Table 1.

Factors affecting polio eradication in developing countries [6]

Themes	Description
Program resources and logistics	Condition of cold chain in all aspects
	Skills and authority in resource allocation and human resource management
	Advocacy and communication resources
Technical aspects	Skills and training among staff at all levels in all aspects of the program
Program operation, management and organization	Availability of public health professionals and state of health service structure
	Administrative issues including:
	-Political influences and factors
	-Factors in vaccination areas and the field program
	-Immunization cards
	Issues around access (availability of staff; waiting times etc)
	Impact of positive/negative attitudes of health care staff
Monitoring, evaluation and feedback	Reporting and monitoring systems
	Decentralization of the health system
Insecurity in high-risk polio areas	Safety issues in regions where polio exists
Vaccine acceptability by caregivers	Perception of sterility induced by polio vaccine
	Literacy status of caregivers
	Influence of religion
	Influence of frequent visits
	Effectiveness of vaccination
	Influence of vaccine side effects
Competing belief systems	Eg, Islamic beliefs or traditional medicines
Influence of community stakeholders	Community leaders as determinants of community vaccination
The nature of disease	The understanding of polio as an influence
Cross-border polio surveillance	Factors that determine polio spread between neighbouring countries