Knowledge, Attitude and Practices of Mothers towards Immunization of Children under 5 years of age at Qazi Hussain Ahmad Medical Complex (QHAMC), MTI, Nowshera

Knowledge, Attitude and Practices of Mothers towards Immunization of Children under 5 years of age at Qazi Hussain Ahmad Medical Complex (QHAMC), MTI, Nowshera | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Knowledge, Attitude and Practices of Mothers towards Immunization of Children under 5 years of age at Qazi Hussain Ahmad Medical Complex (QHAMC), MTI, Nowshera Mushtaq Ahmad, Laiba Malik, Marjan Khan, Syeda Khadijah Mahrukh, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7199378/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background: Vaccination, a public health strategy to prevent childhood illnesses, its success, depends on caregivers’ knowledge, attitudes, and practices (KAP), particularly mothers. Mothers’ KAP towards vaccination is essential for the prevention of disease outbreaks in low- and middle-income countries like Pakistan. When routine vaccination uptake is suboptimal, immunization campaigns serve as targeted public health interventions to rapidly increase coverage in specific populations. Objectives: To evaluate maternal KAP regarding immunization of children under five, at Qazi Hussain Ahmed Medical Complex (QHAMC), Nowshera. Methods: A descriptive cross-sectional study was conducted among 200 mothers attending the pediatric medicine ward at QHAMC between April and October 2025. Simple random sampling was used. Data were collected after informed consent, using a semi-structured KAP questionnaire, and analyzed through descriptive statistics on SPSS. Results: Mothers’ knowledge about vaccination was satisfactory; 85.5% of mothers knew the appropriate starting age. However, misconceptions persisted, as nearly 52% believed vaccination prevents all diseases, and 17% were unaware of its purpose. Attitudes were predominantly positive, as 87% considered it essential for their child's health, and 92% mothers followed the immunization schedule. Vaccination practices were similarly favorable, as 93.5% of mothers had completed or were continuing their children’s immunization, 95% intended to maintain it. However, only 60.5% vaccinated their children on time; delays were due to lack of knowledge, child illness, and family obligations. Despite barriers like low awareness, mistrust, unavailability, etc., 80.5% participated in campaigns, and 94% supported their continuation. Conclusion: Although, majority of mothers showed positive KAP regarding immunization, misconceptions and delays, particularly concerning contraindications and post-vaccination care, remain prevalent. Public health initiatives should prioritize clear, accessible, and culturally tailored education to improve vaccine confidence and timely uptake. Immunization Mothers Knowledge Attitudes Practices Introduction Vaccination is one of the most effective and cost-efficient public health interventions to prevent infectious diseases. [1] Vaccines contain specific antigens that stimulate the immune system to develop protection against targeted pathogens. Routine immunization in children is essential to protect them from vaccine-preventable diseases (VPDs), which continue to contribute significantly to global childhood morbidity and mortality. [2], [3] In 2018 alone, VPDs were responsible for approximately 700,000 child deaths worldwide. [3] In Pakistan, over 50% of post-neonatal child deaths are attributed to VPDs. The country has a national vaccination coverage of only 60.6%, far below the World Health Organization’s (WHO) recommended threshold of 90% at the national level and 80% at the district level. And has one of the highest morbidity and mortality rates in children less than five years of age. [5] [6] Despite improvements since the launch of the Expanded Program of Immunization (EPI) in 1978, full vaccination coverage in Pakistan increased from 50.6% in 2006-07 to just 68.3% in 2017-18. [8] The COVID-19 pandemic further disrupted lifesaving immunization services globally, leaving over 40 million children without measles vaccines and more than 50 million without polio vaccines due to the suspension of routine immunization. [9] Immunization campaigns serve as short-term, large-scale public health strategies to rapidly increase vaccine coverage, particularly where routine immunization is insufficient. [7] . However, multiple factors continue to limit uptake, including false beliefs, poor accessibility, fear of side effects, and lack of awareness, particularly among mothers, who are often the primary caregivers. [8, 9] Several studies indicate that many mothers in Pakistan hold misconceptions about vaccination, including fears of long-term adverse effects. [2] While routine immunization is accepted by some, supplementary campaigns are often met with skepticism or outright refusal. [11] Mothers’ knowledge, attitudes, and practices (KAP) toward immunization have a direct influence on vaccine uptake in children. [12] Research from countries such as Indonesia [13] , the United States [14] , India [15] , and Turkey [16] consistently shows a strong link between maternal education and complete immunization. Within Pakistan, studies in Islamabad [2] and Mardan [18] report encouraging maternal attitudes toward immunization, primarily driven by the belief that vaccines effectively prevent disease. However, no published research has yet examined maternal KAP toward childhood immunization in Nowshera. This lack of local data may hinder the development of targeted, culturally appropriate public health interventions. To cover this gap, we aim to evaluate the KAP of mothers with children under five in Nowshera regarding immunization and to explore the factors influencing these behaviors. The findings aim to inform health authorities and support efforts to improve vaccination uptake in the region. Methodology Study Design and Setting A descriptive cross-sectional study was conducted at Qazi Hussain Ahmad Medical Complex (QHAMC) in Nowshera between April 15 and October 14, 2025. Study Population The study population included mothers visiting the pediatric wards of QHAMC, who had children under five years of age. Mothers who declined to participate or had children over the age of five were excluded. Sample Size and Sampling Technique Using a simple random sampling approach, based on a previous study [15] , reporting a 73% prevalence of maternal knowledge and compliance regarding childhood immunization, the sample size was calculated using the formula: n = Z² × p (1 − p) / d² n = (1.96) ² × 0.763 × (1 − 0.763) / (0.05) ² n ≈ 180 To account for potential non-response and incomplete data, 10% was added to the calculated sample, resulting in a final sample size of 200 participants. Data Collection Data were collected using a semi-structured questionnaire, originally developed in English and translated into Urdu for better comprehension. The questionnaire was adapted from previously validated studies. [20], [2] It consisted of five sections: (1) maternal sociodemographic data (e.g., education, occupation, number of children under 5 and under 18, occupation, and decision maker for immunization); (2) knowledge; (3) attitudes; (4) practices related to childhood immunization; and (5) additional questions regarding awareness and participation in immunization campaigns, child vaccination status, and reasons for non-vaccination. The KAP sections included four questions regarding knowledge, four regarding attitude, and eleven regarding practices. Correct answers were scored as 1, while incorrect or “don’t know” responses received a score of 0. Knowledge scores were categorized as low (≤ 50%), moderate (50%-75%), and high (≥ 75%). Attitude scores ≥ 50% were considered positive, while scores below 50% were considered negative. Practice scores were classified as poor (< 50%) and good ( ≥ 50%) based on previous literature. [17] Data were collected by seven trained third-year MBBS students from Nowshera Medical College (NMC). Before data collection, all team members underwent a standardized training session to ensure consistency in administering the questionnaire. Data Analysis Data were entered and analyzed using SPSS version 28. Descriptive statistics were used to calculate frequencies and percentages. The chi-square test was employed to assess associations between maternal education and their KAP variables. A p-value of < 0.05 was considered statistically significant. Ethical