Identifying Factors Influencing Parental Vaccination Hesitancy in Faisalabad: A Cross Sectional Study

Identifying Factors Influencing Parental Vaccination Hesitancy in Faisalabad: A Cross Sectional Study | 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 Identifying Factors Influencing Parental Vaccination Hesitancy in Faisalabad: A Cross Sectional Study Muhammad Abdullah, Mahum Shaukat, Irha Riaz, Shizza Naveed, Ahsan Ishaq, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6194653/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective This study aims to determine vaccine hesitancy among parents, various factors influencing parental vaccine hesitancy using World Health Organisations (WHO) SAGE working group on vaccine hesitancy survey tool and to give recommendations to authorities about major factors contributing to vaccination hesitancy in Faisalabad District, Punjab, Pakistan. Methods A total of 309 participant's data was analyzed using bivariate and multivariate techniques which includes chi square test and logistic regression to assess vaccine hesitancy. The study examined the impact of child characteristics (sex, age), maternal characteristics (education, employment status, mobile phone ownership), parental characteristics (education, employment status, mobile phone ownership, involvement in child care), household characteristics (family size, amenities, food insecurity, and parental depression), and exposure to negative information on vaccination. Results The analysis revealed that maternal education, mobile phone ownership, parental education, paternal involvement in child care, food insecurity, parental depression, and exposure to negative information significantly influenced parental vaccine hesitancy. Gender of the child showed a slight association with vaccine hesitancy. Among the participants, 74% were female, and 26% were male, with 60.8% of the children being male. The majority of parents (94.5%) recognized the benefits of childhood vaccination, but 13.5% refused vaccination for their children. Conclusion Vaccine hesitancy in Faisalabad District is influenced by various socio-economic and informational factors. Efforts to address these issues, particularly focusing on enhancing maternal education, improving accessibility, and countering misinformation, may reduce vaccination refusal rates and improve immunization coverage in the region. vaccination parental hesitancy INTRODUCTION Vaccination is considered to be the one of the most important discovery of man that has ensured increased life expectancy and reduced mortality among infants. Worldwide, vaccination prevents near about 2–3 million deaths every year and moreover 3.5–4.5 million deaths could be avoided if internationally backed programs of vaccination improves¹. The Expanded Programme on Immunization was introduced in 1978 to provide vaccination to infants to prevent deaths by infectious diseases. New vaccinations were added accordingly later in this schedule to combat lethal diseases. The results were quite fruitful. Vaccine hesitancy is defined as intentional delay or refusal to vaccinate children despite vaccine availability². Since there are many factors that contribute to failure of these government supported programs. Vaccine hesitancy is one of the main reason which accounts for the failure of vaccination² has been defined as by the strategic advisory group of experts (sage) working group as delay in the acceptance or refusal of vaccination services². The World Health organization WHO recognized vaccine hesitancy as one of the major global health threat the world faces, in its five year strategic plan². Vaccine refusal has been the greatest problem in Pakistan as per today polio is still thriving. In developing countries unvaccinated children count is on rise because of different factors which were explored in previous studies conducted. They consist of food insecurity, parental and maternal education status and lack of awareness campaigns etc. Vaccination hesitancy is influenced by these main factors 1) inability to trust 2) there is no need for vaccine 3) lack of certain facilities and vaccinations².As factors were stated above any of these can contribute to vaccine refusal. This study was conducted in hospital in Faisalabad, Punjab to determine the main factors that account for failure of programs introduced by the government. Despite the easy availability of vaccines, another challenge is vaccine hesitancy which can be described as the purposeful avoidance or refusal to vaccinate one’s children. Factors such as inability to trust the system, the needlessness of vaccinating as perceived by some, and access to vaccination sites contribute to this hesitancy. The World Health Organization places vaccine hesitancy in the threath humanitarian importances everywhere for health service provision. In Pakistan, the people’s refusal to be immunized has proven to be a major impediment towards polio eradication. Different assays have shown that there are various indicators that were prevalent in vaccine hesistancy in less developed countries which included security of food, the level of education of the parents and mothers in particular as well as the level of awareness campaigns.¹ This study sought to assess the major reasons which led to the failure of the government vaccine programs in Faisalabad, Punjab. To overcome the challenge of vaccine hesitancy it is important to focus on increasing the awareness of the public, improving the accessibility of vaccination centers, and enhancing the trust through communication. We can save the at-risk population and improve the overall vaccination levels thus bringing the world closer to the eradication of polio within sensible timeframes by addressing such problems. Effective strategies will also need the participation of healthcare providers, policy makers and community leaders as they have to tackle the cultural and logistic dimensions of vaccine hesitance and other barriers to access life saving vaccines. LITERATURE REVIEW A recent study 2020 in Bannu district found a counterintuitive association between. food security and vaccine refusal¹. More research is needed to understand this relationship in the Pakistani context The impact of depression on healthcare decision-making in Pakistan requires further investigation Studies from other countries suggest a potential link between depression and vaccine hesitancy, but this hasn't been explored extensively in Pakistan.Vancines are an important public health tool for slowing down the spread of disease, decreasing the severity of symptoms and the risk of hospitalisation and death³. In 2019, the World Health Organisation has declared vaccination hesitancy as a major threat to global health⁴. Vaccination hesitancy is defined as the "delay in acceptance or refusal of vaccines despite the availability of vaccination services"⁵. Similar to the other countries in this region, Pakistan also has very high proportion of children who have not received any vaccines. Despite the fact that EPI started in 1978 in Pakistan, the national coverage of vaccination is persistently low as reported that only two in every three children are completely vaccinated. There are also extreme discrepancies with respect to immunization of the population of urban and those of rural areas. Some of the factors which were associated with refusal to vaccinate included low level of education particularly father’s education, father’s unemployment, parents exposed to negative rumor, family income and nutrition status.⁶ Most of the parents. who refused vaccination of their children strongly agreed that childhood vaccination programmes are beneficial, and that religious and political leaders support vaccination programmes.Routine childhood immunization is one of the most effective public health interventions, preventing serious infectious diseases. However, vaccine hesitancy and refusal are significant challenges in achieving optimal vaccination coverage, particularly in low-and middle-income countries like Pakistan. A more recent research revealed that vaccine acceptance can be visualized as an iceberg, where a small protruding portion depicts those who outright reject vaccination, whilst the submerged portion signifies the vaccine hesitant populace. Defining vaccine hesitant subpopulations is crucial for the effectiveness of any vaccination campaigns. In a broad as well as a meticulous population based study, along with the multicentric ones, it would be easier to prove that vaccination hesitancy is one of the causes of low vaccination rate. Such studies also describe the various factors which cause VH in different populations.⁷ A study further explores this by comparing parental attitudes towards routine childhood vaccinations and the COVID-19 vaccine, revealing a higher hesitancy towards the COVID-19 vaccine ⁸. A study in Khyber Pakhtunkhwa province delves deeper, exploring the role of religious misconceptions and social media influences in vaccine hesitancy Trust in Healthcare System⁹. A cross-sectional study in Khyber Pakhtunkhwa province, Pakistan, found that trust in healthcare providers positively influenced childhood immunization uptake. There is emerging evidence linking household food insecurity with vaccination hesitancy in low-resource settings¹⁰. Another research in Pakistan explored parental perspectives on childhood vaccination in Karachi, Pakistan. They identified misconceptions about vaccine safety and efficacy as significant contributors to vaccine hesitancy. ¹¹ The SAGE Working Group on Vaccine Hesitancy concluded that vaccine hesitancy refers to delay in acceptance or refusal of vaccination despite availability of vaccination service ¹².Vaccines have been used effectively to prevent and control infectious diseases since early days of its discovery. Recent rise in Vaccine Hesitancy and refusal worldwide has become a public health concern ¹³.Various factors play role in determining attitude of parents towards childhood vaccinations and reasons for vaccine delay or refusal. It is important to understand these factors to improve childhood vaccination rate ¹⁴.In a qualitative study done in Malaysia on parents the main concern for refusal among parents was lack of trust on vaccination efficacy and fear of adverse side effects. Reasons for refusal are dynamic and vary in different communities and it is essential to consider the social, cultural factors of community ¹⁵.Pakistan has poor childhood immunisation rate because of various social and cultural barriers. Globally Pakistan ranks third in the list of countries with highest number of un immunised children¹⁶.In a survey based study in karachi reasons behind immunisation refusal among parents were observed.Lack of appropriate knowledge about adverse event following immunization, unawareness of importance of vaccines were linked to high vaccine refusal¹⁷. OBJECTIVES AND AIMS OF THE STUDY To determine vaccine hesitancy among parents To determine various factors influencing parental vaccine hesitancy using World Health Organisations (WHO) SAGE working group on vaccine hesitancy survey tool. Give recommendations to authorities about major factors contributing to vaccination hesitancy. JUSTIFICATION OF THE STUDY This study was done to determine the prevalence of parental refusal for routine childhood immunizations in Faisalabad district, Punjab, Pakistan and to identify factors associated with parental refusal for routine childhood immunizations using the WHO Vaccine Hesitancy tool. The study also explored contextual factors like access to vaccines and trust in healthcare systems and Individual factors like beliefs about vaccine safety effectiveness. Partenal believes and opinions about vaccination was also assessed. METHODOLOGY Study design Cross sectional study Study setting Outpatient department and Pediatric Ward in Aziz Fatima Hospital,Faisalabad, Punjab. Study duration March 2024 to November 2024 Sample size 309 Sampling technique Convenience sampling Study population The study group consisted of parents and guardians of children. Study tools: WHO SAGE Working Group on Vaccine Hesitancy Survey Tool Household food insecurity access scale(HFIAS) Patient Health Questionnaire-9 (PHQ9) Data Collection The WHO SAGE Working Group on Vaccine Hesitancy Survey Tool was used to collect data after participants provided informed consent . Ethical consideration Oral and written informed consent was taken from participants and face to face interviews were conducted. The study received ethical approval from Aziz Fatima Hospital. Data Analysis Data analysis was done using SPSS version27. Continuous variables were tested changed into categorical variables by dividing range into equal intervals for each class. Chi square Test was used to test the independent variables. Demographic variables with p < 0.05 were included. Inclusion criteria The study group consisted of parents having children of age 0–5 years and having lived in the target geographical region for at least 12 months Exclusion criteria Parents or guardians who were involved in delivery of any type of health services for example health care staff were excluded. Null hypothesis There is no association between dependent variables( Demographics, Maternal and paternal characteristics, Household characteristics including household food insecurity and depression) and parental refusal of routine immunisation in Faisalabad, Pakistan . Alternate hypothesis There is association present between dependent variables ( Demographics, Maternal and paternal characteristics, Household characteristics including Household food insecurity and depression) and parental refusal of routine immunisation in Faisalabad, Pakistan. Operational Definitions: Knowledge about immunization :Parents were asked whether they had undergone all suggested vaccinations and if the vaccinations were done on time and according to the national immunization policy .To asses participants knowledge and attitude towards immunization and vaccination, set of questions were asked and response were recorded .The response options varied from strongly disagree, disagree, neutral, agree and strongly agree. Participants understanding about importance of vaccination and its role in disease prevention were questioned with close ended questions with yes or no options. In addition, a comprehensive complete account of the difficulties, problems, and reasons for the refusal of vaccination was collected. Role of both parents in decision making regarding to vaccination of children was asked . Food insecurity assessment :The Household food insecurity access scale(HFIAS) was used to asses prevalence of household food insecurity and its role in vaccination refusal among parents. It consists of 9 questions that have been used in various countries and appears to diffrentiate food secured and food insecured families in different cultural context. Results are categorised into food secured or mildly, moderately, severely food insecured. Chronic food insecurity is in general linked to spread of infectious diseases and poor health outcomes. Patient Health Questionnaire 9 :The severity of depression among parents or guardian was measured using PHQ-9. The role of depression in parents and its association with refusal rates among parents was observed. It divides depression level into mild, moderate, moderately severe and severe based on PHQ score obtained. Ethical APPROVAL All experimental protocols , data collection and analysis were approved by ethical committee of Aziz Fatimah Medical and Dental College and Aziz Fatimah Hospital. Data Availability Statement All the data is available and is not uploaded due to privacy reasons and can be provided by corresponding author on request. Results The study was conducted in paediatric wards and OPDs of Aziz Fatimah medical and dental college and our research study revealed significant factors contributing to parental vaccination hesitancy. We identified several significant determinants influencing parents' decision-making regarding childhood vaccinations including maternal education , mother's having mobile, paternal education, paternal involvement in child care, food insecurity of household, depression status of parents, exposure to misinformation, and concerns about vaccine safety and efficacy.There was slight association of vaccination hesitancy in parents and gender of child. Total 309 participants took part in the study , 228 (74%) participants were female and remaining 81 (26%) were male . Out of 309 children under study 188 (60.8%) were male and 121 (39.2) were females. Children under studer were upto 5 year of age and are classified as 1-12 months 107 (34.6%), 13-24 months 78 (25.2%) , 25-36 months 55 (17.8%), 37-48 months 57 (18.4%)and 39-50 months 12(3.9%) with the mean of 2.32 years ± 1.231. Maternal age was classified as 19-25 years 51(16.5%) , 26-35 years 217 (70.2%) and 36-45 years 41(13.2%) with the mean of 30.4 ±4.874. Paternal age was classified as 22-32 years 144(46.6%), 33-42 years 130(42.0%), 42-52 years 30(9.7%), 53-66 years 5(1.6%) with the mean of 34.3 ±6.625. Maternal and paternal education was classified as no education, primary education , secondary education and higher education. Out of 309 mothers 37(12.0%) had no education, 77(24.9%) had primary education, 121(39.2%) had secondary education and 74(23.9%) had higher education. Out of 309 fathers 31(10.0%) had no education, 60(19.4%) had primary education,84(27.2%) had secondary education and 134(43.4%) had higher education. 56(18.1%) mothere were employed and 232(75.1%) owned a mobile phone while 286(92.6%) fathers were employed and 303(98.1%) owned a mobile phone. According to data 212(68.6%) fathers were involved in child care. Most of the families were from middle and lower middle class having little to no food insecurity in 181(58.6%), 115( 37.2%) having moderate food insecurity and 13(4.2%) having severe food insecurity. 274 (88.7%) showed mild or no sign of depression while 35(11.3%) showed moderate to severe depression. Majority of the parents belived that childhood vaccination is important and it protects children from diseases. Majority of parents 246(79.6) had received negative information about vaccination while 50(16.2%) thinks they have various reason for not getting there child vaccinated.292(94.5%) parents think childhood vaccination is beneficial while 42(13.5%) have refused for vaccination of their children.[Table1] Table 1: comprehensive overview of all variables with thier frequency and percentages along with range, standard deviation and mean of continuous variables, allowing for a detailed analysis of the study population. Variable Categories Frequency Percentage Gender of child Male 188 60.8 Female 121 39.2 Age of child 0-12 months 107 34.6 13-24 months 78 25.2 25-36 months 55 17.8 37-48 months 57 18.4 49-50 months 12 3.9 Maternal age 19-25 years 51 16.5 35-35 years 217 70.2 35-45 years 41 13.2 Maternal education Higher 74 23.9 Secondary 121 39.2 Primary 77 24.9 No education 37 12 Maternal employment status Not employed 253 81.9 Employed 56 18.1 Mother owns a mobile No 77 24.9 Yes 232 75.1 Paternal age 22-32years 144 46.6 33-42years 130 42 43-52years 30 9.7 Above 52 years 5 1.6 Paternal education Higher 134 43.4 Secondary 84 27.2 Primary 60 19.4 No education 31 10 Paternal Employment status Not employed 23 7.4 Employed 286 92.6 Father owns a mobile No 6 1.9 Yes 303 98.1 Father involved in child care No 97 31.4 Yes 212 68.6 Family members 1-3 64 20.7 4-7 215 69.6 8-10 27 8.7 More than 10 3 1 Household characteristics (number of amenities) 1 4 1.2 2 6 1.9 3 15 4.85 4 27 8.73 5 215 69.5 6 42 13.5 Food insecurity Little to no 181 58.6 Moderate 115 37.2 Severe 13 4.2 Depression No 180 58.3 Mild 94 30.4 Moderate 31 10 Moderately severe 3 1 Severe 1 0.3 Continuous variables Variable Range Minimum Maximum Mean Standard deviation Child age 4 1 5 2.32 1.231 Maternal age 26 19 45 30.40 4.875 Paternal age 44 22 66 34.37 6.625 [ Table 2] identifies several factors significantly associated with parental vaccination refusal, including parental education, employment status, mobile phone ownership, and father's involvement in childcare. Moreover, the study revealed a strong correlation between food insecurity, depression, and parental vaccine refusal. Size of family was slightly associated with vaccination hesitancy. However there was no significant association observed between vaccination refusal and children gender, children age, paternal age, possession of certain household amenities and father's mobile phone ownership. Table 2: Vaccination refusal in parents and its associated factors. Variable Categories Paternal vaccination refusal Test of significance No Yes p-value Gender of child Female 99 22 0.059 Male 168 30 Age of child 0-12 months 95 12 0.432 13-24 months 70 8 25-36 months 44 11 37-48 months 48 9 49-50 months 10 2 Maternal age 19-25 years 51 0 0.045 35-35 years 185 32 35-45 years 31 10 Maternal education Higher 70 4 <0.001 Secondary 112 9 Primary 68 9 No education 17 20 Maternal employment status Not employed 218 35 0.792 Employed 49 7 Mother owns a mobile No 56 21 <0.001 Yes 211 21 Paternal age 22-32years 130 14 0.34 33-42years 109 21 43-52years 23 7 Above 52 years 5 0 Paternal education Higher 128 8 <0.001 Secondary 69 15 Primary 52 8 No education 20 11 Paternal Employment status Not employed 12 11 <0.001 Employed 255 31 Father owns a mobile No 5 1 0.587 Yes 262 42 Father involved in child care No 71 26 <0.001 Yes 196 16 Family members 1-3 61 3 0.028 4-7 183 32 8-10 21 6 More than 10 2 1 Household characteristics (number of amenities) 1 4 0 0.232 2 6 0 3 14 1 4 26 1 5 179 36 6 38 4 Food insecurity Little to no 166 15 0.001 Moderate 93 22 Severe 8 5 Depression No 163 17 <0.001 Mild 83 11 Moderate 19 12 Moderately severe 2 1 Severe 0 1 The data further assesses different aspects that relate to parent's perspective towards childhood vaccinations.The first column consists of either-or answers to the questions regarding attitudes, histories, and beliefs about vaccinating.The last column signifies the statistical significance (p value) of each question in relation to paternal vaccine hesitancy.The important highlights extracted from the table include the following ones: Most parents are of the opinion that vaccination shields children from serious illnesses and that most parents have their children vaccinated.Immunization has been hampered in a large proportion of fathers by factors such as unavailable clinics or their operating hours and high costs.Other life pressures have also affected the decision of parents towards the vaccination. Many parents received negative information about vaccination.Parental hesitation is not significantly related to the endorsement of religious or political figures on the child vaccination. In addition, it could be explained using the data provided that in Faisalabad a range of factors leads to paternal vaccination hesitancy including negative attitudes towards effectiveness and safety of the government provided vaccines, access issues and negative information. It is important to overcome these barriers to increase the number of children vaccinated in this area.[Table 3] Table 3: Vaccination refusal in parents and parental perceptions Variables Categories Paternal vaccination hesitancy Dichotomous questions regarding prescription Yes No P-value 1)Do you believe vaccination protects protect from serious children diseases? Yes 30 262 <0.001 No 12 5 2)Do you think most parents like vou vaccinate their children? Yes 29 258 <0.001 No 13 9 3)Have distance from clinic, timingor costs prevented Immunization? Yes 20 84 0.052 No 22 183 4)Have other pressures in life prevented Immunization? Yes 15 21 <0.001 No 27 246 5)Are there any Reasons you think children should not be vaccinated? Yes 32 18 <0.001 No 10 249 6)Do you think some ethnic religious groups have difficulties with vaccination? Yes 25 97 0.006 No 17 170 7)Have you ever received negative information about vaccination? Yes 41 205 0.001 No 1 62 8)Do leaders (e.g religious political) support child vaccination? Yes 39 233 0.433 No 3 34 [ Table 4] presents the data related to various factors, looking at the parents attitude towards childhood vaccination along with their beliefs and their interaction with the health care provider.The first column includes yes-no questions related to beliefs—all vaccination, particular experiences, and perceptions. The second and third columns display the number of parents who signed up on every category (for example, Agree, Disagree, Neutral), whereas the last column displays the significance (p-value) of every question in relation to fathers’ vaccination hesitation. General observation from the table includes that the overwhelming majority of parents think that childhood vaccination is necessary and helpful not only for the child but the society at large. They also have confidence about the information they received about vaccination.On the other hand, a considerable number of fathers express fears on the dangers brought about by vaccination, which include serious side effects.In the same way, a considerable number of fathers are of the opinion that their children do not require vaccination against rare illnesses. This is probably due to the fact that they do not appreciate the need for herd immunity and the threat of possible epidemics in the absence of high vaccination coverage. Parents who are likely to comply with the pediatrician's advice on child vaccinations are less likely to be vaccination hesitant. This means that trust in health care providers is vital in combating vaccination hesitancy. Overall, the data lead to a conclusion that although the majority of parents in Faisalabad are favorable towards childhood immunization, there still exist some significant issues and ill beliefs that require elimination. Table 4: Vaccination refusal in parents and likert scale of parental perceptions. Variables Categories Paternal vaccination hesitancy Likert scale Yes No P-value Is childhood vaccination important for child health? Agree 19 210 <0.001 Disagree 9 2 Neutral 11 3 Strongly agree 2 52 Strongly disagree 1 0 Child vaccination is important for the health of others in the community. Agree 12 200 <0.001 Disagree 12 7 Neutral 16 29 Strongly agree 1 31 Strongly disagree 1 0 All childhood vaccination programmes are beneficial. Agree 7 198 <0.001 Disagree 18 7 Neutral 15 21 Strongly agree 0 41 Strongly disagree 2 0 New vaccines are more risky than older vaccines. Agree 17 46 0.003 Disagree 8 94 Neutral 15 115 Strongly agree 2 3 Strongly disagree 0 9 Information I received about vaccination is trustworthy and reliable. Agree 8 189 <0.001 Disagree 15 15 Neutral 14 36 Strongly agree 0 26 Strongly disagree 5 1 Vaccination is a good way to protect children from disease. Agree 15 195 <0.001 Disagree 11 10 Neutral 15 32 Strongly agree 0 29 Strongly disagree 1 1 Generally, I do what my doctor recommends regarding child vaccination. Agree 16 180 <0.001 Disagree 10 6 Neutral 13 38 