Peer-reviewed article
Immunization Status and Determinants of Vaccine Hesitancy among Children Under Five Years of Age
Ali Maalik, Saima Gillani, Manahil Shamraiz, Aleena Ashraf, Armaghan Ali et al. ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5-5This hospital-based cross-sectional study looked at the immunisation status of 345 children under five who attended a paediatric department in Abbottabad, Pakistan. About 61% were fully immunised, 30% partially immunised and 9% not immunised. Common barriers were fear of side effects, not knowing the schedule, and not knowing immunisation was needed. Low socioeconomic status, lack of a nearby vaccination facility, concern about lost wages, and gaps in knowledge about follow-up doses, contraindications and the schedule predicted incomplete immunisation. The authors recommend caregiver education, clear counselling, reminders and service-delivery measures that reduce geographic and economic barriers.
Key points
- 212 children (61.4%) were fully immunised, 103 (29.9%) partially immunised and 30 (8.7%) not immunised.
- Most frequent barriers were fear of side effects (49.0%), lack of schedule knowledge (42.6%) and unawareness of the need for immunisation (41.2%).
- Immunisation status was significantly associated with residence, socioeconomic status, parental education and parental occupation.
- After adjustment, low socioeconomic status, unawareness of follow-up doses, misconceptions about contraindications, no nearby vaccination facility, concern about lost wages and poor schedule knowledge independently predicted incomplete immunisation.
- The authors recommend targeted outreach that prioritises rural and socioeconomically disadvantaged households.
Limitations
The study used consecutive non-probability sampling of children presenting at a single hospital, so results may not represent all children in the area or in Pakistan. Immunisation status was verified from records only when available and otherwise relied on caregiver recall, and a cross-sectional design cannot show cause and effect.
Abstract
OBJECTIVES This study aimed to determine immunisation status and identify demographic, socioeconomic, access-related, and caregiver factors associated with incomplete immunisation among children under five years. METHODOLOGY This descriptive cross-sectional study enrolled 345 children who presented to the Department of Paediatrics, Ayub Teaching Hospital, Abbottabad, from October 2025 to April 2026 using non-probability consecutive sampling. Parents or guardians completed a pre-tested structured questionnaire, and immunisation status was verified from Expanded Programme on Immunisation records when available and supplemented with caregiver recall. Children were categorised as fully, partially, or not immunised. We assessed associations using chi-square tests and Cramer's V, followed by binary logistic regression for incomplete immunisation. RESULTSThe mean child age was 28.15 ± 17.19 months. Overall, 212 (61.4%) children were fully immunised, 103 (29.9%) partially immunised, and 30 (8.7%) non-immunised. Frequently reported barriers were fear of side effects (49.0%), lack of schedule knowledge (42.6%), and unawareness of the need for immunisation (41.2%). Immunisation status was significantly associated with residence, socioeconomic status, parental education, and parental occupation. After adjustment, low socioeconomic status, unawareness of follow-up doses, misconceptions about contraindications, lack of a nearby vaccination facility, concern about lost wages, and poor schedule knowledge independently predicted incomplete immunisation. CONCLUSION More than one-third of children had incomplete immunisation. Improving completion requires caregiver education, clear counselling about contraindications and adverse effects, reliable reminders for subsequent doses, and practical service-delivery measures that reduce geographic and economic barriers for vulnerable families. Targeted outreach should consistently prioritise rural and socioeconomically disadvantaged households.