Consideration Ethical approval was obtained from the Ethical Review Board of NMC. Permission to collect data at QHAMC was granted by the hospital’s Medical Director. Participation was voluntary, and verbal informed consent was obtained from all mothers. Confidentiality and anonymity of the participants were ensured throughout the study. Results Socio-Demographic Characteristics A total of 200 mothers participated in the study. Nearly half of the mothers (48.7%) were illiterate, and the vast majority (92.5%) identified as housewives. More than half of the mothers (54.5%) had one child under the age of five. In most cases (61%), decisions related to immunization were made jointly by both parents, while 24.5% of mothers reported making the decisions independently. The overwhelming majority of mothers (98.5%) expressed satisfaction with the immunization services received, and the majority (96.5%) accessed these services through public healthcare facilities ( Table 1 ) . Table 1 Sociodemographic profile of participants (N = 200) Variable Frequency Percent Number of Children under 18 years of age 1 40 20.0 2 55 27.5 3 43 21.5 4 27 13.5 5 23 11.5 6 7 3.5 7 5 2.5 Number of Children under 5 years of age 1 109 54.5 2 80 40.0 3 8 4.0 4 3 1.5 Mothers’ Education Illiterate 98 48.5 Primary 46 23.0 Secondary 38 19.0 Graduate 9 4.5 Masters 9 4.5 Mother’s Occupation Housewife 185 92.5 Govt employed 7 3.5 Self-employed 6 3 Housemaid 1 0.5 Others 1 0.5 Decision-Maker for Immunization Mother 49 24.5 Father 20 10.0 Both 122 61.0 Others 9 4.5 Maternal Knowledge of Childhood Immunization A majority of mothers (52%) believe that vaccination prevents all diseases, while 27% correctly identified that it prevents major childhood illnesses. A small portion (4%) viewed vaccination as a form of disease therapy or were unaware of its purpose (17%). Most respondents (85.5%) correctly identified the appropriate age to begin vaccination, indicating a generally high level of awareness. Regarding vaccine safety, 74.5% of mothers believed that vaccination is not hazardous, while 17.5% were unsure. However, a common misconception was noted: 65.5% incorrectly stated that children with a fever should not receive vaccines ( Table 2 ) . Overall, 71% of mothers demonstrated good knowledge of immunization. Chi-square analysis showed no statistically significant association between maternal education and knowledge of immunization purpose (p = 0.082), appropriate starting age (p = 0.719), perceived harm (p = 0.848), or beliefs about vaccinating during fever (p = 0.161). Nonetheless, trends suggested that higher education levels were generally associated with better understanding. Table 2 Maternal Knowledge Regarding Immunization (N = 200) Knowledge Questions Frequency Percent Why vaccination is necessary? To treat diseases 8 4.0 To prevent all diseases 104 52.0 To prevent major killer diseases 54 27.0 Don't know 34 17.0 Total 200 100 At what age vaccination is started? Knew 171 85.5 Did not know 29 14.5 Total 200 100.0 Do you think vaccinations are harmful? Yes 16 8.0 No 149 74.5 Do not know 35 17.5 Total 200 100.0 Can child with fever be vaccinated? Yes 69 34.5 No 131 65.5 Total 200 100.0 Maternal Attitudes of Childhood Immunization Most mothers demonstrated a positive attitude toward childhood immunization. Specifically, 87% of mothers believed vaccination is essential for their child’s health, and 92% emphasized the importance of adhering to the recommended immunization schedule. In contrast, 2% did not support continued immunization, and 6% were uncertain about its importance. ( Table 3 ) . Overall, 89% of mothers exhibited a positive attitude towards immunization. Chi-square analysis revealed no statistically significant association between maternal education and key attitude indicators, such as perceiving vaccination as important (p = 0.345) or following the recommended immunization schedule (p = 0.211). Table 3 Maternal Attitudes Regarding Immunization (N = 200) Attitude Questions Frequency Percentage Do you think vaccination is important? Yes 178 89.0 No 2 1.0 Do not know 20 10.0 Is it important to follow the vaccination schedule? Yes 184 92.0 No / Do not know 16 8.0 Where do you prefer to receive a vaccination? Government Facility 192 96.0 Private Facility 7 3.5 Are you satisfied with the way vaccination is provided? Yes 197 98.5 No 3 1.5 Maternal Practices of Childhood Immunization The majority of mothers (93.5%) had either completed or were in the process of completing their child's vaccination schedule. Additionally, 95% expressed their intention to continue vaccinating their children in the future, and nearly all (90.5%) reported visiting an immunization clinic ( Table 4 ) . Among the 88.5% of mothers who reported observing side effects post-vaccination, fever was the most commonly noted (74.5%), followed by pain and swelling (10%) and rash (0.6%). Despite this, only 28.2% informed a doctor or healthcare worker about these side effects. However, a majority (80%) reported using medication to manage these symptoms. The remaining 11.5% of mothers reported no side effects. Overall, communication with healthcare providers regarding adverse effects remains suboptimal, indicating a potential gap in post-vaccination care awareness. Table 4 Maternal Practices Regarding Immunization (N = 200) Practice Questions Frequency Percent Was vaccination completed/is it going according to schedule? Yes 187 93.5 No 13 6.5 Did you take your children to immunization centers to be immunized with all the routine vaccines? Yes 181 90.5 No 10 5.0 Do you recommend that it should continue? Yes 185 92.5 No 5 2.5 Do not know 10 5.0 Awareness and Participation in Immunization Campaigns, and Child Vaccination Status Question Response Frequency (N) Have you ever immunized your child during immunization campaigns? Yes 161 No 39 If No, why? The immunization campaign was not available 9 There is no need for immunization if the child is healthy 9 Authorities promote vaccination for personal gains 5 Others 17 Do you recommend that immunization campaigns should continue? Yes 174 No 4 Don’t know 12 A majority of mothers (80.5%) reported vaccinating their children during immunization campaigns, while 19.5% had not. Among those who did not participate, the main reasons included unavailability of campaigns in their area (23.07%), belief that vaccination was unnecessary if the child appeared healthy (23.07%). Mistrust in vaccination campaigns (12.8%) and other specified reasons (43.6%). Nonetheless, 87% of mothers supported the continuation of such campaigns. Regarding vaccination status, 90.5% mothers reported taking their children to an immunization center, while 9.5% had done so only partially, and 5% had never accessed immunization services. Despite this high level of engagement, only 60.5% of mothers reported vaccinating their children on time. The remaining 39.5% experienced delays, with the most commonly cited reasons being child illness (13%), family-related issues such as maternal illness (8.5%), lack of knowledge (4%), and other unspecified factors (8.5%). Overall, 80% of the mothers demonstrated good immunization practices. However, chi-square analysis showed no statistically significant difference between maternal education and key immunization behaviors, such as vaccination completion (p = 0.294) and timely immunization (p = 0.238). Discussion This study aimed to assess maternal KAP towards regular childhood vaccinations in Nowshera. Despite existing information gaps and misconceptions, the findings reveal that mothers demonstrated generally favorable attitudes and good compliance with immunization schedules. Notably, maternal education did not show a statistically significant association with KAP levels. One likely explanation is the influence of health care workers, lady health workers (LHWs), and community awareness programs, which may help disseminate accurate information, regardless of formal educational attainment. [19] In terms of knowledge, 85.5% of mothers correctly identified the appropriate age to begin vaccination, and 52% believed vaccines prevent all diseases, indicating a high level of basic awareness. 