Strongly agree 2 32 Strongly disagree 1 1 I am concerned about serious adverse effects of vaccine Agree 18 80 0.001 Disagree 3 81 Neutral 15 83 Strongly agree 6 13 Strongly disagree 0 11 My child does not need vaccination for uncommon diseases Agree 11 67 0.035 Disagree 7 66 Neutral 22 124 Strongly agree 2 0 Strongly disagree 0 10 Childhood vaccination is effective Agree 11 202 <0.001 Disagree 12 3 Neutral 15 16 Strongly agree 2 46 Strongly disagree 2 0 Table5 shows the logistic regression analysis, conducted in Faisalabad, Pakistan, examined factors influencing parental vaccination hesitancy for children. The results indicate that fathers involved in childcare (OR=4.771, p<0.001), lower maternal education (OR=0.600, p=0.006), and food insecurity (OR=2.083, p=0.034) significantly increased the odds of hesitancy. While maternal mobile phone ownership and paternal employment status showed some association, they were not statistically significant. Paternal education and parental depression did not significantly predict vaccination hesitancy in this study. Table 5 : logistic regression of significant variables Predictor Variable B SE Wald df Sig (p) Exp(B) (Odds Ratio) 95% CI for Exp(B) Mother owns a mobile 0.747 0.424 3.095 1 0.079 2.110 0.918 - 4.848 Paternal Employment Status 0.893 0.595 2.256 1 0.133 2.442 0.762 - 7.831 Father involved in childcare 1.562 0.396 15.593 1 0.000 4.771 2.197 - 10.361 Maternal Education -0.511 0.185 7.601 1 0.006 0.600 0.417 - 0.863 Paternal Education 0.152 0.183 0.686 1 0.407 1.164 0.813 - 1.667 Food Insecurity 0.734 0.346 4.509 1 0.034 2.083 1.058 - 4.101 Depression 0.078 0.152 0.263 1 0.608 1.081 0.803 - 1.455 DISCUSSION Vaccine hesitancy in parents is a major issue worldwide that impedes the efforts of vaccination programmes. In our study we used WHO SAGE vaccine Hesitancy Survey tool to measure the parental vaccination refusal rate²⁴. Moreover we focused on the correlation of vaccines hesitancy and its various factors that are parental education, food insecurity, depression,employment status of parents socioeconomic status. The results show that less than one quarter of the sample parents refused vaccination for their children with parental education and employment status playing significant role. Moreover, depression and food insecurity have a statistically very significant association. A recent study done in Pakistan reported that greater proportion of routine immunisation refusal cases were illiterate parents compared to control parents¹⁶.Eduaction plays pivotal role in the parental opinion toward vaccination .Another study done in Saudi Arabia reports that parents with low education are more prone to believe and spread false and negative information about the childhood vaccination this resulted in a statistically significant association between low education and vaccine hesitancy¹⁸. These previous studies support our study finding which is that low education or no education in parents is one of the reason of parental vaccine hesitancy because of lack of awareness the myths spreading around such parents make them doubtful about the benefits of vaccination .majority of parents (79.6%) in our study had received negative information about the vaccination. Another study done on parental vaccine hesitancy for influenza vaccine reported that parents with more income are less hesitant than the low income parents (15.9% vs 20.8%–25.2%), and similarly have less concerns about the vaccination side effects¹⁹. In our study parental vaccine refusal rate was very low (13.5%)compared to previous studies. A study done in Canada, found that 16.8% vaccine refusal rate is found in parents of two year old for at least one vaccine²⁰. The low vaccine rate was because in our study sample majority of the parents (94.5%) believed that childhood vaccinations are important for the protection of their children from various diseases and that vaccination is beneficial for their children. Another survey done on Jordanian parents, showed a 9.3 % vaccine hesitancy more common in female participants In the same study people with higher income and more education were more likely to get their children vaccinated²¹. In our study, Likert scale regarding parental perceptions about vaccination revealed that the primary concern among parents who opted against vaccinating their children was the perceived risk of severe adverse reactions. The scale also highlighted misconception about the safety of vaccines. Similarly,another study done on Jordanian parents reveals that their main reason for not getting their child vaccinated was vaccine’s adverse effect and how effective it was to prevent the disease ²². Our study finding reports food insecurity as one of the reason for vaccine hesitancy in parents it might be due to the effect that most parents are already concerned about the food insecurity that they find vaccination of their child as a less important thing. Our study’s finding is supported by a study done in Pakistan on polio immunisation hesitancy which reports that parents with food insecurity were more reluctant to accept polio vaccination . In our study, depression has strong correlation(<0.001) with vaccination hesitancy in parents. Which is also supported by another study from Greece explaining parents were more likely to accept the childhood vaccinations, are those who have less stress or depressive symptoms²³.Depression completely occupies the brain of any person.Parents with depression are more likely to neglect their own and their child’s healthcare. Firstly in our study we did primary data collection which includes collecting data by directly interacting with the participants the advantage of which was the accuracy of information and no barrier between researcher and the participants. It eliminates the hurdles of not having internet facilities in some families Our sampling method included simple random sampling in which we collected data from people of any gender and any age that resulted in no selection bias We interacted directly with the parents and asked the questions by ourselves that removed the undercoverage bias resulting when people use google form data collection method . LIMITATIONS Firstly, Our study sample included a vast majority of females proportion because most children were accompanied by their mothers during the hospital visits.Secondly, Lack of education made it difficult for the parents to understand the motive of the research which created hesitation in sharing or opening up about it.Thirdly, Due the cross sectional nature of the study a causal relationship was unable to be made between parental vaccination refusal status and any of the independent variabl CONCLUSION As demonstrated the results of this study carried out in Faisalabad, Pakistan, there are a number of factors that lead to parental vaccine hesitance particularly among fathers. These include knowledge and attitudes, socioeconomic factors, parental involvement, health facilities utilization, and trust in health service providers.Additionally, exposure to anti-vaccine propaganda and safety issues surrounding vaccines were major contributors to vaccine hesitance. Her understanding of why vaccination is important was vague, especially in reference to herd immunity and the risk of diseases that vaccines can prevent. Other socioeconomic factors include low education levels of parents, food insecurity, and depression of the parents that also affected their vaccination decisions. Also, there was a negative correlation between fathers who did not participate in child caring activities and vaccinating their children. Geographic barriers, such as lack of accessible health centers, inconvenient hours, and cost, were other factors that limited vaccination. Lastly, building rapport with health care workers came out as an important strategy in reducing sterility among the parents. RECOMMENDATIONS Based on the results of the study, there are various ways that childhood vaccination rates in Faisalabad can be improved. Information and communication educational campaigns, in particular, are required to debunk myths and encourage the safety and efficacy of vaccines. Herd immunity, as well as the dangers of diseases that can be prevented by vaccination, should also be stressed. Dealing with some social and economic issues like those of food insecurity and depression will assist in curtailing hesitancy. Involvement of fathers in making childcare decisions is also likely to promote a positive attitude towards vaccinations. There is need to enhance healthcare services by increasing the number of clinics, extending the hours of operation, and reducing the services costs. Lastly, maintaining transparent and effective communication and responding to parents worries can help develop a good relationship with health care providers thereby increasing the uptake of vaccinations. Through these above mentioned approaches, pediatricians, government officials, and local societal leaders can come together to safeguard children from vaccine-preventable illnesses and promote health in Faisalabad. The future implications of our study is that government needs to make policies to improve childhood vaccination rate in parents . As seen In our study highest proportion of parental vaccine hesitancy rate was seen in the people suffering from food insecurity which was due to effect that food for them was the first and foremost thing for their child instead of health care government should make programs for such parents and should guide them that vaccination for their children is as important as food for them Also the parents with no education or less eduaction parents should be guided about the importance of vaccination for their children and should also be guided that not getting vaccination is harmful Government should educate parents about the false information spreading about the childhood vaccination These measure will help not only to increase childhood vaccination rate but will also help to create awareness through social media,billboards,newspapers and television. Declarations CONFLICT OF INTEREST There was no potential conflict of interest so the results of the study are free of bias and represent the genuine views of the respondents. This enhances the validity and neutrality of the research which adds to its usefulness in understanding and combating parental vaccine hesitancy in the area. FUNDING The research study titled " Identifing Factors Influencing Paternal Vaccination Hesitancy in Faisalabad : A Cross Sectional Study was carried out solely without any funding from any private or government organisation. Thus, it alleviates the possibility of any vested financial interests in the vaccine or related industries. Author Contribution M.A did analysis and wrote all the results , conclusion along with tables, also managed the data collection and planned the research. M.S wrote discussion and helped in data collection, I.R wrote literature review and helped in data collection. S.N wrote introduction and collected data .A.I wrote abstract and did data collection . The research was done under supervisor of H.SAll author reviewed the final research article . References Khattak FA, Rehman K, Shahzad M, et al. Prevalence of parental refusal rate and its associated factors in routine immunization by using WHO Vaccine Hesitancy tool: A cross-sectional study at district Bannu, KP, Pakistan. Int J Infect Dis. 2021;104:117–24. Guzman-Holst A, DeAntonio R, Prado-Cohrs D, et al. Barriers to vaccination in Latin America: A systematic literature review. Vaccine. 2020;38(3):470–81. Zheng C, Shao W, Chen X, et al. Real-world effectiveness of COVID-19 vaccines: A literature review and meta-analysis. Int J Infect Dis. 2022;114:252–60. World Health Organization. Ten health issues WHO will tackle this year [Internet]. Who.int. 2019. Available from: (link unavailable). Lelliott M, Sahker E, Poudyal H. A review of parental vaccine hesitancy for human papillomavirus in Japan. J Clin Med. 2023;12(5):2004. Butt M, Mohammed R, Butt E, et al. Why have immunization efforts in Pakistan failed to achieve global standards of vaccination uptake and infectious disease control? Risk Manag Healthc Policy. 2020;13:111–24. Thapar R, Kumar N, Priya, Surendran et al. Vaccine hesitancy among mothers of under-five children in coastal South India: A facility-based cross-sectional study. F1000Res [Internet]. 2021 Jan 1 [cited 2024 May 17];10:186. Mashhadi SF, Khan N, Ilyas U, et al. COVID-19 vaccination and routine childhood vaccinations: Comparison of hesitancy among parents. Pak Armed Forces Med J. 2022;72(1):133–8. Shah SA, Khan MA, Ullah F, Khan N. Unveiling the reasons behind vaccine hesitancy in Khyber Pakhtunkhwa, Pakistan: A qualitative exploration. Cureus. 2022;14(4):e22202. Faisal S, Ali A, Khan MA, Ullah R. Factors affecting childhood immunization uptake in Khyber Pakhtunkhwa Province, Pakistan: A cross-sectional study. BMC Public Health. 2018;18(1):1–8. Khan SA, Memon SS, Arain NA, Shaikh AS. A survey exploring reasons behind immunization refusal among parents and caregivers of children under two years living in urban slums of Karachi. Pakistan Vaccines. 2019;7(12):370. MacDonald NE, SAGE Working Group on Vaccine Hesitancy. Vaccine hesitancy: Definition, scope, and determinants.Vaccine,. 2015;33(34):4161-4. Bianco A, Mascaro V, Zucco R, Vaccine et al. 2019;37(7):984–90. Cag Y, Al Madadha ME, Ankarali H, et al. Vaccine hesitancy and refusal among parents: An international ID-IRI survey. J Infect Dev Ctries. 