{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T21:12:48Z","timestamp":1794345168902,"version":"4.9.0"},"reference-count":27,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2024,2,20]],"date-time":"2024-02-20T00:00:00Z","timestamp":1708387200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Bill and Melinda Gates Foundation","award":["INV-017322"],"award-info":[{"award-number":["INV-017322"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Pakistan is one of two countries globally still endemic for poliovirus. While increasing immunization coverage is a concern, providing equitable access to care is also a priority, especially for conflict-affected populations. Recognizing these challenges, Naunehal, an integrated model of maternal, newborn, and child health (MNCH), immunization, and nutrition services delivered through community mobilization, mobile outreach, and private-sector engagement was implemented in conflict-affected union councils (UCs) with high poliovirus transmission, including Kharotabad 1(Quetta, Balochistan) and Bakhmal Ahmedzai (Lakki Marwat, Khyber Pakhtunkhwa). A quasi-experimental pre\u2013post-design was used to assess the impact of the interventions implemented between April 2021 and April 2022, with a baseline and an endline survey. For each of the intervention UCs, a separate, matched-control UC was identified. At endline, the proportion of fully immunized children increased significantly from 27.5% to 51.0% in intervention UCs with a difference-in-difference (DiD) estimate of 13.6%. The proportion of zero-dose children and non-recipients of routine immunization (NR-RI) children decreased from 31.6% to 0.9% and from 31.9% to 3.4%, respectively, with a significant decrease in the latter group. Scaling up and assessing the adoption and feasibility of integrated interventions to improve immunization coverage can inform policymakers of the viability of such services in such contexts.<\/jats:p>","DOI":"10.3390\/pathogens13030185","type":"journal-article","created":{"date-parts":[[2024,2,20]],"date-time":"2024-02-20T04:36:22Z","timestamp":1708403782000},"page":"185","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["A Low-Cost, Integrated Immunization, Health, and Nutrition Intervention in Conflict Settings in Pakistan\u2014The Impact on Zero-Dose Children and Polio Coverage"],"prefix":"10.3390","volume":"13","author":[{"given":"Amira M.","family":"Khan","sequence":"first","affiliation":[{"name":"Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G OA4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imran","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Centre of Excellence in Women and Child Health, Aga Khan University, Karachi 74800, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Jawwad","sequence":"additional","affiliation":[{"name":"Centre of Excellence in Women and Child Health, Aga Khan University, Karachi 74800, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Islam","sequence":"additional","affiliation":[{"name":"Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G OA4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rehman","family":"Tahir","sequence":"additional","affiliation":[{"name":"Trust for Vaccines and Immunization, Al Sehat Centre, Rafiqui Shaheed Road, Karachi 74350, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3263-4182","authenticated-orcid":false,"given":"Saeed","family":"Anwar","sequence":"additional","affiliation":[{"name":"Prime Foundation, Peshawar Medical College, Warsak Road, Peshawar 25160, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed Ali","family":"Nauman","sequence":"additional","affiliation":[{"name":"Prime Foundation, Peshawar Medical College, Warsak Road, Peshawar 25160, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0637-599X","authenticated-orcid":false,"given":"Zulfiqar A.","family":"Bhutta","sequence":"additional","affiliation":[{"name":"Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G OA4, Canada"},{"name":"Centre of Excellence in Women and Child Health, Aga Khan University, Karachi 74800, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,2,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","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":"Morb. 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Health"}],"container-title":["Pathogens"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-0817\/13\/3\/185\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:02:45Z","timestamp":1760104965000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-0817\/13\/3\/185"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,20]]},"references-count":27,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2024,3]]}},"alternative-id":["pathogens13030185"],"URL":"https:\/\/doi.org\/10.3390\/pathogens13030185","relation":{},"ISSN":["2076-0817"],"issn-type":[{"value":"2076-0817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,20]]}}}