87% of mothers believed that vaccinations were necessary for their child's health. These results are consistent with findings from Islamabad by Yasir et al. (2021), where mothers showed a strong understanding of immunization schedules. [2] Similarly, Khan et al. (2023) reported high awareness among mothers in Mardan, attributed to urban exposure and high literacy levels. [17] While our knowledge scores were slightly lower than those reported in urban settings, the findings are encouraging given the lower literacy rates in our population. Regular interaction with healthcare providers, counseling LHWs, and targeted community-based awareness programs likely contributed to this awareness, a pattern consistent with studies in other low-literacy contexts that suggests alternative information channels can compensate for limited formal education. [19], [23] Despite these gains, misconceptions remain. For instance, 65.5% of mothers believed that a child with a low-grade fever should not be vaccinated, a persistent myth about contraindications. This reflects similar findings from Islamabad, where positive attitudes were coupled with enduring myths, and from Mardan, where better education reduced but did not eliminate such misconceptions. [1], [18] These findings underscore the need for targeted health education interventions focused on addressing common vaccination myths and clarifying valid and invalid contraindications. With regards to attitudes, 87% of mothers believed vaccination was necessary for their child's health, and an equal percentage supported the continuation of immunization programs. This positive sentiment mirrors findings from urban and peri-urban areas and may be the result of exposure to national vaccination campaigns, interpersonal counseling, and increased public messaging. [16] However, actual immunization practices were less optimal. Although 93.5% of mothers had either completed or were in the process of completing their child’s vaccinations, only 60.5% reported doing so on time. The most commonly cited reasons for delay included child illness (13%), family-related reasons (8.5%), and lack of awareness (4%). While these rates are lower than those reported in Mardan and Islamabad (76-93.5%), they still indicate a generally good practice. A notable finding was that 61% of mothers reported joint decision-making with their husbands regarding vaccination. This is an important contributor to immunization uptake and has been positively associated with higher coverage in previous studies. [24] Additionally, 80.5% of mothers had participated in supplemental immunization campaigns, suggesting openness to mass vaccination efforts and reinforcing the potential for campaign-based strategies to bridge coverage gaps. Despite these positive indicators, post-vaccination monitoring and health-seeking behavior remain weak. Although 74.5% of mothers observed side effects, mostly fever, only 25% reported these symptoms to healthcare professionals. This highlights a gap in post-vaccination communication, which may undermine trust and adverse event surveillance. [25] Comparatively, a study from Faisalabad also found good coverage (76%) but reported similar knowledge deficits, particularly regarding VPDs and scheduling. [20] 26.5% of mothers in Faisalabad were unaware of the immunization schedule, and only 37% could name common VPDs. [20] These disparities reinforce the notion that while general attitudes and practices are improving, specific knowledge gaps persist, especially around symptom recognition, post-vaccination care, and timing. Limitations This study has several limitations. First, its cross-sectional design restricts the ability to establish a causal relationship between variables. As a questionnaire-based study, there is a possibility that mothers did not provide entirely accurate responses due to social desirability bias, recall bias, or chance selection of responses. Second, the study population was limited to mothers visiting the pediatric wards of the hospital, which introduces selection bias. This group may not be representative of the general population, as hospital visitors are more likely to have children with acute illnesses or greater healthcare access. Additionally, participation was voluntary, potentially excluding mothers less interested or more hesitant about immunization, those who may hold more negative views. Third, we relied on self-reported vaccination status, rather than verifying against standard immunization records or schedules. This could have led to misclassification, particularly if mothers misunderstood or inaccurately reported the vaccination timeline. Lastly, the use of a self-administered questionnaire may have introduced information bias, particularly memory errors or misunderstanding of questions, despite efforts to ensure clarity. Despite these limitations, this study is the first of its kind in District Nowshera, a less-resourced area of Khyber Pakhtunkhwa, and offers valuable insights into maternal KAP regarding childhood vaccination. The study benefits from a robust sample size, a high response rate, and anonymous data collection. Conclusion Our study demonstrated that although mothers in Nowshera exhibit generally good knowledge and positive attitudes towards childhood immunization, critical knowledge and communication gaps persist. The majority of mothers strongly support immunization programs, adhere to vaccination schedules, and utilize public healthcare services. However, persistent misconceptions highlight the need for targeted health education. Despite variations in educational attainment, no statistically significant association was observed with key knowledge or practice indicators, suggesting that interventions to improve awareness should be inclusive of all demographic groups, not only those with limited formal education. To enhance the impact and trust in vaccination services, focused educational strategies are needed, particularly those aimed at correcting common myths and misconceptions. A deeper understanding of maternal beliefs and perceptions related to immunization should also be prioritized. Specific attention should be paid to improving education about vaccination timing, appropriate responses to minor side effects, and addressing misunderstandings about contraindications. To improve compliance and ensure the long-term success of immunization programs, tailored, community-specific education approaches are essential, especially those that address concerns about fever, vaccine safety, and side effects. Future research should explore individual vaccines in more detail, and comparative studies between urban and rural populations would provide a more comprehensive understanding of KAP in different contexts. A larger, multi-regional study would allow findings to better inform national immunization policies. Declarations Human Ethics and Consent to Participate Ethical Review Board (ERB) of Nowshera Medical College approved this study. For the data collection approval were taken from Medical Director of Qazi Hussain Ahmad Medical College (QHAMC). Prior to our data collection, informed consent was taken from each participant. Funding For this cross-sectional study, no funding was received. Authors' Contributions M.A, L.M, M.K, S.K.M, F.K, F.A, I.A, A.M, A,K and K.A.K: All authors have significantly contributed to all the stages of our study, including research design, data collection, analysis, its interpretation and writing of the manuscript. The final version of manuscript was reviewed and approved by all authors. All authors agreed to be accountable for their work. Competing Interests There is no conflict of interest. Acknowledgments: We would like to thank Dr. Sundas Saboor for her valuable contribution in proofreading and editing the manuscript, which greatly improved the clarity and quality of the article. References World Health Organization. Vaccines and immunization: What is vaccination? Geneva: WHO; 2023 [cited 2025 Jul 18]. 