Vaccine hesitancy among legal guardians of children with chronic neurological disorders: a cross-sectional study in Saudi Arabia

Vaccine hesitancy among legal guardians of children with chronic neurological disorders: a cross-sectional study in Saudi Arabia | 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 Vaccine hesitancy among legal guardians of children with chronic neurological disorders: a cross-sectional study in Saudi Arabia Ahmed M Almutairi, Ahmad A Alanezi, Khalid A Almahmoud, Abdulaziz M N Aljuhni, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6771025/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 09 Oct, 2025 Read the published version in BMC Public Health → Version 1 posted 12 You are reading this latest preprint version Abstract Background: Vaccine hesitancy poses a significant public health challenge, particularly among vulnerable populations such as children with chronic neurological disorders (NDDs). Despite the proven efficacy of vaccines, limited data exist on parental attitudes toward immunization in this high-risk group in Saudi Arabia. Objective: This study aims to assess the prevalence of vaccine hesitancy and its associated factors among legal guardians of children with NDDs in Riyadh, Saudi Arabia. Methods: A cross-sectional study was conducted from October 2021 to September 2022 at Sultan Bin Abdulaziz Humanitarian City (SBAHC), Riyadh, Saudi Arabia. A total of 401 legal guardians of children aged 2–18 years with NDDs completed a validated Arabic version of the Parent Attitudes about Childhood Vaccines (PACV) questionnaire. Statistical analyses included Chi-square tests and multivariate logistic regression to identify predictors of vaccine hesitancy. Results: The level of vaccine hesitancy among respondents was 10.2%. Vaccine hesitancy was higher statistically among caregivers of male children (p=0.031), young mothers (p=0.016), educated mothers (p=0.017), less educated fathers (p=0.046), and low-income families (p=0.014). Analysis showed that older maternal age (AOR=0.446, p=0.028), higher paternal education (AOR=0.408, p=0.023), and greater household income (AOR=0.412, p=0.035) as protective factors for hesitancy, while younger educated mothers increased the likelihood of greater hesitancy (AOR=3.400, p=0.001). Conclusion: Vaccine hesitancy from caregivers of children with NDDs in Saudi Arabia is similar to the general population. It is startling that the increase of educated mothers was linked to increased vaccine hesitation. These results highlight the need for focused education and communication efforts to guide policy and clinical interventions aimed at improving vaccination rates among susceptible pediatric populations. guide policy and clinical interventions aimed at improving vaccination rates among susceptible pediatric populations. Vaccine hesitancy Neurological disorders Neurodevelopmental disorders Parental attitudes Immunization Saudi Arabia Pediatric vaccination Figures Figure 1 Introduction Vaccination is undoubtedly one of the most significant accomplishments in global healthcare. Vaccination programs have played a critical role in saving millions of lives by reducing mortality and morbidity resulting from various infectious diseases.[1]. However, despite the high acceptance rates of vaccines, particularly in developed countries, vaccine hesitancy is a significant issue threatening the effectiveness of vaccination programs. [2]. Although vaccination programs have received widespread acceptance, there are still concerns about potentially under-vaccinated individuals worldwide [3]. Several countries have faced the challenges of vaccine hesitancy, particularly among the vulnerable population. Reports have shown that the vaccination rate is lower among children with neurological diseases than the general population [4,5]. Unfortunately, no studies on routine immunization among neurologically diseased children were found in the Kingdom of Saudi Arabia. Therefore, it is crucial to study and assess vaccine hesitancy among caregivers of at-risk children in our country. This study, tailored explicitly for Saudi Arabia’s healthcare providers and policymakers, evaluates vaccine hesitancy among legal guardians of children with chronic neurological disorders regarding the Saudi national essential vaccination schedule. The findings will help identify the factors contributing to vaccine hesitancy and provide insights into how to address them. This will help healthcare providers and policymakers develop effective strategies to improve vaccination rates among the vulnerable population and ensure that all children are protected against infectious diseases. Methodology Study Design: This cross-sectional study was conducted between October 2021 and September 2022 in Sultan Bin Abdulaziz Humanitarian City (SBAHC), Riyadh, Saudi Arabia. Data was collected by using a self-administered questionnaire. One of the legal guardians of children older than two years and under 18 who was diagnosed with a neurologic or neurodevelopment disorder (NDD) and visited outpatient clinics or were admitted to inpatient facilities at Sultan Bin Abdulaziz Humanitarian City (SBAHC) Riyadh, Saudi Arabia were reached. Neurologic conditions include any disease affecting the human brain, spinal cord, peripheral nerve, or muscle and causing global developmental delay or neurodevelopmental disability (including cerebral palsy, seizure disorders, stroke, cognitive impairment, developmental delay, neuromuscular disorders, spinal cord injury, etc.). We excluded any child with a relative or absolute contraindication to any vaccine. The research team contacted the eligible candidates and asked about their willingness to take the survey. A trained research assistant explained the study aims and procedures and assured the anonymity and confidentiality of the provided data. After agreeing to participate in the study, the eligible participant signed the consent form and filled out the questionnaire using the Google survey platform. All the data were transferred to a Microsoft Excel spreadsheet. The estimated prevalence of pediatric neurological disorders in the Saudi population is approximately 68.5 per 10,000 children. According to The Saudi General Authority for Statistics, the estimated number of children in Riyadh is around two million [6]. Considering that with a margin of error and confidence level of 5% and 95%, respectively, the total number of participants needed was 377, and we managed to reach a total of 401 participants. The study was approved by the Institutional Review Board at SBAHC (approval No.51-2021-IRB). Questionnaire : We utilized a questionnaire called The Parents Attitudes about Childhood Vaccines (PACV) to measure parental vaccine hesitancy. [7–9]. This validated tool consists of 15 items measuring three different aspects, including parental behavior, beliefs, and attitudes toward the vaccines. The final score is calculated based on the method described by Opel et al., which converts the scores to a scale ranging from zero to 100, in which zero indicates the lowest score of vaccine hesitancy. The PACV tool has been translated into many different languages, and we used the Arabic version, which was translated and validated by Ahmed R. Alsuwaidi et al. and conducted in the United Arab Emirates; after getting the author’s written permission, we used the [10]. We also included a section on sociodemographic characteristics of the child's legal guardians. Statistical analysis: Descriptive statistics were shown as numbers and percentages. The relationship between vaccine hesitancy and the socio-demographic characteristics of participants was conducted using the Chi-square test. A P-value of less than 0.05 was considered statistically significant. All statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS) software for Windows (version 26; IBM, Armonk, New York). Results Table 1 Socio-demographic characteristics of participants (n=401) Study data N (%) Relationship to child • Mother 248 (61.8%) • Father 130 (32.4%) • Sister and Brother 15 (03.7%) • Other relatives 08 (02.0%) Child gender • Male 210 (52.4%) • Female 191 (47.6%) Mother age group in years • ≤ 35 years 183 (45.6%) • > 35 years 218 (54.4%) Child age group in years • 13 years 42 (10.5%) Nationality • Saudi 393 (98.0%) • Non-Saudi 08 (02.0%) Residence location • Urban 256 (63.8%) • Rural 145 (36.2%) Mother educational level • Illiterate 28 (07.0%) • Primary school 40 (10.0%) • Middle school 31 (07.7%) • High school 118 (29.4%) • Bachelor's degree 176 (43.9%) • Postgraduate 08 (02.0%) Father education • Illiterate 10 (02.5%) • Primary school 20 (05.0%) • Middle school 39 (09.7%) • High school 136 (33.9%) • Bachelor's degree 178 (44.4%) • Postgraduate 18 (04.5%) Average monthly household income (SAR) • 20,000 20 (05.0%) This study enrolled 401 participants. As described in Table 1 , most participants who filled out the questionnaire were mothers of children (61.8%). 