Assessment of Parents' Knowledge, Attitudes, and Satisfaction of Childhood Immunization: A Cross-Sectional Survey from a Rural District of Sindh, Pakistan

Abstract

Background: Immunization is a cornerstone of public health, preventing millions of deaths annually, especially among children. Despite global efforts to increase vaccination coverage, significant gaps remain, influenced by parental knowledge, attitudes, and satisfaction with immunization services. These gaps are particularly pronounced in rural and socio-economically disadvantaged regions. Objective: This study aimed to assess parents' knowledge, attitudes, and satisfaction regarding childhood immunization and to identify barriers to vaccination in a rural district of Sindh, Pakistan. Methods: A cross-sectional survey was conducted in two cities, Mirpurkhas and Digri, within the Mirpur Khas district. Using the Raosoft® Sample Size Calculator, a sample size of 382 participants was determined with a 95% confidence level and a 5% margin of error. Participants were selected through convenience sampling. Data collection involved a semi-structured questionnaire developed from extensive literature review and validated through expert focus group discussions. The questionnaire covered demographics, perceptions of immunization, knowledge of the Expanded Programme on Immunization (EPI) schedule, and satisfaction with immunization services. Data analysis employed SPSS version 25, utilizing descriptive statistics and Mann-Whitney tests to analyze differences between variables. Results: Among 382 respondents, 55.76% were male, and 44.24% were female. A significant proportion (43.45%) were aged between 21–30 years. The majority acknowledged the importance of immunization (96.85% agreement), yet knowledge gaps were evident, with only 10.98% correctly identifying vaccines given at birth. Satisfaction with immunization services was high (73.56% satisfied with hospital services), despite 88.46% reporting incorrect knowledge about the vaccine given at birth. Barriers identified included affordability, vaccine unavailability, and long waiting times. Conclusion: While parental attitudes towards immunization were largely positive, significant knowledge gaps and barriers to immunization persist. Efforts to improve immunization coverage in rural Pakistan must address these knowledge deficits and structural barriers, emphasizing the development of targeted awareness campaigns and enhancing the accessibility and quality of immunization services.