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Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 13 Feb, 2026 Reviews received at journal 06 Nov, 2025 Reviewers agreed at journal 24 Oct, 2025 Reviewers agreed at journal 23 Oct, 2025 Reviewers invited by journal 03 Sep, 2025 Editor assigned by journal 05 Aug, 2025 Submission checks completed at journal 05 Aug, 2025 First submitted to journal 23 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7199378","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":512396929,"identity":"31c2ac2b-d0bd-4f64-a3df-9c6f57d10cfb","order_by":0,"name":"Mushtaq Ahmad","email":"","orcid":"","institution":"Nowshera Medical College","correspondingAuthor":false,"prefix":"","firstName":"Mushtaq","middleName":"","lastName":"Ahmad","suffix":""},{"id":512396930,"identity":"2625eef5-9173-4782-9392-8be7c2145ff8","order_by":1,"name":"Laiba Malik","email":"","orcid":"","institution":"Nowshera Medical 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Kamil","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+0lEQVRIiWNgGAWjYBACewY2IGlgwWAApCQSKoAkM3MDXi2GDWAtEhAtD86AtDDi12JwAKSFAaJF8mEbiENIy+1jiZ9uFEjIm4sdfngjcV5tNH87UMuPim24tZxLOyydYyBhuHN2mrFF4rbjuTMOMzYw9py5jVvLGfYGkBbGDbcTzCQStx3LbQBqYWZsw6ul+TdQi/2G2+nfJBLnHMudT1gL2zGQLYkbbucAbWmoyd1ASIthD1uaNVBLMlBLsUXCsQO5G4FaDuLziz0Pm/HtnD82tkCHbbz5o6Yud975wwcf/KjArQUdHAaTB4hWDwR1pCgeBaNgFIyCEQIAoC9fDVw1bcAAAAAASUVORK5CYII=","orcid":"","institution":"Mirwais regional hospital","correspondingAuthor":true,"prefix":"","firstName":"Kamil","middleName":"Ahmad","lastName":"Kamil","suffix":""}],"badges":[],"createdAt":"2025-07-23 19:38:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7199378/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7199378/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91065272,"identity":"4209be83-f433-4cff-92c2-a9cd701cd8d5","added_by":"auto","created_at":"2025-09-11 09:43:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":997566,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7199378/v1/2cecff19-017e-4848-beca-53d2a7b46a58.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Knowledge, Attitude and Practices of Mothers towards Immunization of Children under 5 years of age at Qazi Hussain Ahmad Medical Complex (QHAMC), MTI, Nowshera","fulltext":[{"header":"Introduction","content":"\u003cp\u003eVaccination is one of the most effective and cost-efficient public health interventions to prevent infectious diseases.\u003csup\u003e[1]\u003c/sup\u003e Vaccines contain specific antigens that stimulate the immune system to develop protection against targeted pathogens. Routine immunization in children is essential to protect them from vaccine-preventable diseases (VPDs), which continue to contribute significantly to global childhood morbidity and mortality.\u003csup\u003e[2], [3]\u003c/sup\u003e In 2018 alone, VPDs were responsible for approximately 700,000 child deaths worldwide.\u003csup\u003e[3]\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eIn Pakistan, over 50% of post-neonatal child deaths are attributed to VPDs. The country has a national vaccination coverage of only 60.6%, far below the World Health Organization’s (WHO) recommended threshold of 90% at the national level and 80% at the district level. And has one of the highest morbidity and mortality rates in children less than five years of age. \u003csup\u003e[5] [6]\u003c/sup\u003e Despite improvements since the launch of the Expanded Program of Immunization (EPI) in 1978, full vaccination coverage in Pakistan increased from 50.6% in 2006-07 to just 68.3% in 2017-18.\u003csup\u003e[8]\u003c/sup\u003e The COVID-19 pandemic further disrupted lifesaving immunization services globally, leaving over 40\u0026nbsp;million children without measles vaccines and more than 50\u0026nbsp;million without polio vaccines due to the suspension of routine immunization.\u003csup\u003e[9]\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eImmunization campaigns serve as short-term, large-scale public health strategies to rapidly increase vaccine coverage, particularly where routine immunization is insufficient. \u003csup\u003e[7]\u003c/sup\u003e. However, multiple factors continue to limit uptake, including false beliefs, poor accessibility, fear of side effects, and lack of awareness, particularly among mothers, who are often the primary caregivers. \u003csup\u003e[8, 9]\u003c/sup\u003e Several studies indicate that many mothers in Pakistan hold misconceptions about vaccination, including fears of long-term adverse effects.\u003csup\u003e[2]\u003c/sup\u003e While routine immunization is accepted by some, supplementary campaigns are often met with skepticism or outright refusal.\u003csup\u003e[11]\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eMothers’ knowledge, attitudes, and practices (KAP) toward immunization have a direct influence on vaccine uptake in children.\u003csup\u003e[12]\u003c/sup\u003e Research from countries such as Indonesia\u003csup\u003e[13]\u003c/sup\u003e, the United States\u003csup\u003e[14]\u003c/sup\u003e, India\u003csup\u003e[15]\u003c/sup\u003e, and Turkey\u003csup\u003e[16]\u003c/sup\u003e consistently shows a strong link between maternal education and complete immunization. Within Pakistan, studies in Islamabad \u003csup\u003e[2]\u003c/sup\u003e and Mardan \u003csup\u003e[18]\u003c/sup\u003e report encouraging maternal attitudes toward immunization, primarily driven by the belief that vaccines effectively prevent disease.\u003c/p\u003e\u003cp\u003eHowever, no published research has yet examined maternal KAP toward childhood immunization in Nowshera. This lack of local data may hinder the development of targeted, culturally appropriate public health interventions.\u003c/p\u003e\u003cp\u003eTo cover this gap, we aim to evaluate the KAP of mothers with children under five in Nowshera regarding immunization and to explore the factors influencing these behaviors. The findings aim to inform health authorities and support efforts to improve vaccination uptake in the region.\u003c/p\u003e\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Methodology","content":"\u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eStudy Design and Setting\u003c/span\u003e\u003c/p\u003e\u003cp\u003eA descriptive cross-sectional study was conducted at Qazi Hussain Ahmad Medical Complex (QHAMC) in Nowshera between April 15 and October 14, 2025.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eStudy Population\u003c/span\u003e\u003c/p\u003e\u003cp\u003eThe study population included mothers visiting the pediatric wards of QHAMC, who had children under five years of age. Mothers who declined to participate or had children over the age of five were excluded.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eSample Size and Sampling Technique\u003c/span\u003e\u003c/p\u003e\u003cp\u003eUsing a simple random sampling approach, based on a previous study \u003csup\u003e[15]\u003c/sup\u003e, reporting a 73% prevalence of maternal knowledge and compliance regarding childhood immunization, the sample size was calculated using the formula:\u003c/p\u003e\u003cp\u003e\u003cb\u003en = Z² × p (1 − p) / d²\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003en = (1.96) ² × 0.763 × (1 − 0.763) / (0.05) ²\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003en ≈ 180\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTo account for potential non-response and incomplete data, 10% was added to the calculated sample, resulting in a final sample size of 200 participants.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eData Collection\u003c/span\u003e\u003c/p\u003e\u003cp\u003eData were collected using a semi-structured questionnaire, originally developed in English and translated into Urdu for better comprehension. The questionnaire was adapted from previously validated studies.\u003csup\u003e[20], [2]\u003c/sup\u003e It consisted of five sections: (1) maternal sociodemographic data (e.g., education, occupation, number of children under 5 and under 18, occupation, and decision maker for immunization); (2) knowledge; (3) attitudes; (4) practices related to childhood immunization; and (5) additional questions regarding awareness and participation in immunization campaigns, child vaccination status, and reasons for non-vaccination.\u003c/p\u003e\u003cp\u003eThe KAP sections included four questions regarding knowledge, four regarding attitude, and eleven regarding practices. Correct answers were scored as 1, while incorrect or “don’t know” responses received a score of 0. Knowledge scores were categorized as low (≤ 50%), moderate (50%-75%), and high (≥ 75%). Attitude scores ≥ 50% were considered positive, while scores below 50% were considered negative. Practice scores were classified as poor (\u0026lt; 50%) and good (\u003cb\u003e≥\u003c/b\u003e 50%) based on previous literature. \u003csup\u003e[17]\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eData were collected by seven trained third-year MBBS students from Nowshera Medical College (NMC). Before data collection, all team members underwent a standardized training session to ensure consistency in administering the questionnaire.