Differences in maternal acceptance of non-national immunization program vaccines between single-child and multiple-children households a hospital-based cross-sectional study

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.