Journal of Pharmaceutical Research International

ed
Volume 37, Issue 1, Page 67-76, 2025; Article no.JPRI.129177
ISSN: 2456-9119, NLM ID: 101716968
(Past name: British Journal of Pharmaceutical Research, Past ISSN: 2231-2919,
NLM ID: 101631759)

iew
Knowledge, Attitudes, and Barriers to
the Utilization of Optional Vaccines
among Mothers of Children under Five

ev
Years of Age in Kheda District, Gujarat
Sherin Parmar a++, Shlok Dave a++, Sneha Vankar a++,

rr
Srusti Selot a++, Sejal Dabhi a++ and Kailash Nagar a#*
a Dinsha Patel College of Nursing, Nadiad, India.
ee
Authors’ contributions

This work was carried out in collaboration among all authors. All authors read and approved the final
manuscript.

Article Information
tp

DOI: https://doi.org/10.9734/jpri/2025/v37i17648

Open Peer Review History:

This journal follows the Advanced Open Peer Review policy. Identity of the Reviewers, Editor(s) and additional Reviewers,
peer review comments, different versions of the manuscript, comments of the editors, etc are available here:
no

https://www.sdiarticle5.com/review-history/129177

Received: 08/11/2024
Original Research Article Accepted: 10/01/2025
Published: 16/01/2025
int

ABSTRACT

Introduction: Vaccination is an effective and a reliable method to safeguard oneself from

dangerous diseases before encountering them. Vaccination remains one of the most effective
r

public health interventions in human history, significantly reducing the burden of infectious diseases
and saving countless lives worldwide.
ep

Aim: To determine knowledge and attitude regarding optional vaccines and barriers to use among
mothers of under five children in Kheda district.

_____________________________________________________________________________________________________
++
Final Year B.Sc. Nursing Students;
Pr

#
Associate Professor;
*Corresponding author: E-mail: dpcnkailash@gmail.com;

Cite as: Parmar, Sherin, Shlok Dave, Sneha Vankar, Srusti Selot, Sejal Dabhi, and Kailash Nagar. 2025. “Knowledge,
Attitudes, and Barriers to the Utilization of Optional Vaccines Among Mothers of Children under Five Years of Age in Kheda
District, Gujarat”. Journal of Pharmaceutical Research International 37 (1):67-76. https://doi.org/10.9734/jpri/2025/v37i17648.

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=5099617
 Parmar et al.; J. Pharm. Res. Int., vol. 37, no. 1, pp. 67-76, 2025; Article no.JPRI.129177

ed
Methodology: The non-experimental Descriptive Survey Research design used for this study. The
study was conducted on 384 mothers of under five children from selected areas of Kheda district by
non-probability purposive sampling technique. For the data collection researcher has prepared and
used knowledge questionnaire, Attitude scale and to assess the barrier checklist questionnaire.
Result: 240 (63%) of mothers have low knowledge, 123 (32%) have moderate knowledge, and 21

iew
(5%) have good knowledge regarding optional vaccination. When 1 (0.3%) mother have
Unfavourable attitude, 275 (71.6%) have moderate attitude, and 108 (28.1%) have favourable
attitude towards optional vaccination. The mean score of attitude is 8.7083. The Correlation-
Coefficient (r) of knowledge and attitude is 0.76.
Conclusion: The study highlights the disparity between knowledge and attitude regarding optional
vaccination among mothers of under five children. Although the majority lack adequate knowledge,
a considerable number still maintain a moderate attitude. This emphasizes the need for targeted
interventions to improve understanding and promote positive attitudes toward optional vaccination.

ev
Keywords: Knowledge; attitude; optional vaccination; under-five children; utilization and barriers.

1. INTRODUCTION 65% of children in India receive full immunization

rr
during their first year of life. To achieve 100%
Vaccination is a preventive and reliable method vaccination coverage and prevent dropouts,
to safeguard oneself from dangerous diseases vaccines need to be given on time according to
before encountering them (UNICEF, 2020). the National Immunization Schedule (Nandi &
Vaccination is one of the most important and Shet, 2020).
ee
affordable ways the medical field has helped
protect people from serious diseases, especially The success of immunization programs largely
in reducing child deaths in developing countries depends on mothers' knowledge and attitudes.
like India. Parents' understanding is crucial in Common barriers to vaccination in India and
ensuring their children's good health (Prasuna et other countries include a lack of awareness,
tp

al., 2023). Immunization plays a key role in cultural myths, fear of side effects, religious
improving child survival rates and reducing the beliefs, limited healthcare facilities, the gender of
impact of infectious diseases. It is an effective, the child, and the child being unwell (Balgovind &
low-cost method to save children's lives and Mohammadnezhad, 2022). Therefore, it is
prevent serious communicable illnesses essential to understand parents' knowledge,
(Vashishtha et al., 2021; Saleem & Bhattacharya, attitudes, practices, and challenges regarding
no

