Objective(s): to determine the barriers associated with non/partial immunization in children less than 2 years of age.

Methodology: This community based cross-sectional study was conducted in 15 UCs of Tehsil Kot Addu, District Muzaffargarh for a period of nine months by recruiting 264 mothers (caregivers). Multistage random sampling technique, lottery method and bottleneck method was used to select the tehsils, UCs and households for the study. Households with children between eighteen to twenty-four months of age and Mothers/Caregivers with age between twenty to fifty years were included in the study. The semi-structured questionnaire was used to collect information regarding demographic and socioeconomic status of mothers/caregivers and social and cultural factors causing non/partial immunization of children were also explored. Data were analyzed using descriptive statistics and association was calculated between immunization status of a children and demographic factors using chi-square test with a 95% confidence interval and value < 0.05 was taken as significant.

Results: The average age of respondents was 32.45 years (ranged from 20 to 50 years) with the average monthly household income of amounted to PKR 20,000 (IQR = 18,750).Parents/caregivers elucidated barriers to routine immunization including influence by in-laws (45.10%), neighbors (39%), or employer (34.80%) for not to vaccinate children; financial (31.10%) and travel issues (34.50%) to far off areas for vaccination; stock-outs at health facility (36.40%); unavailability of trained staff for vaccination (25.80%) and parent’s doubt on the competency of vaccination staff (28.80%). The majority of children (67.40%) were fully immunized followed by partially immunized children (25.80%) and non-immunized children (6.80%). Moreover, the immunization status of a child was not significantly associated with community location (p = 0.299), family type (p = 0.112) and occupation of the mother (p = 0.267).

Conclusion(s): Key barriers identified toward childhood immunization included influence of family and peers, transportation issues, financial issues, and healthcare delivery system related issues like unavailability of vaccines, unavailability of staff. The parents were concerned regarding vaccine quality. The religious leaders and public figures were also highlighted as a key obstacle to vaccinate children in the area.

Index Terms- Barriers, Non-immunization, Southern Punjab, Pakistan, Developing Country