Original Article Knowledge and perceptions of polio and polio immunization in polio high-risk areas of Pakistan Muhammad Atif Habib a, * , Sajid Bashir Soofi a , Noshad Ali a , Imtiaz Hussain a , Farhana Tabassum a , Zamir Suhag a , Saeed Anwar b , Imran Ahmed a , and Zulfiqar Ahmed Bhutta a a Department of Paediatrics and Child Health, Women and Child Health Division, Aga Khan University, Stadium Road, Karachi, Pakistan. E-mail: atif.habib@aku.edu b Peshawar Medical College, Peshawar, Pakistan. *Corresponding author. Abstract Pakistan and Afghanistan remain the only countries where polio is endemic, and Pakistan reports the most cases in the world. Although the rate is lower than in previous years, the situation remains alarming. We conducted a mixed methods study in high-risk areas of Pakistan to identify knowledge, attitu- des, and practices of target populations about polio vaccine and its eradication, and to estimate coverage of routine immunization and oral polio vaccine. We surveyed 10,685 households in Karachi, 2522 in Pishin, and 2005 in Bajaur. Some knowl- edge of polio is universal, but important misconceptions persist. The findings of this study carry strategic importance for program direction and implementation. Journal of Public Health Policy (2016). doi:10.1057/s41271-016-0056-6 Keywords: polio; polio immunization; knowledge and perceptions; Pakistan Introduction Polio was endemic globally in 1988 when the World Health Organi- zation (WHO) estimated that at least 350,000 children developed poliomyelitis each year. 1 Although a global polio eradication initiative has achieved remarkable progress in the last decade, 2,3 no country in the world is safe until the last case disappears. 4 Three countries (Nigeria, Pakistan, and Afghanistan) continued to find confirmed cases of polio (isolation of wild poliovirus from the stools) and continued to be listed as endemic until Nigeria’s progress led to WHO’s removing Nigeria from the list in September 2015. 3 Ó 2016 Macmillan Publishers Ltd. 0197-5897 Journal of Public Health Policy www.palgrave.com/journals