2022;16(06):1081–8. Rumetta J, Abdul-Hadi H, Lee YK. A qualitative study on parents' reasons and recommendations for childhood vaccination refusal in Malaysia. J Infect Public Health. 2020;13(2):199–203. Soofi SB, Vadsaria K, Mannan S, et al. Factors associated with vaccine refusal (polio and routine immunization) in high-risk areas of Pakistan: A matched case-control study. Vaccines. 2023;11(5):947. Khaliq A, Elahi AA, Zahid A, Lassi ZS. A survey exploring reasons behind immunization refusal among parents and caregivers of children under two years living in urban slums of Karachi, Pakistan. Int J Environ Res Public Health. 2022;19(18):11631. Santibanez TA, Nguyen KH, Greby SM et al. Parental vaccine hesitancy and childhood influenza vaccination. Pediatr [Internet]. 2020;146(6). Schellenberg N, Petrucka P, Dietrich Leurer M et al. Determinants of vaccine refusal, delay and reluctance in parents of 2-year-old children in Canada: Findings from the 2017 Childhood National Immunization Coverage Survey (cNICS). Travel Med Infect Dis 2023 May-Jun;53:102584. Al-Iede M, Aljahalin M, Fashho E, et al. Hesitancy toward childhood and influenza vaccines: Experiences from highly educated Jordanian parents. Vaccines (Basel). 2024;12(8):945. Aldakhil H, Albedah N, et al. Vaccine hesitancy towards childhood immunizations as a predictor of mothers' intention to vaccinate their children against COVID-19 in Saudi Arabia. J Infect Public Health. 2021;14(10):1497–504. AlShurman B, Butt ZA. Proposing a new conceptual syndemic framework for COVID-19 vaccine hesitancy: A narrative review. Int J Environ Res Public Health. 2023;20(2):1561. Derdemezis C, Markozannes G, Rontogianni MO, et al. Parental hesitancy towards the established childhood vaccination programmes in the COVID-19 era: Assessing the drivers of a challenging public health concern. Vaccines (Basel). 2022;10(5):814. Strategic Advisory Group of Experts on Immunization [Internet]. www.who.int. Available from: https://www.who.int/groups/strategic-advisory-group-of-experts-on-immunization Additional Declarations No competing interests reported. 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Worldwide, vaccination prevents near about 2\u0026ndash;3\u0026nbsp;million deaths every year and moreover 3.5\u0026ndash;4.5\u0026nbsp;million deaths could be avoided if internationally backed programs of vaccination improves\u0026sup1;. The Expanded Programme on Immunization was introduced in 1978 to provide vaccination to infants to prevent deaths by infectious diseases. New vaccinations were added accordingly later in this schedule to combat lethal diseases. The results were quite fruitful. Vaccine hesitancy is defined as intentional delay or refusal to vaccinate children despite vaccine availability\u0026sup2;. Since there are many factors that contribute to failure of these government supported programs. Vaccine hesitancy is one of the main reason which accounts for the failure of vaccination\u0026sup2; has been defined as by the strategic advisory group of experts (sage) working group as delay in the acceptance or refusal of vaccination services\u0026sup2;.\u003c/p\u003e \u003cp\u003eThe World Health organization WHO recognized vaccine hesitancy as one of the major global health threat the world faces, in its five year strategic plan\u0026sup2;. Vaccine refusal has been the greatest problem in Pakistan as per today polio is still thriving. In developing countries unvaccinated children count is on rise because of different factors which were explored in previous studies conducted. They consist of food insecurity, parental and maternal education status and lack of awareness campaigns etc. Vaccination hesitancy is influenced by these main factors 1) inability to trust 2) there is no need for vaccine 3) lack of certain facilities and vaccinations\u0026sup2;.As factors were stated above any of these can contribute to vaccine refusal. This study was conducted in hospital in Faisalabad, Punjab to determine the main factors that account for failure of programs introduced by the government.\u003c/p\u003e \u003cp\u003eDespite the easy availability of vaccines, another challenge is vaccine hesitancy which can be described as the purposeful avoidance or refusal to vaccinate one\u0026rsquo;s children. Factors such as inability to trust the system, the needlessness of vaccinating as perceived by some, and access to vaccination sites contribute to this hesitancy.\u003c/p\u003e \u003cp\u003eThe World Health Organization places vaccine hesitancy in the threath humanitarian importances everywhere for health service provision. In Pakistan, the people\u0026rsquo;s refusal to be immunized has proven to be a major impediment towards polio eradication. Different assays have shown that there are various indicators that were prevalent in vaccine hesistancy in less developed countries which included security of food, the level of education of the parents and mothers in particular as well as the level of awareness campaigns.\u0026sup1;\u003c/p\u003e \u003cp\u003eThis study sought to assess the major reasons which led to the failure of the government vaccine programs in Faisalabad, Punjab. To overcome the challenge of vaccine hesitancy it is important to focus on increasing the awareness of the public, improving the accessibility of vaccination centers, and enhancing the trust through communication.\u003c/p\u003e \u003cp\u003eWe can save the at-risk population and improve the overall vaccination levels thus bringing the world closer to the eradication of polio within sensible timeframes by addressing such problems. Effective strategies will also need the participation of healthcare providers, policy makers and community leaders as they have to tackle the cultural and logistic dimensions of vaccine hesitance and other barriers to access life saving vaccines.\u003c/p\u003e"},{"header":"LITERATURE REVIEW","content":"\u003cp\u003eA recent study 2020 in Bannu district found a counterintuitive association between. food security and vaccine refusal\u0026sup1;. More research is needed to understand this relationship in the Pakistani context The impact of depression on healthcare decision-making in Pakistan requires further investigation Studies from other countries suggest a potential link between depression and vaccine hesitancy, but this hasn't been explored extensively in Pakistan.Vancines are an important public health tool for slowing down the spread of disease, decreasing the severity of symptoms and the risk of hospitalisation and death\u0026sup3;. In 2019, the World Health Organisation has declared vaccination hesitancy as a major threat to global health⁴. Vaccination hesitancy is defined as the \"delay in acceptance or refusal of vaccines despite the availability of vaccination services\"⁵. Similar to the other countries in this region, Pakistan also has very high proportion of children who have not received any vaccines. Despite the fact that EPI started in 1978 in Pakistan, the national coverage of vaccination is persistently low as reported that only two in every three children are completely vaccinated. There are also extreme discrepancies with respect to immunization of the population of urban and those of rural areas. Some of the factors which were associated with refusal to vaccinate included low level of education particularly father\u0026rsquo;s education, father\u0026rsquo;s unemployment, parents exposed to negative rumor, family income and nutrition status.⁶\u003c/p\u003e \u003cp\u003eMost of the parents. who refused vaccination of their children strongly agreed that childhood vaccination programmes are beneficial, and that religious and political leaders support vaccination programmes.Routine childhood immunization is one of the most effective public health interventions, preventing serious infectious diseases. However, vaccine hesitancy and refusal are significant challenges in achieving optimal vaccination coverage, particularly in low-and middle-income countries like Pakistan.\u003c/p\u003e \u003cp\u003eA more recent research revealed that vaccine acceptance can be visualized as an iceberg, where a small protruding portion depicts those who outright reject vaccination, whilst the submerged portion signifies the vaccine hesitant populace. Defining vaccine hesitant subpopulations is crucial for the effectiveness of any vaccination campaigns. In a broad as well as a meticulous population based study, along with the multicentric ones, it would be easier to prove that vaccination hesitancy is one of the causes of low vaccination rate. Such studies also describe the various factors which cause VH in different populations.⁷\u003c/p\u003e \u003cp\u003eA study further explores this by comparing parental attitudes towards routine childhood vaccinations and the COVID-19 vaccine, revealing a higher hesitancy towards the COVID-19 vaccine ⁸. A study in Khyber Pakhtunkhwa province delves deeper, exploring the role of religious misconceptions and social media influences in vaccine hesitancy Trust in Healthcare System⁹. A cross-sectional study in Khyber Pakhtunkhwa province, Pakistan, found that trust in healthcare providers positively influenced childhood immunization uptake. There is emerging evidence linking household food insecurity with vaccination hesitancy in low-resource settings\u0026sup1;⁰. Another research in Pakistan explored parental perspectives on childhood vaccination in Karachi, Pakistan. They identified misconceptions about vaccine safety and efficacy as significant contributors to vaccine hesitancy. \u0026sup1;\u0026sup1;\u003c/p\u003e \u003cp\u003eThe SAGE Working Group on Vaccine Hesitancy concluded that vaccine hesitancy refers to delay in acceptance or refusal of vaccination despite availability of vaccination service \u0026sup1;\u0026sup2;.Vaccines have been used effectively to prevent and control infectious diseases since early days of its discovery. Recent rise in Vaccine Hesitancy and refusal worldwide has become a public health concern \u0026sup1;\u0026sup3;.Various factors play role in determining attitude of parents towards childhood vaccinations and reasons for vaccine delay or refusal. It is important to understand these factors to improve childhood vaccination rate \u0026sup1;⁴.In a qualitative study done in Malaysia on parents the main concern for refusal among parents was lack of trust on vaccination efficacy and fear of adverse side effects. Reasons for refusal are dynamic and vary in different communities and it is essential to consider the social, cultural factors of community \u0026sup1;⁵.Pakistan has poor childhood immunisation rate because of various social and cultural barriers. Globally Pakistan ranks third in the list of countries with highest number of un immunised children\u0026sup1;⁶.In a survey based study in karachi reasons behind immunisation refusal among parents were observed.Lack of appropriate knowledge about adverse event following immunization, unawareness of importance of vaccines were linked to high vaccine refusal\u0026sup1;⁷.\u003c/p\u003e \u003cp\u003e \u003cb\u003eOBJECTIVES AND AIMS OF THE STUDY\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTo determine vaccine hesitancy among parents\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTo determine various factors influencing parental vaccine hesitancy using World Health Organisations (WHO) SAGE working group on vaccine hesitancy survey tool.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eGive recommendations to authorities about major factors contributing to vaccination hesitancy.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eJUSTIFICATION OF THE STUDY\u003c/h2\u003e \u003cp\u003eThis study was done to determine the prevalence of parental refusal for routine childhood immunizations in Faisalabad district, Punjab, Pakistan and to identify factors associated with parental refusal for routine childhood immunizations using the WHO Vaccine Hesitancy tool. The study also explored contextual factors like access to vaccines and trust in healthcare systems and Individual factors like beliefs about vaccine safety effectiveness. Partenal believes and opinions about vaccination was also assessed.\u003c/p\u003e \u003c/div\u003e"},{"header":"METHODOLOGY","content":"\u003cp\u003e \u003cstrong\u003eStudy design\u003c/strong\u003e \u003cp\u003eCross sectional study\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStudy setting\u003c/strong\u003e \u003cp\u003eOutpatient department and Pediatric Ward in Aziz Fatima Hospital,Faisalabad, Punjab.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStudy duration\u003c/strong\u003e \u003cp\u003eMarch 2024 to November 2024\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eSample size\u003c/strong\u003e \u003cp\u003e309\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eSampling technique\u003c/strong\u003e \u003cp\u003eConvenience sampling\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStudy population\u003c/strong\u003e \u003cp\u003e The study group consisted of parents and guardians of children.\u003c/p\u003e \u003c/p\u003e\n\u003ch3\u003eStudy tools:\u003c/h3\u003e\n\u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eWHO SAGE Working Group on Vaccine Hesitancy Survey Tool\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eHousehold food insecurity access scale(HFIAS)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePatient Health Questionnaire-9 (PHQ9)\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eData Collection\u003c/strong\u003e \u003cp\u003eThe WHO SAGE Working Group on Vaccine Hesitancy Survey Tool was used to collect data after participants provided informed consent .