Document Type : Original Article


1 Department of Pharmacy Practice, Raghavendra Institute of Pharmaceutical Education and Research (RIPER) ‑ Autonomous, Anantapur, Andhra Pradesh, India

2 Department of Pediatrics, Rural Development Trust Hospital, Bathalapalli, Andhra Pradesh, India

3 Department of Pharmacology, Raghavendra Institute of Pharmaceutical Education and Research (RIPER) ‑ Autonomous, Anantapur, Andhra Pradesh, India

4 Department of Pharmaceutics, Sri Krishnadevaraya University College of Pharmaceutical Sciences, S.K. University, Anantapuramu, Andhra Pradesh, India


BACKGROUND: The World Health Organization (WHO) states that vaccine hesitancy is one of
the top 10 threats to global public health. Evidence shows that vaccine hesitancy studies in India
are limited and targeted toward individual vaccines. The study aimed to fill this gap by exploring the
relationship between demographics and SAGE factors toward vaccine hesitancy.
MATERIALS AND METHODS: A hospital‑based, cross‑sectional, analytical study was conducted
in a non‑governmental organization (NGO) hospital with 330 beds, located in Bathalapalli,
Andhra Pradesh, India. Mothers of under‑five children who attended outpatient departments of
pediatrics or obstetrics and gynecology were included. A total of 574 mothers were enrolled and
vaccine hesitancy was determined by reviewing the mother–child protection card for the presence
of delay or refusal of the recommended vaccine. A face‑to‑face interview was conducted to obtain
demographics and WHO–SAGE variables from the participants. Binary logistic regression analysis
was performed to associate independent variables (demographics and SAGE variables) with the
dependent variable (vaccine hesitancy).
RESULTS: Out of 574 respondents, 161 mother’s children were noted as vaccine‑hesitant (refusal = 7;
delay = 154); and the prevalence of vaccine hesitancy was 28.05%. The delay was observed in all
recommended vaccines, but the refusal or reluctance was seen in only four vaccines (hepatitis B
birth dose = 1; IPV 1 and 2 = 2; Measles 1 and 2 = 3; and Rota 1, 2, and 3 = 1). The respondents’
demographics like no or lower parent education (OR = 3.17; 95%CI = 1.50–6.72) and fewer antenatal
visits (OR = 2.30; 95%CI = 1.45–3.36) showed higher odds, whereas the upper socioeconomic
status showed lower odds (OR = 0.09; 95%CI = 0.02–0.36) toward vaccine hesitancy. The WHO–
SAGE dimensions like awareness (OR = 0.14; 95%CI = 0.03–0.53), poor access (OR = 7.76;
95%CI = 3.65–16.51), and low acceptability of the individual (OR = 07.15; 95%CI = 1.87–27.29),
community (OR = 6.21; 95%CI = 1.58–24.33) were significantly associated with vaccine hesitancy.
CONCLUSION: The study concludes that the prevalence of vaccine hesitancy was high. Vaccine
safety and children’s health are primary concerns for parents’ refusal/reluctance. To achieve 100%
immunization coverage, policymakers need to reduce vaccine hesitancy by developing strategies
based on demographic and WHO–SAGE working group predictors.


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