How reliable is the asset score in measuring socioeconomic status? Comparing asset ownership reported by male and female heads of households.

Asset scores are widely used as the preferred method of measuring socioeconomic wellbeing of households in developing countries. We examine the degree of discrepancies in reporting asset ownership by male and female heads of the same household. Household asset scores were estimated separately for male and female responses, using Principal Component Analysis, the method widely used in the literature, and households were categorized into wealth quintiles. The results indicate that only half of the households belonged to the same quintile groups for both male and female response-based asset scores. In addition, the two estimates of asset scores within the same quintile deviate by more than 20% for 71% of households in the top three quintiles and for 18% in the poorest two quintiles. Inter-individual (male/female) variability in reporting the asset ownership was high enough to raise concerns about the validity and reliability of asset scores as a metric of household socioeconomic status. Although the study did not try to ascertain underlying reasons for differential reporting, possible explanations could be a lack of awareness among household members on asset ownership or differential propensity to demonstrate relatively better social status of the household by male and female respondents. To improve reliability of asset scores, methodology for collecting asset ownership information should define who in the household may or may not be used as a respondent. Visual verification of reported ownership of assets will reduce male-female discrepancies but the verification process is time-consuming and intrusive, thus negating the advantages of collecting asset data. Alternatives to asset-based scoring need to be considered and one approach could be to solicit subjective opinions from male and female heads on the location of households in the social hierarchy.

Understanding vaccine hesitancy in polio eradication in northern Nigeria.

BACKGROUND: Vaccine hesitancy constitutes a major threat to the Global Polio Eradication Initiative (GPEI), and to further expansion of routine immunisation. Understanding hesitancy, leading in some cases to refusal, is vital to the success of GPEI. Re-emergence of circulating wild poliovirus in northern Nigeria in mid-2016, after 24months polio-free, gives urgency to this. But it is equally important to protect and sustain the global gains available through routine immunisation in a time of rising scepticism and potential rejection of specific vaccines or immunisation more generally. METHODS AND FINDINGS: This study is based on a purposive sampling survey of 1653 households in high- and low-performing rural, semiurban and urban areas of three high-risk states of northern Nigeria in 2013-14 (Sokoto, Kano and Bauchi). The survey sought to understand factors at household and community level associated with propensity to refuse polio vaccine. Wealth, female education and knowledge of vaccines were associated with lower propensity to refuse oral polio vaccine (OPV) among rural households. But higher risk of refusal among wealthier, more literate urban household rendered these findings ambiguous. Ethnic and religious identity did not appear to be associated with risk of OPV refusal. Risk of vaccine refusal was highly clustered among households within a small sub-group of sampled settlements. Contrary to expectations, households in these settlements reported higher levels of expectation of government as service provider, but at the same time lesser confidence in the efficacy of their relations with government. CONCLUSIONS: Results suggest that strategies to address the micro-political dimension of vaccination - expanding community-level engagement, strengthening the role of local government in public health, and enhancing public participation of women - should be effective in reducing non-compliance, asan important set of strategies complementary to conventional didactic/educational approaches and working through religious and traditional 'influencers'.

Communication for polio eradication: improving the quality of communication programming through real-time monitoring and evaluation.

Communication is a critical component in assuring that children are fully immunized and that simultaneous immunity is attained and maintained across large geographic areas for disease eradication and control initiatives. If service delivery is of good quality and outreach to the population is active, effective communication--through advocacy, social mobilization, and program communication (including behavior change activities and interpersonal communication)--will assist in raising awareness, creating and sustaining demand, preventing or dispelling misinformation and doubts, encouraging acceptance of and participation in vaccination services, more rapid reporting of disease cases and outbreaks, and mobilizing financial resources to support immunization efforts. There is evidence of 12% to 20% or more increases in the absolute level of immunization coverage and 33% to 100% increases in relative coverage compared to baselines when communication is included as a key component of immunization strengthening. This article utilizes evidence from Afghanistan, India, Pakistan, and Nigeria to examine how the Global Polio Eradication Initiative has utilized monitoring and evaluation data to focus and improve the quality and impact of communication activities.

Achieving polio eradication: a review of health communication evidence and lessons learned in India and Pakistan.

Since 1988, the world has come very close to eradicating polio through the Global Polio Eradication Initiative, in which communication interventions have played a consistently central role. Mass media and information dissemination approaches used in immunization efforts worldwide have contributed to this success. However, reaching the hardest-to-reach, the poorest, the most marginalized and those without access to health services has been challenging. In the last push to eradicate polio, Polio Eradication Initiative communication strategies have become increasingly research-driven and innovative, particularly through the introduction of sustained interpersonal communication and social mobilization approaches to reach unreached populations. This review examines polio communication efforts in India and Pakistan between the years 2000 and 2007. It shows how epidemiological, social and behavioural data guide communication strategies that have contributed to increased levels of polio immunity, particularly among underserved and hard-to-reach populations. It illustrates how evidence-based and planned communication strategies - such as sustained media campaigns, intensive community and social mobilization, interpersonal communication and political and national advocacy combined - have contributed to reducing polio incidence in these countries. Findings show that communication strategies have contributed on several levels by: mobilizing social networks and leaders; creating political will; increasing knowledge; ensuring individual and community-level demand; overcoming gender barriers and resistance to vaccination; and reaching out to the poorest and marginalized populations. The review concludes with observations about the added value of communication strategies in polio eradication efforts and implications for global and local public health communication interventions.