\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthical consideration\u003c/strong\u003e \u003cp\u003e Oral and written informed consent was taken from participants and face to face interviews were conducted. The study received ethical approval from Aziz Fatima Hospital.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eData Analysis\u003c/strong\u003e \u003cp\u003eData analysis was done using SPSS version27. Continuous variables were tested changed into categorical variables by dividing range into equal intervals for each class. Chi square Test was used to test the independent variables. Demographic variables with p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were included.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eInclusion criteria\u003c/strong\u003e \u003cp\u003eThe study group consisted of parents having children of age 0\u0026ndash;5 years and having lived in the target geographical region for at least 12 months\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eExclusion criteria\u003c/strong\u003e \u003cp\u003eParents or guardians who were involved in delivery of any type of health services for example health care staff were excluded.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eNull hypothesis\u003c/strong\u003e \u003cp\u003eThere is no association between dependent variables( Demographics, Maternal and paternal characteristics, Household characteristics including household food insecurity and depression) and parental refusal of routine immunisation in Faisalabad, Pakistan .\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eAlternate hypothesis\u003c/strong\u003e \u003cp\u003eThere is association present between dependent variables ( Demographics, Maternal and paternal characteristics, Household characteristics including Household food insecurity and depression) and parental refusal of routine immunisation in Faisalabad, Pakistan.\u003c/p\u003e \u003c/p\u003e\n\u003ch3\u003eOperational Definitions:\u003c/h3\u003e\n\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eKnowledge about immunization\u003c/b\u003e:Parents were asked whether they had undergone all suggested vaccinations and if the vaccinations were done on time and according to the national immunization policy .To asses participants knowledge and attitude towards immunization and vaccination, set of questions were asked and response were recorded .The response options varied from strongly disagree, disagree, neutral, agree and strongly agree. Participants understanding about importance of vaccination and its role in disease prevention were questioned with close ended questions with yes or no options. In addition, a comprehensive complete account of the difficulties, problems, and reasons for the refusal of vaccination was collected. Role of both parents in decision making regarding to vaccination of children was asked .\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eFood insecurity assessment\u003c/b\u003e:The Household food insecurity access scale(HFIAS) was used to asses prevalence of household food insecurity and its role in vaccination refusal among parents. It consists of 9 questions that have been used in various countries and appears to diffrentiate food secured and food insecured families in different cultural context. Results are categorised into food secured or mildly, moderately, severely food insecured. Chronic food insecurity is in general linked to spread of infectious diseases and poor health outcomes.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003ePatient Health Questionnaire 9\u003c/b\u003e:The severity of depression among parents or guardian was measured using PHQ-9. The role of depression in parents and its association with refusal rates among parents was observed. It divides depression level into mild, moderate, moderately severe and severe based on PHQ score obtained.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthical\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;APPROVAL\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll experimental protocols , data collection and analysis were approved by ethical committee of Aziz Fatimah Medical and Dental College and Aziz Fatimah Hospital.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the data is available and is not uploaded due to privacy reasons and can be provided by corresponding author on request.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe study was conducted in paediatric wards and OPDs of Aziz Fatimah medical and dental college and our research study revealed significant factors contributing to parental vaccination hesitancy. We identified several significant determinants influencing parents\u0026apos; decision-making regarding childhood vaccinations including maternal education , mother\u0026apos;s having mobile, paternal education, paternal involvement in child care, food insecurity of household, depression status of parents, exposure to misinformation, and concerns about vaccine safety and efficacy.There was slight association of vaccination hesitancy in parents and gender of child.\u003c/p\u003e\n\u003cp\u003eTotal 309 participants took part in the study , 228 (74%) participants were female and remaining 81 (26%) were male . Out of 309 children under study 188 (60.8%) were male and 121 (39.2) were females. Children under studer were upto 5 year of age and are classified as 1-12 months 107 (34.6%), 13-24 months 78 (25.2%) , 25-36 months 55 (17.8%), 37-48 months 57 (18.4%)and \u0026nbsp;39-50 months 12(3.9%) with the mean of 2.32 years \u0026plusmn; 1.231. Maternal age was classified as 19-25 years 51(16.5%) , 26-35 years 217 (70.2%) and 36-45 years 41(13.2%) with the mean of 30.4 \u0026plusmn;4.874. Paternal age was classified as 22-32 years 144(46.6%), 33-42 years 130(42.0%), 42-52 years 30(9.7%), 53-66 years 5(1.6%) with the mean of 34.3 \u0026plusmn;6.625. Maternal and paternal education was classified as no education, primary education , secondary education and higher education. Out of 309 mothers 37(12.0%) had \u0026nbsp;no education, 77(24.9%) had primary education, 121(39.2%) had secondary education and 74(23.9%) had higher education. Out of 309 fathers 31(10.0%) had no education, 60(19.4%) had primary education,84(27.2%) had secondary education and 134(43.4%) had higher education. 56(18.1%) mothere were employed and 232(75.1%) owned a mobile phone while 286(92.6%) fathers were employed and 303(98.1%) owned a mobile phone. According to data 212(68.6%) fathers were involved in child care. Most of the families were from middle and lower middle class having little to no food insecurity in 181(58.6%), 115( 37.2%) having moderate food insecurity and 13(4.2%) having severe food insecurity. 274 (88.7%) showed mild or no sign of depression while 35(11.3%) showed moderate to severe depression. Majority of the parents belived that childhood vaccination is important and it protects children from diseases. Majority of parents 246(79.6) had received negative information about vaccination while 50(16.2%) thinks they have various reason for not getting there child vaccinated.292(94.5%) parents think childhood vaccination is beneficial while 42(13.5%) have refused for vaccination of their children.[Table1]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: comprehensive overview of all variables with thier frequency and percentages \u0026nbsp;along with range, standard deviation and mean of continuous variables, allowing for a detailed analysis of the study population.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"562\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 405px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eCategories\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eFrequency\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003ePercentage\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender of child\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eMale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e188\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e60.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e39.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"5\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge of child\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0-12 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e34.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e13-24 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e25.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e25-36 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e17.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e37-48 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e18.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e49-50 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e3.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"3\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaternal age\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e19-25 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e16.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e35-35 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e217\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e70.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e35-45 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e13.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"4\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaternal education\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eHigher\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e23.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eSecondary\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e39.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003ePrimary\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e24.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eNo education\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaternal employment status\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eNot employed\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e253\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e81.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eEmployed\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e18.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMother owns a mobile\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e24.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e232\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e75.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"4\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePaternal age\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e22-32years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e46.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e33-42years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e43-52years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e9.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eAbove 52 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"4\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePaternal education\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eHigher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e43.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eSecondary\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e27.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003ePrimary\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e19.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eNo education\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePaternal Employment\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003estatus\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eNot employed\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e7.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eEmployed\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e286\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e92.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFather owns a mobile\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e303\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e98.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFather involved in child care\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e31.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e212\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e68.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"4\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily members\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e1-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e20.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e4-7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e215\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e69.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e8-10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e8.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eMore than 10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"6\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHousehold characteristics (number of amenities)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e4.85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e8.73\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e215\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e69.