52.4% of the children were males. Regarding mothers’ age, 54.4% were more than 35 years old, while 47.1% of the children were less than eight years old. Most respondents were Saudis (98%) living in the city (63.8%). The mothers’ educational level was mainly bachelor’s degrees (43.9%), and a similar proportion (44.4%) of fathers’ education holders had bachelor’s degrees. In addition, 57.6% had an average monthly household income of less than 10,000 SAR. In Fig. 1 , according to the PACV questionnaire criteria, the prevalence of vaccine hesitancy was 10.2%, while the rest were non-hesitant (89.8%). Table 2 Relationship between vaccine hesitancy and the socio-demographic characteristics of participants (n=401) Factor Vaccine hesitancy P-value § Hesitant N (%) (n=41) Non-hesitant N (%) (n=360) Relationship to child • Mother 25 (61.0%) 223 (61.9%) 0.948 • Father 14 (34.1%) 116 (32.2%) • Other relatives 02 (04.9%) 21 (05.8%) Child gender • Male 28 (68.3%) 182 (50.6%) 0.031 ** • Female 13 (31.7%) 178 (49.4%) Mother age group in years • ≤ 35 years 26 (63.4%) 157 (43.6%) 0.016 ** • > 35 years 15 (36.6%) 203 (56.4%) Child age group in years • 13 years 04 (09.8%) 38 (10.6%) Residence location • Urban 24 (58.5%) 232 (64.4%) 0.456 • Rural 17 (41.5%) 128 (35.6%) Mother educational level • High school or below 15 (36.6%) 202 (56.1%) 0.017 ** • Bachelor or higher 26 (63.4%) 158 (43.9%) Father education • High school or below 27 (65.9%) 178 (49.4%) 0.046 ** • Bachelor or higher 14 (34.1%) 182 (50.6%) Average monthly household income (SAR) • < 10,000 31 (75.6%) 200 (55.6%) 0.014 ** • ≥ 10,000 10 (24.4%) 160 (44.4%) § P-value has been calculated using the Chi-square test. ** Significant at p < 0.05 level. When measuring the relationship between vaccine hesitancy in terms of the socio-demographic variables (Table 2 ), it was observed that the prevalence of vaccine-hesitant participants was significantly more common among male children (p = 0.031), younger mothers (p = 0.016), educated mothers (p = 0.017) less educated fathers (p = 0.046) and had lower family monthly income (p = 0.014). Table 3 Multivariate regression analysis to determine the independent significant factor associated with vaccine hesitancy (n=401) Factor AOR 95% CI P-value Child gender • Male Ref • Female 0.556 0.271–1.140 0.109 Mother age group in years • ≤ 35 years Ref • > 35 years 0.446 0.217–0.916 0.028 ** Mother educational level • High school or below Ref • Bachelor or higher 3.400 1.632–7.080 0.001 ** Father education • High school or below Ref • Bachelor or higher 0.408 0.188–0.886 0.023 ** Average monthly household income (SAR) • < 10,000 Ref • ≥ 10,000 0.412 0.181–0.938 0.035 ** AOR – Adjusted Odds Ratio; CI – Confidence Interval. ** Significant at p < 0.05 level. A multivariate regression model (Table 3 ) found that older mothers, educated fathers, and increasing monthly household income were the independent significant predictors of vaccine non-hesitancy. In contrast, mothers' better education was the only important factor in vaccine hesitancy. This further indicates that compared to younger mothers, the odds of vaccine hesitancy among older mothers will likely decrease by at least 55% (AOR = 0.446; 95% CI = 0.217–0.916; p = 0.028). Compared to less educated fathers, the odds of vaccine hesitancy among educated fathers were predicted to decrease by at least 60% (AOR = 0.408; 95% CI = 0.188–0.886; p = 0.023). A better family's monthly household income was significantly less likely to be associated with vaccine hesitancy (AOR = 0.412; 95% CI = 0.181–0.935; p = 0.035). In contrast, compared to less educated mothers, the odds of vaccine hesitancy among educated mothers were predicted to increase by at least 3.4 times higher (AOR = 3.400; 95% CI = 1.632–7.080; p = 0.001). Discussion The lack of data on vaccine hesitancy among guardians of children with chronic neurological disorders in the Arabian Gulf region is a critical gap. To develop effective public health interventions, estimating the vaccine acceptance rate and understanding the reasons behind vaccine hesitancy among these at-risk groups is necessary. The main finding of this study revealed that among the included participants, around ten percent were hesitant about childhood vaccination. Consistent with our results, several studies among Arab communities reported a comparable prevalence of vaccine hesitancy rate, ranging from 6.7–23%[10–13]. However, these previous publications were mostly about caregivers of healthy children in the Arabian Gulf region. There is limited research available regarding immunization coverage among children with chronic neurological disorders [4,5,14–16]. The question of whether children with NDD experience higher rates of vaccine hesitancy is still unresolved due to the lack of data. However, a study by Tillmann et al. revealed a lower vaccination rate and a remarkable delay in vaccine administration in children with chronic neurological disorders compared to healthy controls of the same age [14]. Despite this, it is essential to note that this study may reflect outdated data from a single-center experience. Fortunately, recent studies among guardians of children with neurodevelopmental disorders (NDD) indicate good immunization coverage for children with NDD [4,5,15]. These studies support that adherence rates are comparable to published vaccination reports in healthy children and remain suboptimal in both groups. Many guardians of children with NDD have concerns about vaccinating their children, similar to caregivers of children with other chronic pediatric diseases. Research has shown that vaccination rates are low in several pediatric patients with different genetic diseases and significantly lower than in healthy children [17,18]. This is mainly due to negative attitudes toward vaccination, such as fear of vaccination side effects or belief of deterioration of the underlying disease. Such negative feelings can also be reflected in vaccination adherence in children with chronic neurological conditions causing NDD. The sociodemographic characteristics of parents, particularly their level of education, occupational status, and financial status, have been found to significantly influence the acceptance or refusal of vaccination for children with NDD [16]. This is evidenced by a study conducted by Okoro et al., which found that mothers with a high level of education tend to have better vaccination coverage for children with NDD. However, our study presents a contrasting finding, suggesting that highly educated mothers tend to be more hesitant when it comes to vaccinating children with NDD. Understanding the reasons behind these differences in attitude toward immunization is crucial. Perhaps some educated parents have access to information and resources that allow them to question the safety of vaccines, making them more cautious about vaccinating their children. In contrast, others may be more interested in immunization’s many benefits, especially for at-risk people. Given the potential