author":"Hogan","year":"2023","journal-title":"Vaccine"},{"key":"ref6","year":"2023"},{"key":"ref7","year":"2024"},{"key":"ref8","author":"Thomas Lumley","year":"2024"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1016\/S0140-6736(17)32442-X","article-title":"The polio endgame: securing a world free of all polioviruses","volume":"391","author":"Zaffran","year":"2018","journal-title":"Lancet"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1016\/j.vaccine.2023.12.056","article-title":"Determinants of immunization in polio super high-risk union councils of Pakistan","volume":"42","author":"Khan","year":"2024","journal-title":"Vaccine"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"2124","DOI":"10.1016\/j.vaccine.2021.03.001","article-title":"Quantifying movement patterns and vaccination status of high risk mobile populations in Pakistan and Afghanistan to inform poliovirus risk and vaccination 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Pakistan","volume":"16","author":"Saeed","year":"2018","journal-title":"Anti-Infect Agents"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"70","DOI":"10.3390\/vaccines11010070","article-title":"Vaccine hesitancy and perceptions of the community about polio in high-risk areas of Karachi, Sindh, Pakistan","volume":"11","author":"Abbasi","year":"2022","journal-title":"Vaccine"},{"key":"ref16","first-page":"356","article-title":"Assessing the effectiveness of house-to-house visits on routine oral polio immunization completion and tracking of defaulters","volume":"32","author":"Curry","year":"2014","journal-title":"J Health Popul Nutr"},{"key":"ref17","first-page":"589","article-title":"Evaluation of house-to-house versus fixed-site oral poliovirus vaccine delivery strategies in a mass immunization campaign in Egypt","volume":"73","author":"Linkins","year":"1995","journal-title":"Bull World Health Organ"}],"container-title":["Frontiers in Public 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