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e13.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"3\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFood insecurity\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eLittle to no\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e181\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e58.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eModerate\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e37.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eSevere\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"5\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDepression\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e58.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eMild\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e30.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eModerate\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eModerately severe\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eSevere\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" valign=\"top\" style=\"width: 562px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eContinuous variables\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eMinimum\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003eMaximum\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eStandard deviation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChild age\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e2.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e1.231\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaternal age\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e30.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e4.875\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePaternal age\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e34.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e6.625\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e[\u003c/strong\u003e\u003cstrong\u003eTable 2]\u003c/strong\u003e identifies several factors significantly associated with parental vaccination refusal, including parental education, employment status, mobile phone ownership, and father\u0026apos;s involvement in childcare. Moreover, the study revealed a strong correlation between food insecurity, depression, and parental vaccine refusal. Size of family was slightly associated with vaccination hesitancy. However there was no significant association observed between vaccination refusal and children gender, children age, paternal age, possession of certain household amenities and father\u0026apos;s mobile phone ownership.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Vaccination refusal in parents and its associated factors.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"574\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eCategories\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePaternal vaccination refusal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTest of significance\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender of child\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0.059\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eMale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e168\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge of child\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e0-12 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0.432\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e13-24 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e25-36 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e37-48 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e49-50 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaternal age\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e19-25 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e35-35 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e35-45 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaternal education\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eHigher\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eSecondary\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003ePrimary\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eNo education\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaternal employment status\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eNot employed\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0.792\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eEmployed\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMother owns a mobile\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e211\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePaternal age\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e22-32years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e33-42years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e43-52years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eAbove 52 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePaternal education\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eHigher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eSecondary\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003ePrimary\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eNo education\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePaternal Employment status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eNot employed\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eEmployed\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e255\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFather owns a mobile\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0.587\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e262\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFather involved in child care\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e196\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily members\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e1-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e4-7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e183\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e8-10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eMore than 10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHousehold characteristics (number of amenities)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0.232\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFood insecurity\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eLittle to no\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e166\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eModerate\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eSevere\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDepression\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e163\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eMild\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eModerate\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eModerately severe\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eSevere\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe data further assesses different aspects that relate to parent\u0026apos;s perspective towards childhood vaccinations.The first column consists of either-or answers to the questions regarding attitudes, histories, and beliefs about vaccinating.The last column signifies the statistical significance (p value) of each question in relation to paternal vaccine hesitancy.The important highlights extracted from the table include the following ones:\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Most parents are of the opinion that vaccination shields children from serious illnesses and that most parents have their children vaccinated.Immunization has been hampered in a large proportion of fathers by factors such as unavailable clinics or their operating hours and high costs.Other life pressures have also affected the decision of parents towards the vaccination. Many parents received negative information about vaccination.Parental hesitation is not significantly related to the endorsement of religious or political figures on the child vaccination.\u003c/p\u003e\n\u003cp\u003eIn addition, it could be explained using the data provided that in Faisalabad a range of factors leads to paternal vaccination hesitancy including negative attitudes towards effectiveness and safety of the government provided vaccines, access issues and negative information. It is important to overcome these barriers to increase the number of children vaccinated in this area.[Table 3]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Vaccination refusal in parents and parental perceptions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"559\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 238px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategories\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePaternal vaccination hesitancy\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 238px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDichotomous questions regarding prescription\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 238px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1)Do you believe vaccination protects protect from serious children diseases?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e262\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 238px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2)Do you think most \u0026nbsp;parents like vou vaccinate their children?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e258\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 238px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3)Have distance from clinic, timingor costs prevented Immunization?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e183\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 238px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4)Have other pressures in life prevented Immunization?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e246\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 238px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5)Are there any Reasons you think children should not be vaccinated?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e249\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 238px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6)Do you think some ethnic religious groups have difficulties with vaccination?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e170\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 238px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7)Have you ever received negative information about vaccination?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e205\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 238px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e8)Do leaders (e.g religious political) support child vaccination?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e233\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.433\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;[ Table 4] presents the data related to various factors, looking at the parents attitude towards childhood vaccination along with their beliefs and their interaction with the health care provider.The first column includes yes-no questions related to beliefs\u0026mdash;all vaccination, particular experiences, and perceptions. The second and third columns display the number of parents who signed up on every category (for example, Agree, Disagree, Neutral), whereas the last column displays the significance (p-value) of every question in relation to fathers\u0026rsquo; vaccination hesitation.\u003c/p\u003e\n\u003cp\u003eGeneral observation from the table includes that the overwhelming majority of parents think that childhood vaccination is necessary and helpful not only for the child but the society at large. They also have confidence about the information they received about vaccination.On the other hand, a considerable number of fathers express fears on the dangers brought about by vaccination, which include serious side effects.In the same way, a considerable number of fathers are of the opinion that their children do not require vaccination against rare illnesses. This is probably due to the fact that they do not appreciate the need for herd immunity and the threat of possible epidemics in the absence of high vaccination coverage. Parents who are likely to comply with the pediatrician\u0026apos;s advice on child vaccinations are less likely to be vaccination hesitant. This means that trust in health care providers is vital in combating vaccination hesitancy.\u003c/p\u003e\n\u003cp\u003eOverall, the data lead to a conclusion that although the majority of parents in Faisalabad are favorable towards childhood immunization, there still exist some significant issues and ill beliefs that require elimination.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4: Vaccination refusal in parents and likert scale of parental perceptions.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"535\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategories\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePaternal vaccination hesitancy\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLikert scale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; P-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIs childhood vaccination important for child health?