Impact of Parental Vaccine Hesitancy on Infant Mortality Rates: A Cross-Sectional Study in District Charsadda, Khyber Pakhtunkhwa, Pakistan

Abstract

Background: Vaccine hesitancy has emerged as a critical public-health concern that undermines immunization programs worldwide. In Pakistan, regional variations in parental attitudes toward vaccines contribute to persistent disparities in child survival rates. Objective: This study investigated the association between parental vaccine hesitancy and infant mortality in District Charsadda, Khyber Pakhtunkhwa. Methods: A descriptive cross-sectional analytical design was employed between January and June 2024. Using stratified random sampling, 312 parents of children under five years were surveyed through a structured questionnaire. Vaccine hesitancy was assessed via a validated Vaccine Hesitancy Scale (Cronbach’s α = 0.86). Data was analyzed using descriptive statistics, chi-squared tests, Pearson correlation, and binary logistic regression in SPSS v27, with p < 0.05 considered significant. Results: The prevalence of vaccine hesitancy was 29.5%. Full immunization coverage among children was 66.7%, while the infant mortality rate (IMR) reached 46 per 1,000 live births. Hesitant parents were 3.6 times more likely to experience infant death than non-hesitant parents (OR = 3.59 % CI 1.71–7.53; p = 0.001). Maternal education and income were protective factors. Model fit indices (Hosmer–Lemeshow p = 0.48; Nagelkerke R² = 0.312) indicated strong explanatory power. Conclusion: Vaccine hesitancy constitutes a statistically significant determinant of elevated infant mortality in District Charsadda. Policy emphasis must shift toward behaviorally informed interventions, culturally tailored communication, and community trust-building to achieve Sustainable Development Goal 3.2 and reduce preventable child deaths.