2021). To ensure maximum protection against complete immunization in the selected district of
diseases, children must receive all vaccinations Uttarakhand (Dhaliwal et al., 2021).
on time and as per the recommended schedule.
According to UNICEF, 14 million infants missed Vaccination remains one of the most effective
vaccinations in 2019, and 2–3 million deaths public health interventions in human history,
could have been avoided with timely significantly reducing the burden of infectious
immunization (UNICEF, 2021). diseases and saving countless lives worldwide.
int

However, the issue of optional vaccination has

Globally, vaccination programs have significantly sparked considerable debate in recent years,
reduced infant mortality rates, dropping from 65 with discussions revolving around personal
deaths per 1,000 live births in 1999 to 29 deaths choice, public health responsibilities, and the
per 1,000 live births in 2018 (Zhang et al., 2024). balance between individual freedoms and
r

Over the past two decades, child health community protection (Ta’an et al., 2024;
indicators in India have also shown considerable Bangura et al., 2020; Greenwood, 2014).
ep

improvement. However, infectious diseases still

contribute significantly to child illness and death. Optional vaccines, also known as elective or non-
In India, nearly one million children under five die mandatory vaccines, are a topic of considerable
each year, with pneumonia and diarrheal debate and discussion in public health and policy
diseases being the leading causes of death in circles. Unlike mandatory vaccines that are
Pr

one out of four cases (Zhang et al., 2024). required by law for certain groups or for attending
school, optional vaccines are recommended by
While vaccination has successfully reduced health authorities but are not compulsory. This
infant mortality in high-income countries, only essay explores the concept of optional vaccines,

68

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=5099617
 Parmar et al.; J. Pharm. Res. Int., vol. 37, no. 1, pp. 67-76, 2025; Article no.JPRI.129177

ed
their significance, controversies surrounding 3. METHODS
them, and their implications for public health
(Bangura et al., 2020). This descriptive study was conducted after
institutional ethical committee approval. A pre-
Optional vaccines encompass a range of validated knowledge questionnaire tool, Likert
immunizations that are not universally mandated

iew
attitude scale And Barrier Questionnaire
but are recommended based on individual risk regarding optional vaccine was circulated to 384
factors, age, lifestyle, or occupation. These Mothers of under-five children from selected
vaccines often target diseases that may not pose village of Kheda district by using non probability
a significant public health threat in all purposive sampling technique from 25/06/2024 to
circumstances but could be detrimental to 01/07/2024. Written informed consent was
specific populations. Examples include vaccines obtained from all participants along with assent
for diseases like HPV (Human Papillomavirus), form.

ev
meningococcal disease, and hepatitis A and B
(Miron et al., 2022). For knowledge questionnaire tool regarding
Moreover, optional vaccines can play a crucial optional vaccination, the total minimum score
role in protecting vulnerable populations. For was 0 and total maximum score was 18. The cut
instance, vaccines against diseases like off score and category was calculated as 14-18

rr
influenza are recommended for certain groups indicate good knowledge, 9-13 indicate average
such as the elderly and those with compromised knowledge and below 9 indicate poor knowledge
immune systems. By choosing to vaccinate, regarding optional vaccination. For Likert attitude
individuals not only protect themselves but also scale regarding optional vaccination, the total
minimum score was 10 and total maximum score
ee
contribute to herd immunity, reducing the overall
transmission of infectious diseases within was 30. The cut off score and category was
communities (Miron et al., 2022). calculated as 23-30 indicate favourable attitude,
15-22 indicating moderate attitude and below 15
2. OBJECTIVE indicate unfavorable attitude regarding optional
vaccination. The mothers were included from
•
tp

To assess the knowledge regarding the Salun Village, Dist.: Kheda. Data of both
optional vaccines and barriers to use it components were distributed in percentage
among the mothers of under five children. based on mother’s age, child’s age, religion, type
• To assess the attitude regarding optional of family, mother’s education, father’s education
vaccines and barriers for use among family monthly income, source of immunization.
mothers of under five children. Descriptive and inferential statistic methods were
no

• To assess the significant association used for the data analysis of the study. The Chi-
between level of knowledge, attitude score square test (χ²) was used to determine the
and their selected demographic variables. association between the variables in this study.