\u003c/p\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eData were entered and analyzed using SPSS version 28. Descriptive statistics were used to calculate frequencies and percentages. The chi-square test was employed to assess associations between maternal education and their KAP variables. A p-value of \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eEthical Consideration\u003c/span\u003e\u003c/p\u003e\u003cp\u003eEthical approval was obtained from the Ethical Review Board of NMC. Permission to collect data at QHAMC was granted by the hospital’s Medical Director. Participation was voluntary, and verbal informed consent was obtained from all mothers. Confidentiality and anonymity of the participants were ensured throughout the study.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eSocio-Demographic Characteristics\u003c/span\u003e\u003c/p\u003e\u003cp\u003eA total of 200 mothers participated in the study. Nearly half of the mothers (48.7%) were illiterate, and the vast majority (92.5%) identified as housewives. More than half of the mothers (54.5%) had one child under the age of five. In most cases (61%), decisions related to immunization were made jointly by both parents, while 24.5% of mothers reported making the decisions independently. The overwhelming majority of mothers (98.5%) expressed satisfaction with the immunization services received, and the majority (96.5%) accessed these services through public healthcare facilities \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSociodemographic profile of participants (N\u0026thinsp;=\u0026thinsp;200)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercent\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of Children under 18 years of age\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNumber of Children under 5 years of age\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e109\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e54.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMothers\u0026rsquo; Education\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIlliterate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e48.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGraduate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMasters\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMother\u0026rsquo;s Occupation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHousewife\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e185\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e92.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGovt employed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSelf-employed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHousemaid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDecision-Maker for Immunization\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMother\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFather\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBoth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e122\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e61.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eMaternal Knowledge of Childhood Immunization\u003c/span\u003e\u003c/p\u003e\u003cp\u003eA majority of mothers (52%) believe that vaccination prevents all diseases, while 27% correctly identified that it prevents major childhood illnesses. A small portion (4%) viewed vaccination as a form of disease therapy or were unaware of its purpose (17%). Most respondents (85.5%) correctly identified the appropriate age to begin vaccination, indicating a generally high level of awareness. Regarding vaccine safety, 74.5% of mothers believed that vaccination is not hazardous, while 17.5% were unsure. However, a common misconception was noted: 65.5% incorrectly stated that children with a fever should not receive vaccines \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e\u003cp\u003eOverall, 71% of mothers demonstrated good knowledge of immunization. Chi-square analysis showed no statistically significant association between maternal education and knowledge of immunization purpose (p\u0026thinsp;=\u0026thinsp;0.082), appropriate starting age (p\u0026thinsp;=\u0026thinsp;0.719), perceived harm (p\u0026thinsp;=\u0026thinsp;0.848), or beliefs about vaccinating during fever (p\u0026thinsp;=\u0026thinsp;0.161). Nonetheless, trends suggested that higher education levels were generally associated with better understanding.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMaternal Knowledge Regarding Immunization (N\u0026thinsp;=\u0026thinsp;200)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKnowledge Questions\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercent\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhy vaccination is necessary?\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTo treat diseases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTo prevent all diseases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e104\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e52.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTo prevent major killer diseases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDon't know\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAt what age vaccination is started?\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKnew\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e171\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e85.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDid not know\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e100.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDo you think vaccinations are harmful?\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e149\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e74.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDo not know\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e100.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCan child with fever be vaccinated?\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e131\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e100.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eMaternal Attitudes of Childhood Immunization\u003c/span\u003e\u003c/p\u003e\u003cp\u003eMost mothers demonstrated a positive attitude toward childhood immunization. Specifically, 87% of mothers believed vaccination is essential for their child\u0026rsquo;s health, and 92% emphasized the importance of adhering to the recommended immunization schedule. In contrast, 2% did not support continued immunization, and 6% were uncertain about its importance. \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e\u003cp\u003eOverall, 89% of mothers exhibited a positive attitude towards immunization. Chi-square analysis revealed no statistically significant association between maternal education and key attitude indicators, such as perceiving vaccination as important (p\u0026thinsp;=\u0026thinsp;0.345) or following the recommended immunization schedule (p\u0026thinsp;=\u0026thinsp;0.211).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMaternal Attitudes Regarding Immunization (N\u0026thinsp;=\u0026thinsp;200)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAttitude Questions\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercentage\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDo you think vaccination is important?\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e178\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e89.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDo not know\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIs it important to follow the vaccination schedule?\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e184\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e92.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo / Do not know\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWhere do you prefer to receive a vaccination?\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGovernment Facility\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e192\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e96.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrivate Facility\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAre you satisfied with the way vaccination is provided?\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e197\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e98.