title: Reasons for non-vaccination in pediatric patients visiting tertiary care centers in a polio-prone country.
abstract: BACKGROUND
  The Expanded Program on Immunization (EPI) was initiated by World Health Organization (WHO) in 1974 in order to save children from life threatening, disabling vaccine-preventable diseases (VPDs). In Pakistan, this program was launched in 1978 with the main objectives of eradicating polio by 2012, eliminating measles and neonatal tetanus by 2015, and minimizing the incidence of other VPDs. However, despite the efforts of government and WHO, this program has not received the amount of success that was desired. Hence, the objectives of this study were to elucidate the main reasons behind not achieving the full immunization coverage in Pakistan, the awareness of children's attendant about the importance of vaccination, their attitudes, thoughts and fears regarding childhood immunization, and the major hurdles faced in pursuit of getting their children vaccinated.
  
  
  METHODS
  This was an observational, cross-sectional, questionnaire-based study conducted during a one year period from 4th January, 2012 to 6th January, 2013 at the pediatric outpatient clinics of Civil Hospital (CHK) and National Institute of Child Health (NICH). We attempted to interview all the parents who could be approached during the period of the study. Thus, convenience sampling was employed. The parents were approached in the clinics and interviewed after seeking informed, written consent. Those patients who were not accompanied by either of their parents were excluded from the study. The study instrument comprised of three sections. The first section consisted was concerned with the demographics of the patient and the parents. The second section dealt with the reasons for complete vaccination or under-vaccination. The last section aimed to assess the knowledge, attitudes and beliefs of the respondents.
  
  
  RESULTS
  Out of 1044 patients, only 713(68.3%) were fully vaccinated, 239(22.9%) were partially vaccinated while 92(8.8%) had never been vaccinated. The vaccination status showed statistically significant association with ethnicity, income, residence, number of children and paternal occupation (p < 0.05 for all). The most common provocative factor for vaccination compliance was mass media (61.9%). The most common primary reason for non-vaccination was lack of knowledge (18.1%), whereas the most common secondary reason for non-vaccination was religious taboos (31.4%). Majority of the respondents demonstrated poor knowledge of EPI schedules or VPDs. However, most believed that there was a need for more active government/NGO involvement in this area.
  
  
  CONCLUSIONS
  The most common primary reason for non-vaccination, i.e. lack of knowledge, and the most common secondary reason, i.e. religious taboos, imply that there is dire need to promote awareness among the masses in collaboration with NGOs, and major religious and social organizations.
authors.affiliation: Dow Medical College, Dow University of Health Sciences, Baba-e-Urdu Road, Karachi 74200, Pakistan. asfandyarsheikh@gmail.com.
authors.forename: Asfandyar
authors.initials: A
authors.lastname: Sheikh
authors.forename: Bushra
authors.initials: B
authors.lastname: Iqbal
authors.forename: Anabia
authors.initials: A
authors.lastname: Ehtamam
authors.forename: Maria
authors.initials: M
authors.lastname: Rahim
authors.forename: Hiba Arshad
authors.initials: HA
authors.lastname: Shaikh
authors.forename: Hina Azhar
authors.initials: HA
authors.lastname: Usmani
authors.forename: Javeria
authors.initials: J
authors.lastname: Nasir
authors.forename: Sheharbano
authors.initials: S
authors.lastname: Ali
authors.forename: Muniba
authors.initials: M
authors.lastname: Zaki
authors.forename: Tooba Abdul
authors.initials: TA
authors.lastname: Wahab
authors.forename: Warda
authors.initials: W
authors.lastname: Wasim
authors.forename: Ali Akber
authors.initials: AA
authors.lastname: Aftab