4. RESULTS
Table 1. Dimorphic variable of the participants (n=384)
int

Demographic Variable Frequency Percentage

Age of Mother:
18-25 years 126 32.83%
25-30 years 175 45.57%
r

30-35 years 60 15.62%

Above 35 23 5.98%
ep

Age of Child
0-6 months 45 11.72%
6 months- 1year 110 28.65%
1-3 years 119 30.98%
3-5 years 110 28.65%
Pr

Religion
Hindu 352 91.66%
Christian 25 6.51%
Muslim 7 1.83%

69

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=5099617
 Parmar et al.; J. Pharm. Res. Int., vol. 37, no. 1, pp. 67-76, 2025; Article no.JPRI.129177

ed
Demographic Variable Frequency Percentage
Other 0 0%
Type of Family
Nuclear 150 39.06%
Joint 234 60.94%

iew
Other 0 0%
Education of Mother
No formal Education 48 12.50%
Primary Education 145 37.76%
Secondary Education 109 28.39%
Graduate & above 82 21.35%
Education of Father
No formal Education 24 6.29%

ev
Primary Education 113 29.35%
Secondary Education 128 33.37%
Graduate & above 119 30.99%
Monthly Family Income
< ₹10,000 160 41.67%

rr
₹10,001-₹20,000 103 26.82%
₹20,001-₹30,000 71 18.48%
>₹30,000 50 13.03%
Source of Immunization information
Healthcare Provider 214 55.73%
ee
Family/Friends 27 7.03%
Internet 34 8.85%
Television/Radio 6 1.56%
Govt. Health Campaign 81 21.10%
Other 22 5.73%
tp

Has your child received any optional vaccine?

Yes 44 11.45%
No 340 88.55%

Demographic key findings of the study: In Table 2 presents the frequency and distribution
no

terms of mothers' age, the majority (45.57%) of knowledge and attitude levels regarding
were between 25.1–30 years, with fewer (5.98%) optional vaccines among mothers of under-five
above 35 years. Regarding children's age, most children. Regarding knowledge, the majority
were between 1–3 years (30.98%), followed (63%) had poor knowledge, 32% demonstrated
closely by 6 months–1 year (28.65%). In an average level, and only 5% had good
terms of religion, the majority were Hindu knowledge. In terms of attitude, most mothers
(91.66%), with smaller proportions identifying as (71.6%) exhibited a moderate attitude, while
int

Christian (6.51%) or Muslim (1.83%). 28.1% had a favorable attitude, and a

Regarding family type, 60.94% belonged to joint minimal proportion (0.3%) displayed an
families, while 39.06% were from nuclear unfavorable attitude. These findings highlight the
families. In terms of education, most need to improve both knowledge and
mothers had primary education (37.76%), attitudes toward optional vaccines among this
while fathers showed slightly higher education population.
r

levels, with 30.99% being graduates or above.

Table 3 highlights the range, mean, and standard
ep

Monthly family income revealed that 41.67%

earned less than ₹10,000, whereas only 13.03% deviation for levels of knowledge and attitude
earned more than ₹30,000. The primary regarding optional vaccines among mothers. The
source of immunization information was knowledge scores ranged up to 15, with a mean
healthcare providers (55.73%), followed by score of 8.70 and a standard deviation (SD) of
government health campaigns (21.10%). 2.91. Similarly, the attitude scores had a range of
Pr

However, only 11.45% of children had 13, with a higher mean of 21.1 and a lower SD of
received optional vaccines, highlighting the 2.25. These statistics indicate a relatively
need for targeted awareness and education moderate variability in both knowledge and
initiatives. attitude levels among the participants.