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eMaternal Practices of Childhood Immunization\u003c/span\u003e\u003c/p\u003e\u003cp\u003eThe majority of mothers (93.5%) had either completed or were in the process of completing their child's vaccination schedule. Additionally, 95% expressed their intention to continue vaccinating their children in the future, and nearly all (90.5%) reported visiting an immunization clinic \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e\u003cp\u003eAmong the 88.5% of mothers who reported observing side effects post-vaccination, fever was the most commonly noted (74.5%), followed by pain and swelling (10%) and rash (0.6%). Despite this, only 28.2% informed a doctor or healthcare worker about these side effects. However, a majority (80%) reported using medication to manage these symptoms.\u003c/p\u003e\u003cp\u003eThe remaining 11.5% of mothers reported no side effects. Overall, communication with healthcare providers regarding adverse effects remains suboptimal, indicating a potential gap in post-vaccination care awareness.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMaternal Practices Regarding Immunization (N\u0026thinsp;=\u0026thinsp;200) \u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePractice Questions\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercent\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWas vaccination completed/is it going according to schedule?\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e187\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e93.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDid you take your children to immunization centers to be immunized with all the routine vaccines?\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e181\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e90.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDo you recommend that it should continue?\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e185\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e92.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDo not know\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAwareness and Participation in Immunization Campaigns, and Child Vaccination Status\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuestion\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eResponse\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency (N)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHave you ever immunized your child during immunization campaigns?\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e161\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIf No, why?\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThe immunization campaign was not available\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThere is no need for immunization if the child is healthy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAuthorities promote vaccination for personal gains\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDo you recommend that immunization campaigns should continue?\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e174\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDon\u0026rsquo;t know\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eA majority of mothers (80.5%) reported vaccinating their children during immunization campaigns, while 19.5% had not. Among those who did not participate, the main reasons included unavailability of campaigns in their area (23.07%), belief that vaccination was unnecessary if the child appeared healthy (23.07%). Mistrust in vaccination campaigns (12.8%) and other specified reasons (43.6%). Nonetheless, 87% of mothers supported the continuation of such campaigns.\u003c/p\u003e\u003cp\u003eRegarding vaccination status, 90.5% mothers reported taking their children to an immunization center, while 9.5% had done so only partially, and 5% had never accessed immunization services. Despite this high level of engagement, only 60.5% of mothers reported vaccinating their children on time. The remaining 39.5% experienced delays, with the most commonly cited reasons being child illness (13%), family-related issues such as maternal illness (8.5%), lack of knowledge (4%), and other unspecified factors (8.5%).\u003c/p\u003e\u003cp\u003eOverall, 80% of the mothers demonstrated good immunization practices. However, chi-square analysis showed no statistically significant difference between maternal education and key immunization behaviors, such as vaccination completion (p\u0026thinsp;=\u0026thinsp;0.294) and timely immunization (p\u0026thinsp;=\u0026thinsp;0.238).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to assess maternal KAP towards regular childhood vaccinations in Nowshera. Despite existing information gaps and misconceptions, the findings reveal that mothers demonstrated generally favorable attitudes and good compliance with immunization schedules. Notably, maternal education did not show a statistically significant association with KAP levels. One likely explanation is the influence of health care workers, lady health workers (LHWs), and community awareness programs, which may help disseminate accurate information, regardless of formal educational attainment.\u003csup\u003e[19]\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eIn terms of knowledge, 85.5% of mothers correctly identified the appropriate age to begin vaccination, and 52% believed vaccines prevent all diseases, indicating a high level of basic awareness. 87% of mothers believed that vaccinations were necessary for their child's health.\u003c/p\u003e\u003cp\u003eThese results are consistent with findings from Islamabad by Yasir et al. (2021), where mothers showed a strong understanding of immunization schedules.\u003csup\u003e[2]\u003c/sup\u003e Similarly, Khan et al. (2023) reported high awareness among mothers in Mardan, attributed to urban exposure and high literacy levels.\u003csup\u003e[17]\u003c/sup\u003e While our knowledge scores were slightly lower than those reported in urban settings, the findings are encouraging given the lower literacy rates in our population.\u003c/p\u003e\u003cp\u003eRegular interaction with healthcare providers, counseling LHWs, and targeted community-based awareness programs likely contributed to this awareness, a pattern consistent with studies in other low-literacy contexts that suggests alternative information channels can compensate for limited formal education.\u003csup\u003e[19], [23]\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eDespite these gains, misconceptions remain. For instance, 65.5% of mothers believed that a child with a low-grade fever should not be vaccinated, a persistent myth about contraindications. This reflects similar findings from Islamabad, where positive attitudes were coupled with enduring myths, and from Mardan, where better education reduced but did not eliminate such misconceptions. \u003csup\u003e[1], [18]\u003c/sup\u003e These findings underscore the need for targeted health education interventions focused on addressing common vaccination myths and clarifying valid and invalid contraindications.\u003c/p\u003e\u003cp\u003eWith regards to attitudes, 87% of mothers believed vaccination was necessary for their child's health, and an equal percentage supported the continuation of immunization programs. This positive sentiment mirrors findings from urban and peri-urban areas and may be the result of exposure to national vaccination campaigns, interpersonal counseling, and increased public messaging.\u003csup\u003e[16]\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eHowever, actual immunization practices were less optimal. Although 93.5% of mothers had either completed or were in the process of completing their child\u0026rsquo;s vaccinations, only 60.5% reported doing so on time. The most commonly cited reasons for delay included child illness (13%), family-related reasons (8.5%), and lack of awareness (4%). While these rates are lower than those reported in Mardan and Islamabad (76-93.5%), they still indicate a generally good practice.\u003c/p\u003e\u003cp\u003eA notable finding was that 61% of mothers reported joint decision-making with their husbands regarding vaccination. This is an important contributor to immunization uptake and has been positively associated with higher coverage in previous studies.\u003csup\u003e[24]\u003c/sup\u003e Additionally, 80.5% of mothers had participated in supplemental immunization campaigns, suggesting openness to mass vaccination efforts and reinforcing the potential for campaign-based strategies to bridge coverage gaps.