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e210\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eNeutral\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eStrongly agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eStrongly disagree\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChild vaccination is important for the health of others in the community.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eNeutral\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eStrongly agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eStrongly disagree\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAll childhood vaccination programmes are beneficial.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e198\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eNeutral\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eStrongly agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eStrongly disagree\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNew vaccines are more risky than older vaccines.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eNeutral\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e115\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eStrongly agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eStrongly disagree\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInformation I received about vaccination is trustworthy and reliable.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e189\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eNeutral\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eStrongly agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eStrongly disagree\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVaccination is a good way to protect children \u0026nbsp;from disease.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e195\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eNeutral\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eStrongly agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eStrongly disagree\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGenerally, I do what my doctor recommends regarding child vaccination.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eNeutral\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eStrongly agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eStrongly disagree\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eI am concerned about serious adverse effects of vaccine\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eNeutral\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eStrongly agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eStrongly disagree\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMy child does not need vaccination for uncommon diseases\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.035\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eNeutral\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e124\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eStrongly agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eStrongly disagree\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChildhood vaccination is effective\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eNeutral\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eStrongly agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eStrongly disagree\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable5 shows the logistic regression analysis, conducted in Faisalabad, Pakistan, examined factors influencing parental vaccination hesitancy for children. The results indicate that fathers involved in childcare (OR=4.771, p\u0026lt;0.001), lower maternal education (OR=0.600, p=0.006), and food insecurity (OR=2.083, p=0.034) significantly increased the odds of hesitancy. While maternal mobile phone ownership and paternal employment status showed some association, they were not statistically significant. Paternal education and parental depression did not significantly predict vaccination hesitancy in this study.\u003c/p\u003e\n\u003cp\u003eTable 5 : logistic regression of significant variables\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003ePredictor\u003c/p\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eWald\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003edf\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eSig (p)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003eExp(B)\u003c/p\u003e\n \u003cp\u003e(Odds\u003c/p\u003e\n \u003cp\u003eRatio)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e95%\u0026nbsp;CI for Exp(B)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003eMother\u003c/p\u003e\n \u003cp\u003eowns\u0026nbsp;a\u003c/p\u003e\n \u003cp\u003emobile\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.747\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.424\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3.095\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.079\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e2.110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0.918\u0026nbsp;-\u003c/p\u003e\n \u003cp\u003e4.848\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003ePaternal \u0026nbsp; \u0026nbsp; Employment Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.893\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.595\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e2.256\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e2.442\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0.762\u0026nbsp;-\u003c/p\u003e\n \u003cp\u003e7.831\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003eFather\u003c/p\u003e\n \u003cp\u003einvolved\u0026nbsp;in\u0026nbsp;childcare\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e1.562\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.396\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e15.593\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e4.771\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e2.197\u0026nbsp;-\u003c/p\u003e\n \u003cp\u003e10.361\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003eMaternal \u0026nbsp; Education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e-0.511\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e7.601\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.600\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0.417\u0026nbsp;-\u003c/p\u003e\n \u003cp\u003e0.863\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003ePaternal \u0026nbsp; \u0026nbsp;Education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.152\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.183\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.686\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.407\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e1.164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0.813\u0026nbsp;-\u003c/p\u003e\n \u003cp\u003e1.667\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003eFood\u003c/p\u003e\n \u003cp\u003eInsecurity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.734\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.346\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e4.509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e2.083\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e1.058\u0026nbsp;-\u003c/p\u003e\n \u003cp\u003e4.101\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003eDepression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.078\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.152\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.263\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.608\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e1.081\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0.803\u0026nbsp;-\u003c/p\u003e\n \u003cp\u003e1.455\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eVaccine hesitancy in parents is \u0026nbsp;a major issue worldwide that impedes the efforts of vaccination programmes. In our study we used \u0026nbsp;WHO SAGE vaccine Hesitancy Survey tool to measure the parental vaccination refusal rate²⁴. Moreover we focused on the correlation \u0026nbsp;of \u0026nbsp;vaccines hesitancy and its \u0026nbsp;various factors that are parental education, food insecurity, depression,employment status of parents socioeconomic status.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe results show that less than one quarter of the sample parents refused vaccination for their children with parental education and employment status playing significant role. Moreover, depression and food insecurity have a statistically very significant association. A recent study done in Pakistan reported that greater proportion of routine immunisation refusal cases were illiterate parents compared to control parents¹⁶.Eduaction plays pivotal role in the parental opinion toward vaccination .Another study done in Saudi Arabia \u0026nbsp; reports that parents with low education are more prone to believe and spread false and negative information about the childhood vaccination this resulted in a statistically significant association between low education and vaccine hesitancy¹⁸. These previous studies support our study finding which is that low education or no education in parents is one of the reason of parental vaccine hesitancy \u0026nbsp;because of lack of awareness the myths spreading around such parents make them doubtful about the benefits of vaccination .majority of parents (79.6%) in our study had received negative information about the vaccination.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAnother study done on parental vaccine hesitancy for influenza vaccine reported that parents with more income are less hesitant than the low income parents (15.9% vs 20.8%–25.2%), and similarly have less concerns about the vaccination side effects¹⁹.\u003c/p\u003e\n\u003cp\u003eIn our study parental vaccine refusal rate was very low (13.5%)compared to previous studies. A study done in Canada, found that 16.8% vaccine refusal rate is found in parents of two year old for at least one vaccine²⁰. The low vaccine rate was because in our study sample majority of the parents (94.5%) believed that childhood vaccinations are important for the protection of their children from various diseases and that vaccination is beneficial for their children.\u003c/p\u003e\n\u003cp\u003eAnother survey done on Jordanian parents, showed a 9.3 % vaccine hesitancy more common in female participants In the same study people with higher income and more education were more likely to get their children vaccinated²¹.\u003c/p\u003e\n\u003cp\u003eIn our study, Likert scale regarding parental perceptions about vaccination revealed that the primary concern among parents who opted against vaccinating their children was the perceived risk of severe adverse reactions. The scale also highlighted misconception about the safety of vaccines. Similarly,another study done \u0026nbsp;on Jordanian parents reveals that \u0026nbsp;their main reason for not getting their child vaccinated was vaccine’s adverse effect and how effective it was to prevent the disease ²².\u003c/p\u003e\n\u003cp\u003eOur study finding reports food insecurity as one of the reason for vaccine hesitancy in parents it might be due to the effect that most parents are already concerned about the food insecurity that they find vaccination of their child as a less important thing. Our study’s finding is supported by a study done in Pakistan on polio immunisation hesitancy which reports that parents with food insecurity were more reluctant to accept polio vaccination .\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;In our study, depression has strong correlation(\u0026lt;0.001) with vaccination hesitancy in parents. Which is also supported by another study from Greece explaining parents were \u0026nbsp;more likely to accept the childhood vaccinations, are those who have less stress or depressive symptoms²³.Depression completely occupies the brain of any person.Parents with depression are more likely to neglect their own and their child’s healthcare. \u0026nbsp;Firstly in our study \u0026nbsp; we did primary data collection which includes collecting data by directly interacting with the participants the advantage of which was the accuracy of information and no barrier between researcher and the participants. It eliminates the hurdles of not having internet facilities in some families Our sampling method included simple random sampling in which we collected data from people of any gender and any age \u0026nbsp;that resulted in no selection bias We interacted directly with the parents and asked the questions by ourselves that removed the undercoverage bias resulting when people use google form data collection method .