Abstract
Introduction: Vaccination is a cost-effective public health intervention, but sustaining coverage is challenged by vaccine hesitancy. Bihar shows high uptake of early vaccines with documented dropout as children age.
Objectives: To estimate the prevalence of vaccine hesitancy among primary caregivers of children aged 0-23 months in rural Patna, Bihar, and to identify socio-demographic factors associated with hesitancy.
Methods: A community-based cross-sectional study was conducted among 300 primary caregivers in rural Patna from July to December 2025 using probability proportional to size cluster sampling (10 clusters of 30 children). Hesitancy was assessed with the Parent Attitudes about Childhood Vaccines (PACV) global item. Active hesitancy was defined as a response of very hesitant or somewhat hesitant. Respondents who answered not sure were grouped with no active hesitancy in the primary analysis. Immunization history was verified from cards, facility registers, or the U-WIN portal. Associations were examined with Pearson chi-square or Fisher's exact tests and with multivariable logistic regression.
Results: Active vaccine hesitancy was present in 23 of 300 caregivers (7.7%; 95% confidence interval [CI] 5.2-11.2). A further 257 caregivers (85.7%) answered not sure, although 96.0% of children had received at least one routine vaccine. In multivariable analysis, secondary or higher maternal education (adjusted odds ratio [aOR] 0.37; 95% CI 0.15-0.94) and institutional delivery (aOR 0.28; 95% CI 0.12-0.67) were independently associated with lower odds of active hesitancy. The comparison by respondent gender was underpowered (one hesitant male caregiver) and is not interpretable.
Conclusions: Active hesitancy was uncommon in this rural cohort, but uncertainty was pervasive despite high uptake. The estimate depends on a single PACV item and on classifying “not sure” as no active hesitancy. Immunization programmes in this setting should treat coverage as distinct from caregiver confidence and should strengthen counselling for home-delivered births and caregivers with lower formal education.
Keywords: vaccine hesitancy, PACV, pediatric immunization, maternal education, institutional delivery, Bihar