\u003c/p\u003e\u003cp\u003eDespite these positive indicators, post-vaccination monitoring and health-seeking behavior remain weak. Although 74.5% of mothers observed side effects, mostly fever, only 25% reported these symptoms to healthcare professionals. This highlights a gap in post-vaccination communication, which may undermine trust and adverse event surveillance.\u003csup\u003e[25]\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eComparatively, a study from Faisalabad also found good coverage (76%) but reported similar knowledge deficits, particularly regarding VPDs and scheduling.\u003csup\u003e[20]\u003c/sup\u003e 26.5% of mothers in Faisalabad were unaware of the immunization schedule, and only 37% could name common VPDs.\u003csup\u003e[20]\u003c/sup\u003e These disparities reinforce the notion that while general attitudes and practices are improving, specific knowledge gaps persist, especially around symptom recognition, post-vaccination care, and timing.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eLimitations\u003c/span\u003e\u003c/p\u003e\u003cp\u003eThis study has several limitations. First, its cross-sectional design restricts the ability to establish a causal relationship between variables. As a questionnaire-based study, there is a possibility that mothers did not provide entirely accurate responses due to social desirability bias, recall bias, or chance selection of responses.\u003c/p\u003e\u003cp\u003eSecond, the study population was limited to mothers visiting the pediatric wards of the hospital, which introduces selection bias. This group may not be representative of the general population, as hospital visitors are more likely to have children with acute illnesses or greater healthcare access. Additionally, participation was voluntary, potentially excluding mothers less interested or more hesitant about immunization, those who may hold more negative views.\u003c/p\u003e\u003cp\u003eThird, we relied on self-reported vaccination status, rather than verifying against standard immunization records or schedules. This could have led to misclassification, particularly if mothers misunderstood or inaccurately reported the vaccination timeline.\u003c/p\u003e\u003cp\u003eLastly, the use of a self-administered questionnaire may have introduced information bias, particularly memory errors or misunderstanding of questions, despite efforts to ensure clarity.\u003c/p\u003e\u003cp\u003eDespite these limitations, this study is the first of its kind in District Nowshera, a less-resourced area of Khyber Pakhtunkhwa, and offers valuable insights into maternal KAP regarding childhood vaccination. The study benefits from a robust sample size, a high response rate, and anonymous data collection.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur study demonstrated that although mothers in Nowshera exhibit generally good knowledge and positive attitudes towards childhood immunization, critical knowledge and communication gaps persist. The majority of mothers strongly support immunization programs, adhere to vaccination schedules, and utilize public healthcare services. However, persistent misconceptions highlight the need for targeted health education. Despite variations in educational attainment, no statistically significant association was observed with key knowledge or practice indicators, suggesting that interventions to improve awareness should be inclusive of all demographic groups, not only those with limited formal education.\u003c/p\u003e\u003cp\u003eTo enhance the impact and trust in vaccination services, focused educational strategies are needed, particularly those aimed at correcting common myths and misconceptions. A deeper understanding of maternal beliefs and perceptions related to immunization should also be prioritized. Specific attention should be paid to improving education about vaccination timing, appropriate responses to minor side effects, and addressing misunderstandings about contraindications. To improve compliance and ensure the long-term success of immunization programs, tailored, community-specific education approaches are essential, especially those that address concerns about fever, vaccine safety, and side effects. Future research should explore individual vaccines in more detail, and comparative studies between urban and rural populations would provide a more comprehensive understanding of KAP in different contexts. A larger, multi-regional study would allow findings to better inform national immunization policies.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate\u003cbr\u003e\u003c/strong\u003eEthical Review Board (ERB) of Nowshera Medical College approved this study. For the data collection approval were taken from Medical Director of Qazi Hussain Ahmad Medical College (QHAMC). Prior to our data collection, informed consent was taken from each participant. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003cbr\u003e\u003c/strong\u003eFor this cross-sectional study, no funding was received.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; Contributions\u003cbr\u003e\u003c/strong\u003eM.A, L.M, M.K, S.K.M, F.K, F.A, I.A, A.M, A,K and K.A.K: All authors have significantly contributed to all the stages of our study, including research design, data collection, analysis, its interpretation and writing of the manuscript. The final version of manuscript was reviewed and approved by all authors. All authors agreed to be accountable for their work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere is no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eAcknowledgments:\u003c/u\u003e\u003c/strong\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;We would like to thank Dr. Sundas Saboor for her valuable contribution in proofreading and editing the manuscript, which greatly improved the clarity and quality of the article.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. Vaccines and immunization: What is vaccination? Geneva: WHO; 2023 [cited 2025 Jul 18]. Available from: https://www.who.int/news-room/questions-and-answers/item/vaccines-and-immunization-what-is-vaccination\u003c/li\u003e\n\u003cli\u003eYasir I, Javaid A, Pervaiz M, Chaudhry H, Channa A, Farooq U. Knowledge, attitude, and practice of mothers with children under five years of age about vaccination. Rawal Med J. 2023;48(4):914-917.\u003c/li\u003e\n\u003cli\u003eFrenkel LD. The global burden of vaccine-preventable infectious diseases in children less than 5 years of age: implications for COVID-19 vaccination. Allergy Asthma Proc. 2021;42(5):378-385.\u003c/li\u003e\n\u003cli\u003eSavoy M. ACP releases 2016 childhood immunization recommendations. Am Fam Physician. 2016;93:317\u0026ndash;322.\u003c/li\u003e\n\u003cli\u003eBrown D. W. (2018). Definition and use of \u0026quot;valid\u0026quot; district-level vaccination coverage to monitor Global Vaccine Action Plan (GVAP) achievement: evidence for revisiting the district indicator. Journal of global health, 8(2), 020404. https://doi.org/10.7189/jogh.08.020404.\u003c/li\u003e\n\u003cli\u003eUmer MF, Zofeen S, Hu W, Qi X, Zhuang G. Spatiotemporal clustering analysis of Expanded Program on Immunization (EPI) vaccination coverage in Pakistan. Sci Rep. 2020;10:10980.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Immunization campaigns: implementation and guidance. Geneva: WHO; 2023 [cited 2025 Jul 1]. Available from: https://www.who.int/teams/immunization-vaccines-and-biologicals/essential-programme-on-immunization/implementation/immunization-campaigns\u003c/li\u003e\n\u003cli\u003eHaq, Z., Shaikh, B. T., Tran, N., Hafeez, A., \u0026amp; Ghaffar, A. (2019). System within systems: challenges and opportunities for the Expanded Programme on Immunisation in Pakistan. Health research policy and systems, 17, 1-10.\u003c/li\u003e\n\u003cli\u003eRana, M.S., Ikram, A., Salman, M. et al. Negative impact of the COVID-19 pandemic on routine childhood immunization: experience from Pakistan. Nat Rev Immunol 21, 689\u0026ndash;690 (2021). https://doi.org/10.1038/s41577-021-00627-7.\u003cbr\u003e \u003c/li\u003e\n\u003cli\u003eMurtaza, F., Mustafa, T., \u0026amp; Awan, R. (2016). Determinants of nonimmunization of children under 5 years of age in Pakistan. Journal of family \u0026amp; community medicine, 23(1), 32\u0026ndash;37. https://doi.org/10.4103/2230-8229.172231.\u003c/li\u003e\n\u003cli\u003eSpencer J, Pawlowski R, Thomas S. Vaccine adverse events: separating myth from reality. Am Family Physician. 2017;95:786-94.