Immunization Status and Determinants of Vaccine Hesitancy among Children Under Five Years of Age

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.