Demography and determinants of incomplete immunization in children aged 1–5 years and vaccine-hesitancy among caregivers: An Eastern Indian perspective

Background: World Health Organization (WHO) declared vaccine-hesitancy (VH) as an emerging threat to global health. There are limited studies from developing countries, especially from Eastern India, addressing parental VH's determinants and its impact on childhood immunization. Current study aims to assess the prevalence of incomplete immunization in children and parental VH, explore the socio-demographic determinants, and delineate their interconnections. Material and methods: In this hospital-based, cross-sectional study vaccination cards or parents’ recall method were used to inquire about immunization status and the Likert-vaccine hesitancy scale (VHS) developed by WHO Strategic Advisory Group Experts on Immunization (SAGE) was utilized as an instrument to measure VH. Multivariate analyses were performed to identify the independent predictors. Results: The prevalence of incomplete immunization and VH were 18.9% and 41.6% respectively. Significant predictors of incomplete immunization were maternal education, socioeconomic status, gender, and place of delivery. Most responders believed vaccines are effective (99%), important for child's health (98%) and most vaccines offered by the government are beneficial (95%) but were also concerned about serious adverse effects (41%) and feared about new vaccines carrying more risk than old vaccines (16%). Maternal education and family type were significant determinants of VH. Incomplete immunization was significantly prevalent among children with vaccine-hesitant caregivers, though it was not found to be an independent predictor in multivariate analysis. Conclusions: This study emphasizes the magnitude of the issue of incomplete immunization, VH, and unravels its contributing factors which will help public-health care providers with a roadmap to prioritize resources and focus on preventable measures like health education, ensuring institutional births, and free health-service delivery expansion to increase immunization coverage. Caregivers’ VH is a major roadblock to attaining better immunization coverage which can be tackled through proper counselling to improve their health literacy.