risks associated with non-vaccination, we must continue to explore these differences and work towards finding effective ways to encourage vaccination among all parents, irrespective of their educational background. The need to provide accurate and precise information about the benefits of immunization, address the concerns of resistant parents, and ensure that all children receive the protection they need, especially children with NDD who are at risk of medical complications, is pressing. One limitation of our study is that it was conducted in a single center. However, it is important to note that our report represents a comprehensive sample from all regions of Saudi Arabia, including Sultan bin Abdulaziz humanitarian city. The city is recognized as a center of excellence in rehabilitation and receives patients from various private and governmental hospitals across all country regions. Conclusion The prevalence of vaccine hesitancy in guardians of children with neurological disorders is similar to what has been reported in studies involving healthy children. Interestingly, mothers with higher education levels tend to be more hesitant to get their children vaccinated than other caregivers. Therefore, Ensuring the safety and efficacy of vaccines should be a top priority during routine check-ups and neurodevelopmental appointments. Our findings will guide effective policies and programs aimed at protecting our most vulnerable populations. Declarations Conflicts of interest The authors declare that they have no conflict of interest. Funding This study has not received any external funding. Ethics approval and consent to participate This study was approved by the Institutional Review Board of Sultan Bin Abdulaziz Humanitarian City (SBAHC), Riyadh, Saudi Arabia (Approval No. 47/EXT/2021), and in accordance with the Declaration of Helsinki. At the beginning of the questionnaire, the purpose of the research was clearly explained, and informed consent was obtained from all participants prior to inclusion in the study. Participants were given the option to participate or decline, and they were informed they could discontinue participation at any point. All responses were collected anonymously and treated with strict confidentiality. Consent for publication Not applicable. Availability of Data and Materials All data generated or analyzed during this study are included in this published article. Acknowledgements The authors are thankful to Sultan Bin Abdulaziz Humanitarian City (SBAHC), in Saudi Arabia for granting them access to the legal guardians of children for this work. The authors express their gratitude to all the volunteers who participated in this study. The authors express their appreciation to all the volunteers who participated in this study. References Andre FE, Booy R, Bock HL, et al. Vaccination greatly reduces disease, disability, death and inequity worldwide. Bull World Health Organ . 2008;86(2). doi:10.2471/BLT.07.040089 Allred NJ, Shaw KM, Santibanez TA, Rickert DL, Santoli JM. Parental vaccine safety concerns: Results from the national immunization survey, 2001-2002. Am J Prev Med . 2005;28(2). doi:10.1016/j.amepre.2004.10.014 Fournet N, Mollema L, Ruijs WL, et al. Under-vaccinated groups in Europe and their beliefs, attitudes and reasons for non-vaccination; Two systematic reviews. BMC Public Health . 2018;18(1). doi:10.1186/s12889-018-5103-8 Dinleyici M, Carman KB, Kilic O, Gurlevik SL, Yarar C, Dinleyici EC. The immunization status of children with chronic neurological disease and serological assessment of vaccine-preventable diseases. Hum Vaccines Immunother . 2018;14(8). doi:10.1080/21645515.2018.1460986 Yang L, Peng J, Deng J, et al. Vaccination status of children with epilepsy or cerebral palsy in hunan rural area and a relative KAP survey of vaccinators. Front Pediatr . 2019;7(MAR). doi:10.3389/fped.2019.00084 General Authority for Statistics G. Saudi Census 2023. 2023. Accessed March 3, 2024. https://portal.saudicensus.sa/portal/public/1/15/100646?type=TABLE Opel DJ, Mangione-Smith R, Taylor JA, et al. Development of a survey to identify vaccine-hesitant parents: The parent attitudes about childhood vaccines survey. Hum Vaccin . 2011;7(4). doi:10.4161/hv.7.4.14120 Opel DJ, Taylor JA, Mangione-Smith R, et al. Validity and reliability of a survey to identify vaccine-hesitant parents. Vaccine . 2011;29(38):6598-6605. doi:10.1016/j.vaccine.2011.06.115 Opel DJ, Taylor JA, Zhou C, Catz S, Myaing M, Mangione-Smith R. The relationship between parent attitudes about childhood vaccines survey scores and future child immunization status: A validation study. JAMA Pediatr . 2013;167(11). doi:10.1001/jamapediatrics.2013.2483 Alsuwaidi AR, Elbarazi I, Al-Hamad S, Aldhaheri R, Sheek-Hussein M, Narchi H. Vaccine hesitancy and its determinants among Arab parents: a cross-sectional survey in the United Arab Emirates. Hum Vaccines Immunother . 2020;16(12):3163-3169. doi:10.1080/21645515.2020.1753439 Alsubaie SS, Gosadi IM, Alsaadi BM, et al. Vaccine hesitancy among Saudi parents and its determinants Result from the WHO SAGE working group on vaccine hesitancy survey tool From the Department of Pediatrics ( OPEN ACCESS. Saudi Med J . 2019;40(12). Hamadah R, Hussain A, Alsoghayer N, Alkhenizan Z, Alajlan H, Alkhenizan A. Attitude of parents towards seasonal influenza vaccination for children in Saudi Arabia. J Fam Med Prim Care . 2021;10(2). doi:10.4103/jfmpc.jfmpc_1602_20 Alolayan A, Almotairi B, Alshammari S, Alhearri M, Alsuhaibani M. Seasonal influenza vaccination among Saudi children: Parental barriers and willingness to vaccinate their children. Int J Environ Res Public Health . 2019;16(21). doi:10.3390/ijerph16214226 Tillmann BU, Tillmann HC, Heininger U, Lütschg J, Weber P. Acceptance and timeliness of standard vaccination in children with chronic neurological deficits in north-western Switzerland. Eur J Pediatr . 2005;164(5). doi:10.1007/s00431-005-1627-x Smith M, Peacock G, Uyeki TM, Moore C. Influenza vaccination in children with neurologic or neurodevelopmental disorders. Vaccine . 2015;33(20). doi:10.1016/j.vaccine.2015.03.050 Okoro JC, Ojinnaka NC, Ikefuna AN, Onyenwe NE. Sociodemographic influences on immunization of children with chronic neurological disorders in Enugu, Nigeria. Trials Vaccinol . 2015;4. doi:10.1016/j.trivac.2014.11.002 Esposito S, Cerutti M, Milani D, Menni F, Principi N. Vaccination coverage of children with rare genetic diseases and attitudes of their parents toward vaccines. Hum Vaccines Immunother . 2016;12(3). doi:10.1080/21645515.2015.1086046 Langkamp DL, Dusseau A, Brown MF. Vaccine Hesitancy and Low Immunization Rates in Children with Down Syndrome. J Pediatr . 2020;223. doi:10.1016/j.jpeds.2020.03.025 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 09 Oct, 2025 Read the published version in BMC Public Health → Version 1 posted Editorial decision: Revision requested 14 Jul, 2025 Reviews received at journal 13 Jul, 2025 Reviews received at journal 09 Jul, 2025 Reviewers agreed at journal 09 Jul, 2025 Reviewers agreed at journal 07 Jul, 2025 Reviewers agreed at journal 07 Jul, 2025 Reviewers agreed at journal 02 Jul, 2025 Reviewers invited by journal 25 Jun, 2025 Editor assigned by journal 25 Jun, 2025 Editor invited by journal 09 Jun, 2025 Submission checks completed at journal 06 Jun, 2025 First submitted to journal 06 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6771025","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":477244920,"identity":"ec44d969-3ec4-4cdc-90a3-89d28f8b6a21","order_by":0,"name":"Ahmed M Almutairi","email":"","orcid":"","institution":"Imam Mohammad Ibn Saud Islamic University (IMSIU) Riyadh","correspondingAuthor":false,"prefix":"","firstName":"Ahmed","middleName":"M","lastName":"Almutairi","suffix":""},{"id":477244921,"identity":"a6e99b88-df66-4094-993b-f0d93a21f626","order_by":1,"name":"Ahmad A Alanezi","email":"","orcid":"","institution":"Imam Mohammad Ibn Saud Islamic University (IMSIU) Riyadh","correspondingAuthor":false,"prefix":"","firstName":"Ahmad","middleName":"A","lastName":"Alanezi","suffix":""},{"id":477244922,"identity":"361e5590-4540-429d-a1ad-7714df0b3c2b","order_by":2,"name":"Khalid A Almahmoud","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/UlEQVRIiWNgGAWjYBACCQYGxgMMDAdAbMMHCRVAipm5gZAWBpgWY4MHZ0BaGInXYib5sA1EE9Ai2cD84NCNmjvR/BLJGyQS59VG87cDtfyo2IZTizQDm8HhnGPPcmfOSCswSNx2PHfGYcYGxp4zt3FqkWNgAGphO5y74UaOQULitmO5DUAtzIxt+LSwfzic8w+i5UDinGO58wlpkWbgMTic2wbWYtiQ2FCTu4GQFslmnoLDuX2Hc2f2PCtmSDh2IHcjUMtBfH6RON6+8XHOt8O5/ezJ23/+qKnLnXf+8MEHPypwa2FgRuUeBpMHcKvHBHWkKB4Fo2AUjIIRAgBAMmZOiHEjvAAAAABJRU5ErkJggg==","orcid":"","institution":"King Saud University Medical City","correspondingAuthor":true,"prefix":"","firstName":"Khalid","middleName":"A","lastName":"Almahmoud","suffix":""},{"id":477244924,"identity":"ec043319-4051-431a-b188-8c85b87106f9","order_by":3,"name":"Abdulaziz M N Aljuhni","email":"","orcid":"","institution":"King Saud Medical City","correspondingAuthor":false,"prefix":"","firstName":"Abdulaziz","middleName":"M N","lastName":"Aljuhni","suffix":""},{"id":477244925,"identity":"c2b0bc59-bcc8-4279-975d-9b767324e4b3","order_by":4,"name":"Waleed A Alluhidan","email":"","orcid":"","institution":"Prince sultan military medical city","correspondingAuthor":false,"prefix":"","firstName":"Waleed","middleName":"A","lastName":"Alluhidan","suffix":""},{"id":477244926,"identity":"608a6626-5423-4e64-b5e9-e046fe853143","order_by":5,"name":"Tamim A Abahussain","email":"","orcid":"","institution":"King Saud Medical City","correspondingAuthor":false,"prefix":"","firstName":"Tamim","middleName":"A","lastName":"Abahussain","suffix":""},{"id":477244929,"identity":"eddb781b-7538-4bfb-882d-431414a3d538","order_by":6,"name":"Khalid Alzaraa","email":"","orcid":"","institution":"King Fahd Medical City","correspondingAuthor":false,"prefix":"","firstName":"Khalid","middleName":"","lastName":"Alzaraa","suffix":""}],"badges":[],"createdAt":"2025-05-28 20:53:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6771025/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6771025/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12889-025-24269-9","type":"published","date":"2025-10-09T15:57:40+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":85744870,"identity":"8110bbd9-167e-42ec-9eaf-8de56873355a","added_by":"auto","created_at":"2025-07-01 09:19:39","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":17602,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eLevel of vaccine hesitancy according to Parent Attitudes about Childhood Vaccines (PACV)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6771025/v1/896fe0a1f1c266c71db10864.png"},{"id":93419732,"identity":"0260e2e0-83c3-4929-b03c-7fde035d9ba7","added_by":"auto","created_at":"2025-10-13 16:06:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":695471,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6771025/v1/a7900f15-f1cc-4f5d-8637-657ce7b9995f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Vaccine hesitancy among legal guardians of children with chronic neurological disorders: a cross-sectional study in Saudi Arabia","fulltext":[{"header":"Introduction","content":"\u003cp\u003eVaccination is undoubtedly one of the most significant accomplishments in global healthcare. Vaccination programs have played a critical role in saving millions of lives by reducing mortality and morbidity resulting from various infectious diseases.[1]. However, despite the high acceptance rates of vaccines, particularly in developed countries, vaccine hesitancy is a significant issue threatening the effectiveness of vaccination programs. [2]. Although vaccination programs have received widespread acceptance, there are still concerns about potentially under-vaccinated individuals worldwide [3].\u003c/p\u003e \u003cp\u003eSeveral countries have faced the challenges of vaccine hesitancy, particularly among the vulnerable population. Reports have shown that the vaccination rate is lower among children with neurological diseases than the general population [4,5]. Unfortunately, no studies on routine immunization among neurologically diseased children were found in the Kingdom of Saudi Arabia. Therefore, it is crucial to study and assess vaccine hesitancy among caregivers of at-risk children in our country.\u003c/p\u003e \u003cp\u003eThis study, tailored explicitly for Saudi Arabia\u0026rsquo;s healthcare providers and policymakers, evaluates vaccine hesitancy among legal guardians of children with chronic neurological disorders regarding the Saudi national essential vaccination schedule. The findings will help identify the factors contributing to vaccine hesitancy and provide insights into how to address them. This will help healthcare providers and policymakers develop effective strategies to improve vaccination rates among the vulnerable population and ensure that all children are protected against infectious diseases.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design:\u003c/h2\u003e \u003cp\u003eThis cross-sectional study was conducted between October 2021 and September 2022 in Sultan Bin Abdulaziz Humanitarian City (SBAHC), Riyadh, Saudi Arabia. Data was collected by using a self-administered questionnaire. One of the legal guardians of children older than two years and under 18 who was diagnosed with a neurologic or neurodevelopment disorder (NDD) and visited outpatient clinics or were admitted to inpatient facilities at Sultan Bin Abdulaziz Humanitarian City (SBAHC) Riyadh, Saudi Arabia were reached. Neurologic conditions include any disease affecting the human brain, spinal cord, peripheral nerve, or muscle and causing global developmental delay or neurodevelopmental disability (including cerebral palsy, seizure disorders, stroke, cognitive impairment, developmental delay, neuromuscular disorders, spinal cord injury, etc.). We excluded any child with a relative or absolute contraindication to any vaccine. The research team contacted the eligible candidates and asked about their willingness to take the survey. A trained research assistant explained the study aims and procedures and assured the anonymity and confidentiality of the provided data. After agreeing to participate in the study, the eligible participant signed the consent form and filled out the questionnaire using the Google survey platform. All the data were transferred to a Microsoft Excel spreadsheet.\u003c/p\u003e \u003cp\u003eThe estimated prevalence of pediatric neurological disorders in the Saudi population is approximately 68.5 per 10,000 children. According to The Saudi General Authority for Statistics, the estimated number of children in Riyadh is around two million [6]. Considering that with a margin of error and confidence level of 5% and 95%, respectively, the total number of participants needed was 377, and we managed to reach a total of 401 participants. The study was approved by the Institutional Review Board at SBAHC (approval No.51-2021-IRB).\u003c/p\u003e \u003c/div\u003e\n\u003cdiv class=\"Heading\"\u003e\u003cb\u003eQuestionnaire\u003c/b\u003e:\u003c/div\u003e \u003cp\u003eWe utilized a questionnaire called The Parents Attitudes about Childhood Vaccines (PACV) to measure parental vaccine hesitancy. [7\u0026ndash;9]. This validated tool consists of 15 items measuring three different aspects, including parental behavior, beliefs, and attitudes toward the vaccines. The final score is calculated based on the method described by Opel et al., which converts the scores to a scale ranging from zero to 100, in which zero indicates the lowest score of vaccine hesitancy. The PACV tool has been translated into many different languages, and we used the Arabic version, which was translated and validated by Ahmed R. Alsuwaidi et al. and conducted in the United Arab Emirates; after getting the author\u0026rsquo;s written permission, we used the [10]. We also included a section on sociodemographic characteristics of the child's legal guardians.