\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLIMITATIONS\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFirstly, Our study \u0026nbsp;sample included a vast \u0026nbsp;majority of females proportion because most children were accompanied by their mothers during the hospital visits.Secondly, Lack of education made it difficult for the parents to understand the motive of the research which created hesitation in sharing or opening up about it.Thirdly, Due the cross sectional nature of the study a causal relationship was unable to be made between parental vaccination refusal status and any of the independent variabl\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eAs demonstrated the results of this study carried out in Faisalabad, Pakistan, there are a number of factors that lead to parental vaccine hesitance particularly among fathers. These include knowledge and attitudes, socioeconomic factors, parental involvement, health facilities utilization, and trust in health service providers.Additionally, exposure to anti-vaccine propaganda and safety issues surrounding vaccines were major contributors to vaccine hesitance. Her understanding of why vaccination is important was vague, especially in reference to herd immunity and the risk of diseases that vaccines can prevent. Other socioeconomic factors include low education levels of parents, food insecurity, and depression of the parents that also affected their vaccination decisions. Also, there was a negative correlation between fathers who did not participate in child caring activities and vaccinating their children. Geographic barriers, such as lack of accessible health centers, inconvenient hours, and cost, were other factors that limited vaccination. Lastly, building rapport with health care workers came out as an important strategy in reducing sterility among the parents.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRECOMMENDATIONS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBased on the results of the study, there are various ways that childhood vaccination rates in Faisalabad can be improved. Information and communication educational campaigns, in particular, are required to debunk myths and encourage the safety and efficacy of vaccines. Herd immunity, as well as the dangers of diseases that can be prevented by vaccination, should also be stressed. Dealing with some social and economic issues like those of food insecurity and depression will assist in curtailing hesitancy. Involvement of fathers in making childcare decisions is also likely to promote a positive attitude towards vaccinations. There is need to enhance healthcare services by increasing the number of clinics, extending the hours of operation, and reducing the services costs. Lastly, maintaining transparent and effective communication and responding to parents worries can help develop a good relationship with health care providers thereby increasing the uptake of vaccinations. Through these above mentioned approaches, pediatricians, government officials, and local societal leaders can come together to safeguard children from vaccine-preventable illnesses and promote health in Faisalabad.\u003c/p\u003e\n\u003cp\u003eThe future implications of our study is that government needs to make policies to improve childhood vaccination rate in parents . As seen In \u0026nbsp; our study \u0026nbsp;highest proportion of parental vaccine hesitancy rate was seen in the people suffering from food insecurity which was due to effect that food for them was the first and foremost thing \u0026nbsp;for their child instead of health care government should make programs for such parents and should guide them that vaccination for their children is as important as food for them Also the parents with no education or less eduaction parents should be guided about the importance of vaccination for their children and should also be guided that not getting vaccination is harmful Government should educate parents about the false information spreading about the childhood vaccination These measure will help not only to increase childhood vaccination rate but will also help to create awareness through social media,billboards,newspapers and television.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eCONFLICT OF INTEREST\u003c/h2\u003e\n\u003cp\u003eThere was no potential conflict of interest so the results of the study are free of bias and represent the genuine views of the respondents. This enhances the validity and neutrality of the research which adds to its usefulness in understanding and combating parental vaccine hesitancy in the area.\u003c/p\u003e\n\u003ch2\u003eFUNDING\u003c/h2\u003e\n\u003cp\u003eThe research study titled \u0026quot; Identifing Factors Influencing Paternal Vaccination Hesitancy in Faisalabad : A Cross Sectional Study was carried out solely without any funding from any private or government organisation. Thus, it alleviates the possibility of any vested financial interests in the vaccine or related industries.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eM.A did analysis and wrote all the results , conclusion along with tables, also managed the data collection and planned the research. M.S wrote discussion and helped in data collection, I.R wrote literature review and helped in data collection. S.N wrote introduction and collected data .A.I wrote abstract and did data collection . The research was done under supervisor of H.SAll author reviewed the final research article .\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKhattak FA, Rehman K, Shahzad M, et al. Prevalence of parental refusal rate and its associated factors in routine immunization by using WHO Vaccine Hesitancy tool: A cross-sectional study at district Bannu, KP, Pakistan. Int J Infect Dis. 2021;104:117\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuzman-Holst A, DeAntonio R, Prado-Cohrs D, et al. Barriers to vaccination in Latin America: A systematic literature review. Vaccine. 2020;38(3):470\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZheng C, Shao W, Chen X, et al. Real-world effectiveness of COVID-19 vaccines: A literature review and meta-analysis. Int J Infect Dis. 2022;114:252\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. Ten health issues WHO will tackle this year [Internet]. Who.int. 2019. Available from: (link unavailable).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLelliott M, Sahker E, Poudyal H. A review of parental vaccine hesitancy for human papillomavirus in Japan. J Clin Med. 2023;12(5):2004.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eButt M, Mohammed R, Butt E, et al. Why have immunization efforts in Pakistan failed to achieve global standards of vaccination uptake and infectious disease control? Risk Manag Healthc Policy. 2020;13:111\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThapar R, Kumar N, Priya, Surendran et al. Vaccine hesitancy among mothers of under-five children in coastal South India: A facility-based cross-sectional study. F1000Res [Internet]. 2021 Jan 1 [cited 2024 May 17];10:186.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMashhadi SF, Khan N, Ilyas U, et al. COVID-19 vaccination and routine childhood vaccinations: Comparison of hesitancy among parents. Pak Armed Forces Med J. 2022;72(1):133\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShah SA, Khan MA, Ullah F, Khan N. Unveiling the reasons behind vaccine hesitancy in Khyber Pakhtunkhwa, Pakistan: A qualitative exploration. Cureus. 2022;14(4):e22202.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFaisal S, Ali A, Khan MA, Ullah R. Factors affecting childhood immunization uptake in Khyber Pakhtunkhwa Province, Pakistan: A cross-sectional study. BMC Public Health. 2018;18(1):1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhan SA, Memon SS, Arain NA, Shaikh AS. A survey exploring reasons behind immunization refusal among parents and caregivers of children under two years living in urban slums of Karachi. Pakistan Vaccines. 2019;7(12):370.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMacDonald NE, SAGE Working Group on Vaccine Hesitancy. Vaccine hesitancy: Definition, scope, and determinants.Vaccine,. 2015;33(34):4161-4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBianco A, Mascaro V, Zucco R, Vaccine et al. 2019;37(7):984\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCag Y, Al Madadha ME, Ankarali H, et al. Vaccine hesitancy and refusal among parents: An international ID-IRI survey. J Infect Dev Ctries. 2022;16(06):1081\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRumetta J, Abdul-Hadi H, Lee YK. A qualitative study on parents' reasons and recommendations for childhood vaccination refusal in Malaysia. J Infect Public Health. 2020;13(2):199\u0026ndash;203.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSoofi SB, Vadsaria K, Mannan S, et al. Factors associated with vaccine refusal (polio and routine immunization) in high-risk areas of Pakistan: A matched case-control study. Vaccines. 2023;11(5):947.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhaliq A, Elahi AA, Zahid A, Lassi ZS. A survey exploring reasons behind immunization refusal among parents and caregivers of children under two years living in urban slums of Karachi, Pakistan. Int J Environ Res Public Health. 2022;19(18):11631.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSantibanez TA, Nguyen KH, Greby SM et al. Parental vaccine hesitancy and childhood influenza vaccination. Pediatr [Internet]. 2020;146(6).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchellenberg N, Petrucka P, Dietrich Leurer M et al. Determinants of vaccine refusal, delay and reluctance in parents of 2-year-old children in Canada: Findings from the 2017 Childhood National Immunization Coverage Survey (cNICS). Travel Med Infect Dis 2023 May-Jun;53:102584.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl-Iede M, Aljahalin M, Fashho E, et al. Hesitancy toward childhood and influenza vaccines: Experiences from highly educated Jordanian parents. Vaccines (Basel). 2024;12(8):945.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAldakhil H, Albedah N, et al. Vaccine hesitancy towards childhood immunizations as a predictor of mothers' intention to vaccinate their children against COVID-19 in Saudi Arabia. J Infect Public Health. 2021;14(10):1497\u0026ndash;504.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlShurman B, Butt ZA. Proposing a new conceptual syndemic framework for COVID-19 vaccine hesitancy: A narrative review. Int J Environ Res Public Health. 2023;20(2):1561.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDerdemezis C, Markozannes G, Rontogianni MO, et al. Parental hesitancy towards the established childhood vaccination programmes in the COVID-19 era: Assessing the drivers of a challenging public health concern. Vaccines (Basel). 2022;10(5):814.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStrategic Advisory Group of Experts on Immunization [Internet]. www.who.int. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/groups/strategic-advisory-group-of-experts-on-immunization\u003c/span\u003e\u003cspan address=\"https://www.who.int/groups/strategic-advisory-group-of-experts-on-immunization\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"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":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"vaccination, parental, hesitancy","lastPublishedDoi":"10.21203/rs.3.rs-6194653/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6194653/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis study aims to determine vaccine hesitancy among parents, various factors influencing parental vaccine hesitancy using World Health Organisations (WHO) SAGE working group on vaccine hesitancy survey tool and to give recommendations to authorities about major factors contributing to vaccination hesitancy in Faisalabad District, Punjab, Pakistan.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA total of 309 participant's data was analyzed using bivariate and multivariate techniques which includes chi square test and logistic regression to assess vaccine hesitancy. The study examined the impact of child characteristics (sex, age), maternal characteristics (education, employment status, mobile phone ownership), parental characteristics (education, employment status, mobile phone ownership, involvement in child care), household characteristics (family size, amenities, food insecurity, and parental depression), and exposure to negative information on vaccination.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe analysis revealed that maternal education, mobile phone ownership, parental education, paternal involvement in child care, food insecurity, parental depression, and exposure to negative information significantly influenced parental vaccine hesitancy. Gender of the child showed a slight association with vaccine hesitancy. Among the participants, 74% were female, and 26% were male, with 60.8% of the children being male. The majority of parents (94.5%) recognized the benefits of childhood vaccination, but 13.5% refused vaccination for their children.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eVaccine hesitancy in Faisalabad District is influenced by various socio-economic and informational factors. Efforts to address these issues, particularly focusing on enhancing maternal education, improving accessibility, and countering misinformation, may reduce vaccination refusal rates and improve immunization coverage in the region.\u003c/p\u003e","manuscriptTitle":"Identifying Factors Influencing Parental Vaccination Hesitancy in Faisalabad: A Cross Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-16 09:26:02","doi":"10.21203/rs.3.rs-6194653/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4c9ab5f1-1836-4cb6-a8ec-68a2be7d1921","owner":[],"postedDate":"May 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-22T04:38:25+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-16 09:26:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6194653","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6194653","identity":"rs-6194653","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}