Factors influencing the implementation of Global Polio Eradication Initiative in low- and middle-income countries: a qualitative evidence synthesis

Abstract

# Background The World Health Organization's Global Polio Eradication Initiative (GPEI) has succeeded in reducing the cases of Polio by 99%. The persistence of the remaining 1% in Pakistan, Afghanistan and Nigeria has continued to pose threats to polio-free neighbouring countries. This systematic review aims to contribute to ongoing efforts to eradicate polio by exploring factors that influence the successful implementation of the GPEI in low- and middle-income countries. # Methods We reviewed qualitative research or mixed methods study reports published between 2012-2018 from studies conducted in low- and middle-income countries. We extracted qualitative research data using a standardised data extraction form and assessed study quality using the Critical Appraisal Skills Programme (CASP) qualitative checklist. We then conducted best-fit framework synthesis to organise, and explore patterns in, the data relating to new and existing themes. We report data on factors influencing the implementation of polio eradication efforts organised by theme. # Results We included 11 studies published between 2012 and 2017. Most of the studies were conducted in Pakistan and Nigeria with other countries (Ethiopia, Cameroon, Angola) also represented. The ten themes included structural factors (the development of capacity, through infrastructure and training) and attitudinal factors (including cultural and religious beliefs), were particularly important given the characteristics of included low- and middle-income countries. Common factors emerged across the included studies and generally these mapped well to the underpinning "best fit" framework. # Conclusions This qualitative evidence synthesis offers a useful expanded framework by which policymakers can explore factors specific to their geographical and population-based context although it should be recognised that individual factors relating to personal values and belief systems may moderate any community response to a polio vaccination programme.