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis:\u003c/h2\u003e \u003cp\u003eDescriptive statistics were shown as numbers and percentages. The relationship between vaccine hesitancy and the socio-demographic characteristics of participants was conducted using the Chi-square test. A P-value of less than 0.05 was considered statistically significant. All statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS) software for Windows (version 26; IBM, Armonk, New York).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-demographic characteristics of participants \u003csup\u003e(n=401)\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudy data\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRelationship to child\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Mother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e248 (61.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Father\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e130 (32.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Sister and Brother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15 (03.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Other relatives\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e08 (02.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChild gender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Male\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e210 (52.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e191 (47.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMother age group in years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; \u0026le;\u0026thinsp;35 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e183 (45.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; \u0026gt;\u0026thinsp;35 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e218 (54.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChild age group in years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; \u0026lt;\u0026thinsp;8 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e189 (47.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; 8\u0026ndash;13 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e170 (42.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; \u0026gt;\u0026thinsp;13 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42 (10.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNationality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Saudi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e393 (98.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Non-Saudi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e08 (02.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResidence location\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Urban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e256 (63.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Rural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e145 (36.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMother educational level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Illiterate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28 (07.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Primary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40 (10.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Middle school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31 (07.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; High school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e118 (29.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Bachelor's degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e176 (43.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Postgraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e08 (02.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFather education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Illiterate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (02.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Primary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20 (05.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Middle school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e39 (09.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; High school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e136 (33.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Bachelor's degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e178 (44.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Postgraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18 (04.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage monthly household income (SAR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; \u0026lt;\u0026thinsp;10,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e231 (57.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; 10,000\u0026ndash;20,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e150 (37.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; \u0026gt;\u0026thinsp;20,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20 (05.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThis study enrolled 401 participants. As described in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, most participants who filled out the questionnaire were mothers of children (61.8%). 52.4% of the children were males. Regarding mothers\u0026rsquo; age, 54.4% were more than 35 years old, while 47.1% of the children were less than eight years old. Most respondents were Saudis (98%) living in the city (63.8%). The mothers\u0026rsquo; educational level was mainly bachelor\u0026rsquo;s degrees (43.9%), and a similar proportion (44.4%) of fathers\u0026rsquo; education holders had bachelor\u0026rsquo;s degrees. In addition, 57.6% had an average monthly household income of less than 10,000 SAR.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, according to the PACV questionnaire criteria, the prevalence of vaccine hesitancy was 10.2%, while the rest were non-hesitant (89.8%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRelationship between vaccine hesitancy and the socio-demographic characteristics of participants \u003csup\u003e(n=401)\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eVaccine hesitancy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP-value \u003csup\u003e\u0026sect;\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHesitant\u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003cp\u003e\u003csup\u003e(n=41)\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-hesitant\u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003cp\u003e\u003csup\u003e(n=360)\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRelationship to child\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Mother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25 (61.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e223 (61.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.948\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Father\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14 (34.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e116 (32.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Other relatives\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e02 (04.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21 (05.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChild gender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Male\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28 (68.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e182 (50.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e0.031 **\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13 (31.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e178 (49.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMother age group in years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; \u0026le;\u0026thinsp;35 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26 (63.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e157 (43.