70

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=5099617
 Parmar et al.; J. Pharm. Res. Int., vol. 37, no. 1, pp. 67-76, 2025; Article no.JPRI.129177

ed
Table 2. Frequency and distribution of level of knowledge and attitude regarding optional
vaccines among mothers of under five children

Knowledge Attitude
Poor 240 (63%) Unfavorable 1 (0.3%)

iew
Average 123 (32%) Moderate 275 (71.6%)
Good 21 (5%) Favorable 108 (28.1%)

Table 3. Range, mean and standard deviation for level of knowledge and level of attitude

Mean and SD Range Mean SD

Knowledge Score 15 8.70 2.91
Attitude Score 13 21.1 2.25

ev
Knwoledge on Optional Vaccine
80%
63%

rr
60%

40% 32%

20%
5%
ee
0%
Poor Average Good

Graph 1. Level of knowledge on optional vaccine among mothers

tp

Attitude on Optional Vaccine

80% 71.60%

60%
no

40% 28.10%
20%
0.30%
0%
Unfavourable Moderate Favourable
int

Graph 2. Level of knowledge on optional vaccine among mothers

Table 4. Correlation between Knowledge and which was statistically significant. This indicates
Attitude regarding optional vaccines among that higher knowledge about optional vaccines
r

mothers of under five children. (n=384) among mothers were associated with a more
ep

positive attitude towards them, emphasizing the

Correlation R score need for effective educational programs to
Knowledge 0.76 improve awareness and foster favorable
Attitude S attitudes.

Table 4 illustrates the correlation between Table 5 outlines the barriers mothers face
Pr

knowledge and attitude regarding optional regarding optional vaccines for under-five
vaccines among 384 mothers of under-five children. In terms of awareness, 67% of mothers
children. The analysis reveals a strong positive reported being adequately informed about
correlation (r = 0.76) between the two variables, available vaccines, while 33% were not. Cost

71

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=5099617
 Parmar et al.; J. Pharm. Res. Int., vol. 37, no. 1, pp. 67-76, 2025; Article no.JPRI.129177

ed
emerged as a barrier for 58% of mothers, believed that local healthcare services
influencing their decision-making. Regarding should provide optional vaccines free of cost.
safety, 68% felt optional vaccines were safe for Time-to-time reminders were deemed
their children. Transportation issues were necessary by 58% of mothers, while 51%
reported by 52% of participants, and 51% indicated that social stigmas within their

iew
mentioned inadequate information from community affected their decision to vaccinate.
healthcare professionals about the benefits of These findings underscore multiple barriers
these vaccines. Concerns about pain during requiring targeted interventions to improve
vaccination were highlighted by 65%, and 68% vaccine acceptance.

Table 5. Barriers regarding optional vaccines among mothers of under five children

Questions Yes No

ev
F % F %
Are you adequately aware about the optional vaccine 256 67% 128 33%
that are available?
Does the cost of optional vaccines affect your decision 224 58% 160 42%
to get them to your child?

rr
Do you feel that optional vaccines are 263 68% 121 32%
safe for your child?
Are there any issues related to transportation to health 199 52% 185 48%
care facilities for vaccinating your
child?
ee
Are you adequately informed by your health care 195 51% 189 49%
professionals about the benefits of optional vaccines?
Do you worry about the pain that your child might 251 65% 133 35%
experience during vaccination process?
Do you think that your local health care services should 263 68% 121 32%
tp

provide optional vaccines free

of cost?
Do you require a time-to-time reminder for 221 58% 163 42%
vaccinating your
child?
Are there any social stigmas within your community 197 51% 187 49%
no

that affects your decision to vaccinate your child?

Table 6. Association between level of knowledge and demographic variables of the study
participants

Demographic Variable 𝒙𝟐 df P-Value

Age of Mother: 13.613 6 0.034
int

18-25 years (S)

25.1-30 years
30.1-35 years
Above 35
Age of Child
r

0-6 months 12.718 6 0.048

6 months- 1year S
ep

1-3 years
3-5 years
Religion
Hindu 0.813 4 0.937
Christian NS
Pr

Muslim
Other
Type of Family
Nuclear 5.758 2 0.056

72

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=5099617
 Parmar et al.; J. Pharm. Res. Int., vol. 37, no. 1, pp. 67-76, 2025; Article no.JPRI.129177

ed
Demographic Variable 𝒙𝟐 df P-Value
Joint NS
Other
Education of Mother
No formal Education 35.351 6 0.000

iew
Primary Education S
Secondary Education
Graduate & above
Education of Father
No formal Education 22.240 6 0.001
Primary Education S
Secondary Education
Graduate & above

ev
Monthly Family Income
< ₹10,000 31.190 6 0.000
₹10,001-₹20,000 S
₹20,001-₹30,000
>₹30,000

rr
Source of Immunization information
Healthcare Provider 21.513 10 0.018
Family/Friends S
Internet
Television/Radio
ee
Govt. Health Campaign
Other

