PESHAWAR, 18 August 2008 (IRIN) - Turab Khan, 24, is finding life tough in Peshawar, the capital of Pakistan's North West Frontier Province (NWFP). "I have not found a job yet and am actually not really qualified for anything as I have worked with my family's goats most of the time till now," he told IRIN.

However, despite the difficulties in supporting his wife and two children, Turab, from Bannu (about 250km southwest of Peshawar), is determined to stay on.

Factors include his wish to earn a good income, be independent and educate his children, but also a more unusual one: "I am determined my children will be vaccinated against polio and all other diseases," he said.

Turab has already had his youngest son, aged eight months, vaccinated against polio since arriving in Peshawar a month ago.

"At home my wife's family - and even my own - opposed giving children the drops, so there were many difficulties for us," he said.

He said these problems were linked to the campaign by extremists against administering polio drops, largely on the basis of superstition and a belief that the drops rendered children sterile.

Polio cases this year: 29

Such misconceptions have been a factor in the emergence of 29 cases of polio in Pakistan this year, compared to only 11 during the same period in 2007, according to specialists. At least nine of these cases have been reported from the NWFP, where refusals by parents to allow children to be vaccinated and the lack of access to conflict-hit areas contribute to the problem.

H.B. Memon, the national programme manager of the Expanded Programme on Immunisation (EPI), said "superstitions are a factor for refusals".

"This year the problem is more acute as we face accessibility problems in areas such as the tribal areas and Swat due to the law and order issues there. Almost no work has been done for the last eight to nine months," Memon said.

Pakistan remains one of only four countries in the world where the disease is still endemic, the others being Afghanistan, India and Nigeria.

The vaccination drive in Swat was halted last month after renewed hostilities between the Pakistan military and local extremists.

Hiring locals to administer drops

To help tackle the issues of accessibility, Memon said, "We have hired local people who administer drops in troubled areas. They are available there full time. Then people can get children vaccinated at their convenience without waiting for a fixed date".

But problems also exist outside the NWFP. At least 11 cases have surfaced in the southern province of Sindh, two in the Punjab (the largest province), four in Balochistan, and one in Islamabad, where no previous case of polio had been reported since 2003.

The problem has led to in-depth discussions between Pakistan's health officials and World Health Organization (WHO) experts. Potential reasons for the failure to wipe out the disease were identified as: administrative issues hindering the vaccination drive notably in Sindh; the migration of people from one part of the country to the other; the possibility that drops may not be absorbed because a child has diarrhoea at the time of administration.

"Many mothers have no idea diarrhoea can make vaccines ineffective. They need to be educated since diarrhoea is endemic," Naseem Jan, a government lady health visitor in Peshawar, said.

But despite the setbacks suffered recently, levels of commitment remain high. The fact that people such as Turab Khan, an uneducated villager, is determined to battle family pressures to have his children vaccinated is evidence of changing mindsets.

Winning hearts and minds

The Pakistani authorities, with WHO support, have also been working to persuade religious leaders to back the anti-polio campaign. Last week, a well-known cleric in NWFP, Maulana Hamidullah Jan, became the latest to issue an edict backing polio vaccination for all children and delivering this message to his supporters.

"The words of men we trust and respect have an impact in easing our doubts about the vaccine," said Amjad Ahmed Khan, 35, a Peshawar-based shopkeeper who said he had heard the "polio vaccine itself causes polio". He now knows this is not true.

At present, with conflict continuing across Bajaur Agency and other tribal areas in the NWFP between government forces and militants, problems of access remain. The influence of extremists also means efforts to thwart the efforts of anti-polio vaccination teams continue. But despite this, steps forward continue to be taken, and, as Turab Khan says, "More and more people like me will soon see the need to ensure our children grow up strong and healthy".

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