\u003c/li\u003e\n\u003cli\u003eMugada V, Chandrabhotla S, Kaja DS, Machara SGK. Knowledge towards childhood immunization among mothers \u0026amp; reasons for incomplete immunization. J Appl Pharm Sci. 2017 Oct; 7(10):157-161.\u003c/li\u003e\n\u003cli\u003eMaryati, Salmarini DD, Darsono PV, Kusvitasari H. Relationship between maternal knowledge and compliance with measles-rubella immunization. Health Sci Int J. 2024;3(1):15-25. DOI: https://doi.org/10.71357/hsij.v3i1.48\u003c/li\u003e\n\u003cli\u003eZell-Baran LM, Starling AP, Glueck DH, et al. Vaccination trends and family-level characteristics associated with incomplete or delayed childhood immunizations: The Healthy Start Study. Am J Health Promot. 2022;37(4):524-528. https://doi.org/10.1177/08901171221136532\u003c/li\u003e\n\u003cli\u003eVikram K, Vanneman R, Desai S. Linkages between maternal education and childhood immunization in India. Soc Sci Med. 2012;75(2):331-339. https://doi.org/10.1016/j.socscimed.2012.02.043\u003c/li\u003e\n\u003cli\u003e\u0026Ouml;zer M, Fidrmuc J, Eryurt MA. Maternal education and childhood immunization in Turkey. Health Econ. 2018;27(8):1218-1229. https://doi.org/10.1002/hec.3770\u003c/li\u003e\n\u003cli\u003eAbbas M, Scaria LM, Elmasry A, et al. Mothers\u0026rsquo; knowledge, attitudes, and practices toward childhood immunization in Sudan: a cross-sectional study. \u003cem\u003eBMC Public Health\u003c/em\u003e. 2023;23(1):1289. doi:10.1186/s12889-023-16061-4\u003c/li\u003e\n\u003cli\u003eKhan MQ, Khan MJ, Gul H, Amir I, Matiullah S, Ahmed A. Attitudes towards the children\u0026apos;s immunization at the population level in Sheikh Maltoon Town, Mardan, KPK. Int J Health Sci. 2023;7(S1):2074-2091.\u003c/li\u003e\n\u003cli\u003eHarvard School of Public Health. Lady health workers in Pakistan: improving access to health care for rural women and families. Boston: HSPH; 2014 [cited 2025 Jul 18]. Available from: https://content.sph.harvard.edu/wwwhsph/sites/2413/2014/09/HSPH-Pakistan5.pdf\u003c/li\u003e\n\u003cli\u003eTagbo, Beckie \u0026amp; Uleanya, Nwachinemere \u0026amp; Nwokoye, Ikenna \u0026amp; Eze, Jude \u0026amp; Omotowo, Babatunde. (2012). Mothers\u0026rsquo; knowledge, perception, and practice of childhood immunization in Enugu. Nigerian Journal of Paediatrics. 39. 10.4314/njp.v39i3.1. \u003c/li\u003e\n\u003cli\u003eOdusanya OO, Alufohai EF, Meurice FP, Ahonkhai VI. Determinants of vaccination coverage in rural Nigeria. BMC Public Health. 2008;8:381. doi:10.1186/1471-2458-8-381.\u003c/li\u003e\n\u003cli\u003eKhan MS, Shaikh BT. Mother\u0026apos;s knowledge, attitude and practices about child immunization: A study in district Faisalabad, Pakistan. J Pak Med Assoc. 2015;65(1):45\u0026ndash;9 https://www.researchgate.net/publication/285244700_Mother\u0026apos;s_knowledge_attitude_and_practices_about_child\u003cbr\u003e_immunization_A_study_in_district_Faisalabad_Pakistan\u003c/li\u003e\n\u003cli\u003eGlenton C, Scheel IB, Lewin S, Swingler GH. Can lay health workers increase the uptake of childhood immunization? A systematic review. \u003cem\u003eBMC Int Health Hum Rights.\u003c/em\u003e 2011;11(Suppl 1):S10. doi:10.1186/1472-698X-11-S1-S10\u003c/li\u003e\n\u003cli\u003eMuhoza DN, Rutayisire PC, Umubyeyi A, Binagwaho A. The effects of parental decision-making on full immunization of children: evidence from Demographic and Health Surveys in 6 countries. \u003cem\u003eBMC Public Health\u003c/em\u003e. 2016;16:956. doi:10.1186/s12889-016-3628-y\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Global manual on surveillance of adverse events following immunization. Geneva: WHO; 2016 [cited 2025 Jul 18]. Available from: https://www.who.int/publications/i/item/9789241507767\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-epidemiology-and-global-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Journal of Epidemiology and Global Health](https://www.springer.com/journal/44197)","snPcode":"44197","submissionUrl":"https://submission.nature.com/new-submission/44197/3","title":"Journal of Epidemiology and Global Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Immunization, Mothers, Knowledge, Attitudes, Practices","lastPublishedDoi":"10.21203/rs.3.rs-7199378/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7199378/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eVaccination, a public health strategy to prevent childhood illnesses, its success, depends on caregivers\u0026rsquo; knowledge, attitudes, and practices (KAP), particularly mothers. Mothers\u0026rsquo; KAP towards vaccination is essential for the prevention of disease outbreaks in low- and middle-income countries like Pakistan. When routine vaccination uptake is suboptimal, immunization campaigns serve as targeted public health interventions to rapidly increase coverage in specific populations.\u003c/p\u003e\u003cp\u003e\u003cb\u003eObjectives:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTo evaluate maternal KAP regarding immunization of children under five, at Qazi Hussain Ahmed Medical Complex (QHAMC), Nowshera.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA descriptive cross-sectional study was conducted among 200 mothers attending the pediatric medicine ward at QHAMC between April and October 2025. Simple random sampling was used. Data were collected after informed consent, using a semi-structured KAP questionnaire, and analyzed through descriptive statistics on SPSS.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eMothers\u0026rsquo; knowledge about vaccination was satisfactory; 85.5% of mothers knew the appropriate starting age. However, misconceptions persisted, as nearly 52% believed vaccination prevents all diseases, and 17% were unaware of its purpose. Attitudes were predominantly positive, as 87% considered it essential for their child's health, and 92% mothers followed the immunization schedule. Vaccination practices were similarly favorable, as 93.5% of mothers had completed or were continuing their children\u0026rsquo;s immunization, 95% intended to maintain it. However, only 60.5% vaccinated their children on time; delays were due to lack of knowledge, child illness, and family obligations. Despite barriers like low awareness, mistrust, unavailability, etc., 80.5% participated in campaigns, and 94% supported their continuation.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAlthough, majority of mothers showed positive KAP regarding immunization, misconceptions and delays, particularly concerning contraindications and post-vaccination care, remain prevalent. Public health initiatives should prioritize clear, accessible, and culturally tailored education to improve vaccine confidence and timely uptake.\u003c/p\u003e","manuscriptTitle":"Knowledge, Attitude and Practices of Mothers towards Immunization of Children under 5 years of age at Qazi Hussain Ahmad Medical Complex (QHAMC), MTI, Nowshera","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-11 09:27:39","doi":"10.21203/rs.3.rs-7199378/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"237190917830132366291457602239361357179","date":"2026-02-13T16:26:57+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-06T10:04:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"253684192132953154355694301339234396621","date":"2025-10-25T03:40:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"296817255797422928170869254955147518585","date":"2025-10-23T08:37:34+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-03T15:32:07+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-05T06:06:25+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-05T05:07:27+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Epidemiology and Global Health","date":"2025-07-23T19:22:48+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-epidemiology-and-global-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Journal of Epidemiology and Global Health](https://www.springer.com/journal/44197)","snPcode":"44197","submissionUrl":"https://submission.nature.com/new-submission/44197/3","title":"Journal of Epidemiology and Global Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"31daf749-6ac1-4097-93a8-387f3e585ed1","owner":[],"postedDate":"September 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-09-11T09:27:39+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-11 09:27:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7199378","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7199378","identity":"rs-7199378","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}