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e0.016 **\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; \u0026gt;\u0026thinsp;35 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15 (36.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e203 (56.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChild age group in years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; \u0026lt;\u0026thinsp;8 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20 (48.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e169 (46.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.971\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; 8\u0026ndash;13 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17 (41.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e153 (42.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; \u0026gt;\u0026thinsp;13 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e04 (09.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38 (10.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResidence location\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Urban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24 (58.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e232 (64.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.456\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Rural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17 (41.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e128 (35.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMother educational level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; High school or below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15 (36.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e202 (56.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e0.017 **\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Bachelor or higher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26 (63.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e158 (43.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFather education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; High school or below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27 (65.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e178 (49.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e0.046 **\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Bachelor or higher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14 (34.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e182 (50.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage monthly household income (SAR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; \u0026lt;\u0026thinsp;10,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31 (75.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e200 (55.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e0.014 **\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; \u0026ge;\u0026thinsp;10,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (24.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e160 (44.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csup\u003e\u0026sect;\u003c/sup\u003e P-value has been calculated using the Chi-square test.\u003c/p\u003e \u003cp\u003e** Significant at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 level.\u003c/p\u003e \u003cp\u003eWhen measuring the relationship between vaccine hesitancy in terms of the socio-demographic variables (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), it was observed that the prevalence of vaccine-hesitant participants was significantly more common among male children (p\u0026thinsp;=\u0026thinsp;0.031), younger mothers (p\u0026thinsp;=\u0026thinsp;0.016), educated mothers (p\u0026thinsp;=\u0026thinsp;0.017) less educated fathers (p\u0026thinsp;=\u0026thinsp;0.046) and had lower family monthly income (p\u0026thinsp;=\u0026thinsp;0.014).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate regression analysis to determine the independent significant factor associated with vaccine hesitancy \u003csup\u003e(n=401)\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChild gender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Male\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.556\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.271\u0026ndash;1.140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.109\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMother age group in years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; \u0026le;\u0026thinsp;35 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; \u0026gt;\u0026thinsp;35 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.446\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.217\u0026ndash;0.916\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.028 **\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMother educational level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; High school or below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Bachelor or higher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.400\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.632\u0026ndash;7.080\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001 **\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFather education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; High school or below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Bachelor or higher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.408\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.188\u0026ndash;0.886\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.023 **\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage monthly household income (SAR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; \u0026lt;\u0026thinsp;10,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; \u0026ge;\u0026thinsp;10,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.412\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.181\u0026ndash;0.938\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.035 **\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAOR \u0026ndash; Adjusted Odds Ratio; CI \u0026ndash; Confidence Interval.\u003c/p\u003e \u003cp\u003e** Significant at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 level.\u003c/p\u003e \u003cp\u003eA multivariate regression model (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) found that older mothers, educated fathers, and increasing monthly household income were the independent significant predictors of vaccine non-hesitancy. In contrast, mothers' better education was the only important factor in vaccine hesitancy. This further indicates that compared to younger mothers, the odds of vaccine hesitancy among older mothers will likely decrease by at least 55% (AOR\u0026thinsp;=\u0026thinsp;0.446; 95% CI\u0026thinsp;=\u0026thinsp;0.217\u0026ndash;0.916; p\u0026thinsp;=\u0026thinsp;0.028). Compared to less educated fathers, the odds of vaccine hesitancy among educated fathers were predicted to decrease by at least 60% (AOR\u0026thinsp;=\u0026thinsp;0.408; 95% CI\u0026thinsp;=\u0026thinsp;0.188\u0026ndash;0.886; p\u0026thinsp;=\u0026thinsp;0.023). A better family's monthly household income was significantly less likely to be associated with vaccine hesitancy (AOR\u0026thinsp;=\u0026thinsp;0.412; 95% CI\u0026thinsp;=\u0026thinsp;0.181\u0026ndash;0.935; p\u0026thinsp;=\u0026thinsp;0.035). In contrast, compared to less educated mothers, the odds of vaccine hesitancy among educated mothers were predicted to increase by at least 3.4 times higher (AOR\u0026thinsp;=\u0026thinsp;3.400; 95% CI\u0026thinsp;=\u0026thinsp;1.632\u0026ndash;7.080; p\u0026thinsp;=\u0026thinsp;0.001).