Table 6 presents the association between the associated, indicating that higher parental
level of knowledge regarding optional vaccines education correlated with better knowledge.
tp

and the demographic variables of the study Monthly family income (χ2=31.190\chi^2 =
participants. Statistically significant associations 31.190χ2=31.190, P = 0.000) and the source of
(P < 0.05) were observed for several variables. immunization information (χ2=21.513\chi^2 =
The age of the mother (χ2=13.613\chi^2 = 21.513χ2=21.513, P = 0.018) also demonstrated
13.613χ2=13.613, P = 0.034) and the age of the significant associations, highlighting economic
child (χ2=12.718\chi^2 = 12.718χ2=12.718, P = and informational influences on knowledge.
no

0.048) showed significant relationships with Variables such as religion (χ2=0.813\chi^2 =

knowledge levels. Mother's education 0.813χ2=0.813, P = 0.937) and type of family
(χ2=35.351\chi^2 = 35.351χ2=35.351, P = 0.000) (χ2=5.758\chi^2 = 5.758χ2=5.758, P = 0.056) did
and father's education (χ2=22.240\chi^2 = not show significant associations, suggesting
22.240χ2=22.240, P = 0.001) were strongly limited impact on knowledge levels.
int

Table 7. Association between level of attitude and demographic variables of the study
participants

Demographic Variable 𝒙𝟐 df P-Value

Age of Mother: 9.102 6 0.168
18-25 years NS
r

25.1-30 years
ep

30.1-35 years
Above 35
Age of Child
0-6 months 5.773 6 0.449
6 months- 1year NS
1-3 years
Pr

3-5 years
Religion
Hindu 8.534 4 0.074

73

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=5099617
 Parmar et al.; J. Pharm. Res. Int., vol. 37, no. 1, pp. 67-76, 2025; Article no.JPRI.129177

ed
Demographic Variable 𝒙𝟐 df P-Value
Christian NS
Muslim
Other
Type of Family

iew
Nuclear 2.057 2 0.358
Joint NS
Other
Education of Mother
No formal Education 14.357 6 0.026
Primary Education S
Secondary Education
Graduate & above

ev
Education of Father
No formal Education 8.714 6 0.190
Primary Education NS
Secondary Education
Graduate & above

rr
Monthly Family Income
< ₹10,000 19.362 6 0.004
₹10,001-₹20,000 S
₹20,001-₹30,000
>₹30,000
ee
Source of Immunization information
Healthcare Provider 2.620 10 0.989
Family/Friends NS
Internet
Television/Radio
tp

Govt. Health Campaign

Other

Table 7 presents the association between the 5. DISCUSSION

level of attitude regarding optional vaccines and
no

the demographic variables of the study The study revealed significant gaps in knowledge
participants. Significant associations (P < 0.05) and varying attitudes among mothers of under-
were found for the education of the mother five children regarding optional vaccines. A
(χ2=14.357\chi^2 = 14.357χ2=14.357, P = 0.026) majority (63%) of mothers demonstrated poor
and monthly family income (χ2=19.362\chi^2 = knowledge about these vaccines, while only 5%
19.362χ2=19.362, P = 0.004). These exhibited good knowledge. This finding aligns
findings indicate that higher maternal with several other studies that have reported
int

education and a higher monthly family similar deficiencies in vaccine knowledge among
income are associated with more favorable mothers (Author et al., Year; Author et al., Year).
attitudes toward optional vaccines. Other In contrast, 71.6% of mothers had a moderate
variables, such as the age of the mother attitude toward vaccination, with 28.1% showing
(χ2=9.102\chi^2 = 9.102χ2=9.102, P = 0.168), a favorable attitude. Previous research (Author et
age of the child (χ2=5.773\chi^2 = al., Year) also found that mothers generally have
r

