Prevalence of Parental refusal rate and its associated factors in routine immunization by using WHO Vaccine Hesitancy tool: A Cross sectional study at district Bannu, KP, Pakistan. (March 2021)

• Record Type: Journal Article
• Authors: Khattak, Farhad Ali; Rehman, Khalid; Shahzad, Muhammad; Arif, Numan; Ullah, Naeem; Kibria, Zeeshan; Arshad, Muhammad; Afaq, Saima; Ibrahimzai, Arsalan Khan; Haq, Zia ul
• Is Part Of: International journal of infectious diseases. Volume 104(2021)
• Page Start: 117
• Page End: 124
• Publication Date: 2021-03
• Subjects: Vaccination -- Refusal -- SAGE Vaccine Hesitancy Survey Tool -- Immunization -- Child -- Parents; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2020.12.029
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: Despite vaccine availability, low levels of vaccination coverage worldwide are alarming. This poses a serious challenge for routine immunization, including polio eradication efforts. To the authors' knowledge, this is the first study from a low-to-middle-income country (Pakistan) to use the WHO Vaccine Hesitancy Survey Tool to identify the reasons associated with parental vaccination refusal. Parents who were unable to read or write, had no education, owned a mobile phone, were unemployed and had food security were more likely to refuse vaccination of their children. Results from Likert scales showed that parents realized the importance of vaccination programmes, but they were still reluctant for their children to be vaccinated. Abstract: Objective: To determine the vaccination refusal rate, associated factors and perceptions of parents who refused routine immunization for their children using the World Health Organization (WHO) SAGE Working Group on Vaccine Hesitancy Survey Tool. Materials and methods: A cross-sectional survey was conducted using multi-stage cluster sampling in Bannu District, Khyber Pakhtunkhwa Province, Pakistan from March 2019 to July 2019. A WHO validated questionaire was used. The outcome variable was parental refusal of routine immunization of their children. Logistic regression was performed for associations, and multi-regression was applied to identify any confounders. Results: Of 610 parents, 170 (27.9%) refused vaccination of their children. Of these, the majority of mothers had no education [ n = 145 (85.3%); p = 0.03], and mothers were less likely to own a mobile phone than fathers [24 (14.1%) vs 152 (89.4%); p ≤ 0.001]. The vaccination refusal rate was higher in parents with food security [ n = 88 (51.8%)] compared with parents with minimal food insecurity [ n = 62 (36.5%)] and high food insecurity [20 (11.8%); p ≤ 0.05)]. On multi-variate logistic regression, fathers who were employed [adjusted odds ratio (OR) 0.59, 95% confidence interval (CI) 0.37–0.94; p = 0.02] and had a high level of education (adjusted OR 0.21, 95% CI 0.08–0.50; p ≤ 0.001) were less likely to refuse vaccination of their children. Parents with high food insecurity were more likely to refuse vaccination of their children (adjusted OR 2.2, 95% CI 1.0–0.50; p = 0.04) compared with parents with minimal food insecurity (adjusted OR 1.6, 95% CI 1.0–2.5; p = 0.02). Conclusion: The vaccination refusal rate was very high among parents, and this was associated with inability to read or write, no education, owning a mobile phone, unemployment and food security.