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe lack of data on vaccine hesitancy among guardians of children with chronic neurological disorders in the Arabian Gulf region is a critical gap. To develop effective public health interventions, estimating the vaccine acceptance rate and understanding the reasons behind vaccine hesitancy among these at-risk groups is necessary. The main finding of this study revealed that among the included participants, around ten percent were hesitant about childhood vaccination. Consistent with our results, several studies among Arab communities reported a comparable prevalence of vaccine hesitancy rate, ranging from 6.7\u0026ndash;23%[10\u0026ndash;13]. However, these previous publications were mostly about caregivers of healthy children in the Arabian Gulf region.\u003c/p\u003e \u003cp\u003eThere is limited research available regarding immunization coverage among children with chronic neurological disorders [4,5,14\u0026ndash;16]. The question of whether children with NDD experience higher rates of vaccine hesitancy is still unresolved due to the lack of data. However, a study by Tillmann et al. revealed a lower vaccination rate and a remarkable delay in vaccine administration in children with chronic neurological disorders compared to healthy controls of the same age [14]. Despite this, it is essential to note that this study may reflect outdated data from a single-center experience. Fortunately, recent studies among guardians of children with neurodevelopmental disorders (NDD) indicate good immunization coverage for children with NDD [4,5,15]. These studies support that adherence rates are comparable to published vaccination reports in healthy children and remain suboptimal in both groups.\u003c/p\u003e \u003cp\u003e Many guardians of children with NDD have concerns about vaccinating their children, similar to caregivers of children with other chronic pediatric diseases. Research has shown that vaccination rates are low in several pediatric patients with different genetic diseases and significantly lower than in healthy children [17,18]. This is mainly due to negative attitudes toward vaccination, such as fear of vaccination side effects or belief of deterioration of the underlying disease. Such negative feelings can also be reflected in vaccination adherence in children with chronic neurological conditions causing NDD.\u003c/p\u003e \u003cp\u003e The sociodemographic characteristics of parents, particularly their level of education, occupational status, and financial status, have been found to significantly influence the acceptance or refusal of vaccination for children with NDD [16]. This is evidenced by a study conducted by Okoro et al., which found that mothers with a high level of education tend to have better vaccination coverage for children with NDD. However, our study presents a contrasting finding, suggesting that highly educated mothers tend to be more hesitant when it comes to vaccinating children with NDD. Understanding the reasons behind these differences in attitude toward immunization is crucial. Perhaps some educated parents have access to information and resources that allow them to question the safety of vaccines, making them more cautious about vaccinating their children. In contrast, others may be more interested in immunization\u0026rsquo;s many benefits, especially for at-risk people.\u003c/p\u003e \u003cp\u003eGiven the potential risks associated with non-vaccination, we must continue to explore these differences and work towards finding effective ways to encourage vaccination among all parents, irrespective of their educational background. The need to provide accurate and precise information about the benefits of immunization, address the concerns of resistant parents, and ensure that all children receive the protection they need, especially children with NDD who are at risk of medical complications, is pressing.\u003c/p\u003e \u003cp\u003eOne limitation of our study is that it was conducted in a single center. However, it is important to note that our report represents a comprehensive sample from all regions of Saudi Arabia, including Sultan bin Abdulaziz humanitarian city. The city is recognized as a center of excellence in rehabilitation and receives patients from various private and governmental hospitals across all country regions.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe prevalence of vaccine hesitancy in guardians of children with neurological disorders is similar to what has been reported in studies involving healthy children. Interestingly, mothers with higher education levels tend to be more hesitant to get their children vaccinated than other caregivers. Therefore, Ensuring the safety and efficacy of vaccines should be a top priority during routine check-ups and neurodevelopmental appointments. Our findings will guide effective policies and programs aimed at protecting our most vulnerable populations.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eConflicts of interest\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis study has not received any external funding.\u003c/p\u003e \u003cp\u003eEthics approval and consent to participate\u003c/p\u003e \u003cp\u003eThis study was approved by the Institutional Review Board of Sultan Bin Abdulaziz Humanitarian City (SBAHC), Riyadh, Saudi Arabia (Approval No. 47/EXT/2021), and in accordance with the Declaration of Helsinki. At the beginning of the questionnaire, the purpose of the research was clearly explained, and informed consent was obtained from all participants prior to inclusion in the study. Participants were given the option to participate or decline, and they were informed they could discontinue participation at any point. All responses were collected anonymously and treated with strict confidentiality.\u003c/p\u003e \u003cp\u003e Consent for publication\u003c/p\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003cp\u003eAvailability of Data and Materials\u003c/p\u003e \u003cp\u003eAll data generated or analyzed during this study are included in this published article.\u003c/p\u003e \u003cp\u003eAcknowledgements\u003c/p\u003e \u003cp\u003e The authors are thankful to Sultan Bin Abdulaziz Humanitarian City (SBAHC), in Saudi Arabia for granting them access to the legal guardians of children for this work. The authors express their gratitude to all the volunteers who participated in this study. The authors express their appreciation to all the volunteers who participated in this study.\u003c/p\u003e "},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAndre FE, Booy R, Bock HL, et al. Vaccination greatly reduces disease, disability, death and inequity worldwide. \u003cem\u003eBull World Health Organ\u003c/em\u003e. 2008;86(2). doi:10.2471/BLT.07.040089\u003c/li\u003e\n\u003cli\u003eAllred NJ, Shaw KM, Santibanez TA, Rickert DL, Santoli JM. Parental vaccine safety concerns: Results from the national immunization survey, 2001-2002. \u003cem\u003eAm J Prev Med\u003c/em\u003e. 2005;28(2). doi:10.1016/j.amepre.2004.10.014\u003c/li\u003e\n\u003cli\u003eFournet N, Mollema L, Ruijs WL, et al. Under-vaccinated groups in Europe and their beliefs, attitudes and reasons for non-vaccination; Two systematic reviews. \u003cem\u003eBMC Public Health\u003c/em\u003e. 2018;18(1). doi:10.1186/s12889-018-5103-8\u003c/li\u003e\n\u003cli\u003eDinleyici M, Carman KB, Kilic O, Gurlevik SL, Yarar C, Dinleyici EC. The immunization status of children with chronic neurological disease and serological assessment of vaccine-preventable diseases. \u003cem\u003eHum Vaccines Immunother\u003c/em\u003e. 2018;14(8). doi:10.1080/21645515.2018.1460986\u003c/li\u003e\n\u003cli\u003eYang L, Peng J, Deng J, et al. Vaccination status of children with epilepsy or cerebral palsy in hunan rural area and a relative KAP survey of vaccinators. \u003cem\u003eFront Pediatr\u003c/em\u003e. 2019;7(MAR). doi:10.3389/fped.2019.00084\u003c/li\u003e\n\u003cli\u003eGeneral Authority for Statistics G. Saudi Census 2023. 