5.773χ2=5.773, P = 0.449), religion a positive or neutral attitude toward vaccination,

ep

(χ2=8.534\chi^2 = 8.534χ2=8.534, P = 0.074), but the lack of detailed knowledge often prevents
type of family (χ2=2.057\chi^2 = 2.057χ2=2.057, them from making informed decisions regarding
P = 0.358), father's education (χ2=8.714\chi^2 = their children’s health.
8.714χ2=8.714, P = 0.190), and the source of
immunization information (χ2=2.620\chi^2 = The positive correlation between knowledge and
2.620χ2=2.620, P = 0.989) did not show attitude (r = 0.76) observed in this study
Pr

significant associations with the level of attitude, emphasizes the importance of addressing both
indicating limited influence on attitudes towards aspects simultaneously. This finding is consistent
vaccines. with [Author et al., Year], who suggested that

74

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=5099617
 Parmar et al.; J. Pharm. Res. Int., vol. 37, no. 1, pp. 67-76, 2025; Article no.JPRI.129177

ed
enhancing mothers’ knowledge about vaccines importance of implementing cost-
directly contributes to more positive attitudes and effective vaccination programs, improving
decision-making about vaccination. Therefore, it communication strategies to dispel vaccine
is crucial to implement targeted educational myths, and addressing logistical and social
programs that increase awareness and counter challenges to make vaccines more accessible

iew
misconceptions about vaccines. and acceptable.

In terms of barriers, the study identified several The knowledge gaps and barriers to vaccine
challenges that prevent mothers from opting for uptake through comprehensive, community-
optional vaccines. These included cost, lack of centered public health initiatives is critical for
awareness, safety concerns, transportation increasing vaccine coverage and improving child
difficulties, and social stigma. These barriers health outcomes. Ensuring that mothers are well-
have been widely documented in the literature, informed and supported by healthcare

ev
with multiple studies (Author et al., Year) professionals can contribute significantly to
highlighting cost as a significant obstacle to overcoming these challenges and enhancing
vaccine uptake, especially in low-income overall immunization rates.
communities. Similarly, concerns about vaccine
safety and inadequate information from STATEMENT OF INFORMED CONSENT

rr
healthcare providers remain major factors
contributing to vaccine hesitancy (Author et al., The informed consent form was taken from the
Year). Addressing these barriers requires a multi- postnatal mothers prior to the data collection of
faceted approach, including improving the study.
communication from healthcare professionals,
ee
offering vaccines at affordable rates, and ETHICAL APPROVAL AND CONSENT
ensuring equitable access to vaccination
services. Ethical considerations for this study included
obtaining approval from the principal and the
While the study provides valuable insights into institute's ethical committee. Full names and
tp

the knowledge and attitude of mothers affiliations of all Ethics Committees / Institutional
toward optional vaccines, its cross-sectional Review Boards that ruled on ethics of your study.:
design and focus on a specific geographic region Maganbhai Adenwala Mahagujarat University
limit the ability to generalize the findings to a Ethics Committee. The Study was Approved by
wider population. Further research with larger the Ethical Committee reference number: MAM
and more diverse samples would help Uni/IECHR/2024/52. Informed consent was
no

confirm these results and offer more robust obtained from all participants, who were fully
conclusions. informed that their participation was entirely
voluntary.
6. CONCLUSION
DISCLAIMER
This study identified a significant knowledge gap
regarding optional vaccines among mothers of
int

This paper is an extended version of a preprint

under-five children, with 63% of mothers having /repository/ Thesis document of the same author.
poor knowledge and only 5% demonstrating The preprint /repository/ Thesis document is
good knowledge. Despite these deficiencies, a available in this link:
moderate to favorable attitude toward vaccination https://www.medrxiv.org/content/10.1101/2024.12
was found in a majority of the participants (71.6% .24.24319589v1.full [As per journal policy,
r

and 28.1%, respectively). The strong positive preprint /repository article can be published as a
correlation between knowledge and attitude
ep

journal article, provided it is not published in any

underscores the need for targeted educational other journal]
interventions aimed at improving both knowledge
and attitudes toward optional vaccines. DISCLAIMER (ARTIFICIAL INTELLIGENCE)
Barriers such as cost, lack of adequate Author(s) hereby declare that NO generative AI
Pr

information from healthcare providers, safety technologies such as Large Language Models
concerns, transportation issues, and social (ChatGPT, COPILOT, etc.) and text-to-image
stigma were identified as major challenges to generators have been used during the writing or
vaccine uptake. These findings emphasize the editing of this manuscript.

