Peer-reviewed article
Differences in maternal acceptance of non-national immunization program vaccines between single-child and multiple-children households a hospital-based cross-sectional study.
Xing R, Wu Y, Lin Y, Hao Y, Zhang L et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined whether mothers in single-child households were more willing to purchase non-national immunization program vaccines for their children compared to mothers in multiple-child households in China. Among 395 mothers of young children, 65% overall were willing to accept these vaccines, but mothers with only one child showed higher willingness (68%) than mothers with multiple children (59%). Mothers in single-child households tended to be younger, more educated, employed, and urban-based. The study suggests that household structure influences parental vaccination decisions for vaccines that families must pay for themselves.
Key points
- Overall maternal willingness to accept non-national immunization program vaccines was 64.81%
- Single-child households had significantly higher willingness (67.94%) compared to multiple-children households (58.65%)
- Multiple-children households had 66% lower odds of accepting non-national vaccines compared to single-child households
- Mothers in single-child households were younger (mean 31.4 vs 35.5 years), more educated (94% vs 71% with senior high school education), and more likely employed (90% vs 78%)
- Findings remained consistent in sensitivity analysis using propensity score overlap weighting
Limitations
This is a hospital-based cross-sectional study, so it cannot establish causal relationships or account for unmeasured confounding factors. The study captured only mothers who attended hospitals at specific times, which may not represent the full population of parents making vaccination decisions.
Abstract
Background Non-National Immunization Program vaccines (non-NIPV) are recommended but not publicly funded in China, complementing National Immunization Program vaccines (NIPV) by providing protection against additional vaccine-preventable diseases. Their uptake depends largely on parental decision-making. Objectives Assess maternal willingness to use non-NIPV (WNV) for their children across single-child households (SCH) and multiple-children households (MCH). Methods A cross-sectional questionnaire survey was conducted among biological mothers of children aged 42 days to 3 years. The primary endpoint was the proportion expressing WNV. The exploratory endpoint compared WNV between household types. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CI). Propensity score overlap weighting was implemented as a sensitivity analysis. Results Among 395 biological mothers of children aged 42 days to 3 years, mothers in SCH were younger than those in MCH (31.36 ± 4.24 vs. 35.51 ± 4.28 years). Compared with MCH, SCH had higher proportions of mothers with senior high school education or above (94.27% vs. 70.68%), employment (89.69% vs. 78.20%), and urban residence (83.97% vs. 72.93%). Overall WNV was 64.81%. WNV was higher in SCH than in MCH (67.94% vs. 58.65%). MCH was associated with lower odds of WNV (OR 0.34, 95% CI 0.18, 0.64, p = 0.001). Findings were consistent in overlap-weighted dataset analyses (OR 0.46, 95% CI 0.23, 0.90, p = 0.022). Conclusion Maternal WNV varied by household structure, with lower willingness among MCH. Family composition may represent an important contextual factor in discretionary vaccination decisions. These findings support the consideration of household context and parental perceptions when designing communication strategies for non-NIPV.