Hakim Muhammad, Ali Farhad, Pervaiz Aslam, Afaq Saima, Haq Zia Ul
National Stop Transmission of Polio (N-STOP), Program, Pakistan.
Institute of Public Health & Social Sciences (IPH&SS), Khyber Medical University (KMU), Peshawar, Pakistan.
BMC Public Health. 2025 Jan 29;25(1):369. doi: 10.1186/s12889-025-21388-1.
Vaccine hesitancy is a serious public health problem globally, particularly in low- and middle-income countries like Pakistan. This study aims to determine the vaccination refusal rate, associated factors and perceptions of parents who refused routine immunisation within Peshawar, Khyber Pakhtunkhwa, Pakistan.
A cross-sectional study conducted in July-2024, among 340 parents of children aged 0-59 months. Data was collected using a structured vaccine hesitancy Survey Tool of the Strategic Advisory Group of Experts(SAGE). Multistage stratified cluster sampling was employed to ensure a representative sample of tehsils in district Peshawar. Chi-squared tests and multivariable logistic regression were used to identify factors associated with vaccine refusal.
Among 340 participants, 22% (n = 74) refused vaccines for their children. A total of 15% employed mothers refused vaccines compared to only 4.5% unemployed mothers (p = 0.004). The highest refusal rate was in tehsil Shaheen Muslim Town where 41% of parents refused vaccination (p = 0.035). Parents who refused were less inclined to believe that vaccines protect children from vaccine preventable diseases (77% vs. 98%, p < 0.001) and expressed higher rates of vaccine hesitancy (47% vs. 29%, p = 0.003). Multivariable logistic regression revealed that employed mothers were over three times more inclined to refuse vaccination (AOR: 3.11, 95% CI: 1.25, 7.67), while factors like the total depression score was not significantly associated with refusal (p = 0.13). Barriers including distance from health facility and associated cost, (AOR: 1.82, 95% CI:1.10,3.02), and the concerns about the necessity of vaccines (AOR: 2.50, 95% CI: 1.45, 4.30) was significantly associated with vaccine refusal.
The high immunization refusal rate in Peshawar among parents was associated with maternal employment, logistical challenges such as distance immunisation services, associated cost, vaccine hesitancy and safety of vaccines. It is recommended to deploy mobile immunisation units and outreach sessions to improve access, using targeted, evidence-based education to address vaccine safety concerns.
疫苗犹豫是一个全球性的严重公共卫生问题，在巴基斯坦等低收入和中等收入国家尤为突出。本研究旨在确定巴基斯坦开伯尔-普赫图赫瓦省白沙瓦市内拒绝常规免疫接种的父母的疫苗拒绝率、相关因素及看法。
于2024年7月开展一项横断面研究，对象为340名0至59个月儿童的父母。使用战略咨询专家组（SAGE）的结构化疫苗犹豫调查工具收集数据。采用多阶段分层整群抽样以确保白沙瓦地区各县乡的代表性样本。使用卡方检验和多变量逻辑回归来确定与疫苗拒绝相关的因素。
在340名参与者中，22%（n = 74）的父母拒绝为其子女接种疫苗。有工作的母亲中有15%拒绝接种疫苗，而无工作的母亲中只有4.5%拒绝（p = 0.004）。拒绝率最高的是沙欣穆斯林镇，那里41%的父母拒绝接种疫苗（p = 0.035）。拒绝接种的父母不太倾向于相信疫苗能保护儿童免受疫苗可预防疾病的侵害（77%对98%，p < 0.001），且疫苗犹豫率更高（47%对29%，p = 0.003）。多变量逻辑回归显示，有工作的母亲拒绝接种疫苗的倾向是未工作母亲的三倍多（调整后比值比：3.11，95%置信区间：1.25，7.67），而诸如抑郁总分等因素与拒绝接种无显著关联（p = 0.13）。包括距离医疗机构的远近和相关费用（调整后比值比：1.82，95%置信区间：1.10，3.02）以及对疫苗必要性的担忧（调整后比值比：2.50，95%置信区间：1.45，4.30）等障碍与疫苗拒绝显著相关。
白沙瓦父母中较高的免疫接种拒绝率与母亲就业、诸如距离免疫接种服务地点远近、相关费用等后勤挑战、疫苗犹豫以及疫苗安全性有关。建议部署流动免疫接种单位并开展外展活动以改善可及性，利用有针对性的、基于证据的教育来解决疫苗安全问题。