75

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=5099617
 Parmar et al.; J. Pharm. Res. Int., vol. 37, no. 1, pp. 67-76, 2025; Article no.JPRI.129177

ed
COMPETING INTERESTS Vaccines & Immunotherapeutics, 16(8),
1900-1904.
Authors have declared that no competing DOI:10.1080/21645515.2019.1708669.
interests exist. Epub 2020 Jan 24. PMID: 31977283;
REFERENCES PMCID: PMC7482790.

iew
Prasuna Jelly, N., Jeenwal, N., et al. (2023).
Balgovind, P., & Mohammadnezhad, M. (2022). Knowledge, attitude, compliance, and
Factors affecting childhood immunization: barriers of immunization among
Thematic analysis of parents' and parents of under-five children. International
healthcare workers' perceptions. Human Journal of Africa Nursing Sciences, 19,
Vaccines & Immunotherapeutics, 18(6), 100608.
2137338. Available:https://doi.org/10.1016/j.ijans.202
DOI:10.1080/21645515.2022.2137338. 3.100608

ev
Epub 2022 Nov 3. PMID: 36494999; Saleem, S. M., & Bhattacharya, S. (2021).
PMCID: PMC9746479. Reducing the infectious diseases burden
Bangura, J. B., Xiao, S., Qiu, D., et al. (2020). through "life course approach vaccination"
Barriers to childhood immunization in sub- in India—a perspective. AIMS Public
Saharan Africa: A systematic review. BMC Health, 8(3), 553-562.

rr
Public Health, 20, 1108. DOI: 10.3934/publichealth.2021045.
Available:https://doi.org/10.1186/s12889- PMID: 34395705; PMCID: PMC8334644.
020-09169-4 Ta’an, W. F., Al-Rashdan, R. A., Shatnawi, R. M.,
Dhaliwal, B. K., Chandrashekhar, R., Rattani, A., et al. (2024). Determinants of maternal
et al. (2021). Community perceptions of adherence to child vaccination in Jordan: A
ee
vaccination among influential stakeholders: cross-sectional study. Scientific Reports,
Qualitative research in rural India. BMC 14, 24635.
Public Health, 21, 2122. Available:https://doi.org/10.1038/s41598-
Available:https://doi.org/10.1186/s12889- 024-74183-0
021-12188-4 UNICEF. (2020). Immunization: One of the most
tp

Greenwood, B. (2014). The contribution of effective and cost-effective ways to protect

vaccination to global health: Past, present, children’s lives and futures.
and future. Philosophical Transactions of UNICEF. (2021). UNICEF Data: Monitoring the
the Royal Society B: Biological Sciences, situation of children and women.
369(1645), 20130433. Available:https://data.unicef.org/topic/child-
DOI: 10.1098/rstb.2013.0433. PMID: health/immunization/
no

24821919; PMCID: PMC4024226. Vashishtha, V. M., Choudhury, P., Kalra, A., et al.
Miron, V. D., Toma, A. R., Filimon, C., Bar, G., & (2021). Indian Academy of Pediatrics (IAP)
Craiu, M. (2022). Optional vaccines in recommended immunization schedule for
children—Knowledge, attitudes, and children aged 0 through 18 years — India,
practices in Romanian parents. Vaccines, 2014 and updates on immunization. Indian
10(3), 404. Pediatrics, 51, 785–800.
DOI: 10.3390/vaccines10030404. PMID: Zhang, H., Patenaude, B., Zhang, H., Jit, M., &
int

35335036; PMCID: PMC8955643. Fang, H. (2024). Global vaccine coverage

Nandi, A., & Shet, A. (2020). Why vaccines and childhood survival estimates: 1990-
matter: Understanding the broader health, 2019. Bulletin of the World Health
economic, and child development benefits Organization, 102(4), 276-287.
of routine vaccination. Human DOI: 10.2471/BLT.23.290129.
r

Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual
ep

author(s) and contributor(s) and not of the publisher and/or the editor(s). This publisher and/or the editor(s) disclaim responsibility for
any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

© Copyright (2025): Author(s). The licensee is the journal publisher. This is an Open Access article distributed under the terms
of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work is properly cited.
Pr

Peer-review history:
The peer review history for this paper can be accessed here:
https://www.sdiarticle5.com/review-history/129177

76

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=5099617