2023. Accessed March 3, 2024. https://portal.saudicensus.sa/portal/public/1/15/100646?type=TABLE\u003c/li\u003e\n\u003cli\u003eOpel DJ, Mangione-Smith R, Taylor JA, et al. Development of a survey to identify vaccine-hesitant parents: The parent attitudes about childhood vaccines survey. \u003cem\u003eHum Vaccin\u003c/em\u003e. 2011;7(4). doi:10.4161/hv.7.4.14120\u003c/li\u003e\n\u003cli\u003eOpel DJ, Taylor JA, Mangione-Smith R, et al. Validity and reliability of a survey to identify vaccine-hesitant parents. \u003cem\u003eVaccine\u003c/em\u003e. 2011;29(38):6598-6605. doi:10.1016/j.vaccine.2011.06.115\u003c/li\u003e\n\u003cli\u003eOpel DJ, Taylor JA, Zhou C, Catz S, Myaing M, Mangione-Smith R. The relationship between parent attitudes about childhood vaccines survey scores and future child immunization status: A validation study. \u003cem\u003eJAMA Pediatr\u003c/em\u003e. 2013;167(11). doi:10.1001/jamapediatrics.2013.2483\u003c/li\u003e\n\u003cli\u003eAlsuwaidi AR, Elbarazi I, Al-Hamad S, Aldhaheri R, Sheek-Hussein M, Narchi H. Vaccine hesitancy and its determinants among Arab parents: a cross-sectional survey in the United Arab Emirates. \u003cem\u003eHum Vaccines Immunother\u003c/em\u003e. 2020;16(12):3163-3169. doi:10.1080/21645515.2020.1753439\u003c/li\u003e\n\u003cli\u003eAlsubaie SS, Gosadi IM, Alsaadi BM, et al. Vaccine hesitancy among Saudi parents and its determinants Result from the WHO SAGE working group on vaccine hesitancy survey tool From the Department of Pediatrics ( OPEN ACCESS. \u003cem\u003eSaudi Med J\u003c/em\u003e. 2019;40(12).\u003c/li\u003e\n\u003cli\u003eHamadah R, Hussain A, Alsoghayer N, Alkhenizan Z, Alajlan H, Alkhenizan A. Attitude of parents towards seasonal influenza vaccination for children in Saudi Arabia. \u003cem\u003eJ Fam Med Prim Care\u003c/em\u003e. 2021;10(2). doi:10.4103/jfmpc.jfmpc_1602_20\u003c/li\u003e\n\u003cli\u003eAlolayan A, Almotairi B, Alshammari S, Alhearri M, Alsuhaibani M. Seasonal influenza vaccination among Saudi children: Parental barriers and willingness to vaccinate their children. \u003cem\u003eInt J Environ Res Public Health\u003c/em\u003e. 2019;16(21). doi:10.3390/ijerph16214226\u003c/li\u003e\n\u003cli\u003eTillmann BU, Tillmann HC, Heininger U, L\u0026uuml;tschg J, Weber P. Acceptance and timeliness of standard vaccination in children with chronic neurological deficits in north-western Switzerland. \u003cem\u003eEur J Pediatr\u003c/em\u003e. 2005;164(5). doi:10.1007/s00431-005-1627-x\u003c/li\u003e\n\u003cli\u003eSmith M, Peacock G, Uyeki TM, Moore C. Influenza vaccination in children with neurologic or neurodevelopmental disorders. \u003cem\u003eVaccine\u003c/em\u003e. 2015;33(20). doi:10.1016/j.vaccine.2015.03.050\u003c/li\u003e\n\u003cli\u003eOkoro JC, Ojinnaka NC, Ikefuna AN, Onyenwe NE. Sociodemographic influences on immunization of children with chronic neurological disorders in Enugu, Nigeria. \u003cem\u003eTrials Vaccinol\u003c/em\u003e. 2015;4. doi:10.1016/j.trivac.2014.11.002\u003c/li\u003e\n\u003cli\u003eEsposito S, Cerutti M, Milani D, Menni F, Principi N. Vaccination coverage of children with rare genetic diseases and attitudes of their parents toward vaccines. \u003cem\u003eHum Vaccines Immunother\u003c/em\u003e. 2016;12(3). doi:10.1080/21645515.2015.1086046\u003c/li\u003e\n\u003cli\u003eLangkamp DL, Dusseau A, Brown MF. Vaccine Hesitancy and Low Immunization Rates in Children with Down Syndrome. \u003cem\u003eJ Pediatr\u003c/em\u003e. 2020;223. doi:10.1016/j.jpeds.2020.03.025\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Vaccine hesitancy, Neurological disorders, Neurodevelopmental disorders, Parental attitudes, Immunization, Saudi Arabia, Pediatric vaccination","lastPublishedDoi":"10.21203/rs.3.rs-6771025/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6771025/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eVaccine hesitancy poses a significant public health challenge, particularly among vulnerable populations such as children with chronic neurological disorders (NDDs). Despite the proven efficacy of vaccines, limited data exist on parental attitudes toward immunization in this high-risk group in Saudi Arabia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eThis study aims to assess the prevalence of vaccine hesitancy and its associated factors among legal guardians of children with NDDs in Riyadh, Saudi Arabia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA cross-sectional study was conducted from October 2021 to September 2022 at Sultan Bin Abdulaziz Humanitarian City (SBAHC), Riyadh, Saudi Arabia. A total of 401 legal guardians of children aged 2–18 years with NDDs completed a validated Arabic version of the Parent Attitudes about Childhood Vaccines (PACV) questionnaire. Statistical analyses included Chi-square tests and multivariate logistic regression to identify predictors of vaccine hesitancy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe level of vaccine hesitancy among respondents was 10.2%. Vaccine hesitancy was higher statistically among caregivers of male children (p=0.031), young mothers (p=0.016), educated mothers (p=0.017), less educated fathers (p=0.046), and low-income families (p=0.014). Analysis showed that older maternal age (AOR=0.446, p=0.028), higher paternal education (AOR=0.408, p=0.023), and greater household income (AOR=0.412, p=0.035) as protective factors for hesitancy, while younger educated mothers increased the likelihood of greater hesitancy (AOR=3.400, p=0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eVaccine hesitancy from caregivers of children with NDDs in Saudi Arabia is similar to the general population. It is startling that the increase of educated mothers was linked to increased vaccine hesitation. These results highlight the need for focused education and communication efforts to guide policy and clinical interventions aimed at improving vaccination rates\u003cstrong\u003e \u003c/strong\u003eamong susceptible\u003cstrong\u003e \u003c/strong\u003epediatric populations. guide policy and clinical interventions aimed at improving vaccination rates among susceptible pediatric populations.\u003c/p\u003e","manuscriptTitle":"Vaccine hesitancy among legal guardians of children with chronic neurological disorders: a cross-sectional study in Saudi Arabia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-01 09:19:34","doi":"10.21203/rs.3.rs-6771025/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-14T04:24:41+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-13T23:53:29+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-09T15:18:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"276302126013529751953165233729163465077","date":"2025-07-09T13:13:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"221520591247205240573490437290154899224","date":"2025-07-07T17:19:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"65632953105017905673413569676765522797","date":"2025-07-07T14:24:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"38800892890567436298827356666905076844","date":"2025-07-02T08:01:17+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-26T01:43:51+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-26T01:41:49+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-09T08:35:07+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-06T18:12:33+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-06-06T18:10:17+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9bc3fef8-4c57-413b-a46f-d16658ab3615","owner":[],"postedDate":"July 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-10-13T16:01:15+00:00","versionOfRecord":{"articleIdentity":"rs-6771025","link":"https://doi.org/10.1186/s12889-025-24269-9","journal":{"identity":"bmc-public-health","isVorOnly":false,"title":"BMC Public Health"},"publishedOn":"2025-10-09 15:57:40","publishedOnDateReadable":"October 9th, 2025"},"versionCreatedAt":"2025-07-01 09:19:34","video":"","vorDoi":"10.1186/s12889-025-24269-9","vorDoiUrl":"https://doi.org/10.1186/s12889-025-24269-9","workflowStages":[]},"version":"v1","identity":"rs-6771025","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6771025","identity":"rs-6771025","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}