Published: 2022-09-26

Perception and preference of caregivers towards routine immunization amidst COVID-19

Ragavi A., Alexander Mannu, Jaishree Vasudevan, Vinoth Gnana Chellaiyan D.



Background: Immunization rates for routine vaccines show a drop during the COVID-19 pandemic. To assess the perception and preferences of caregivers towards routine immunization services amidst COVID-19.

Methods: A cross-sectional study was conducted in southern Chennai and adjoining districts of Chengalpattu and Kanchipuram, Tamil Nadu. The duration of the study was from January to June 2021. Parents of under-five children residing in the community for the last 3 years were selected as the study population. Using a simple random technique, 431 participants were selected. A pilot study was conducted with 50 participants to check for the comprehension and validity of the questionnaire and subsequent changes have been done. The co Guide version V.1.0.3 was used for statistical analysis.

Results: The majority 236 (54.76%) of the study population were residents of the urban locality. Two hundred (46.40%) participants were women attending antenatal clinics. A majority (395, 91.65%) felt their child needs all recommended vaccines according to national immunization schedule. If vaccines were missed, the major reason was (168, 38.98%) lockdown.

Conclusions: The present study population was well aware of routine immunization. Imposition of lockdown caused a disturbance in scheduled vaccinations and there was hesitancy of caregivers for COVID-19 vaccine to their children.



COVID-19, Routine Immunization, Lockdown, Vaccination

Full Text:



Steinglass R. Routine immunization: An essential but wobbly platform. Glob Heal Sci Pract. 2013;1(3):295-301.

Chan M. Beyond expectations: 40 years of EPI. Lancet (London, England). 2014;383(9930):1697-8.

Mansour Z, Arab J, Said R, Rady A, Hamadeh R, Gerbaka B et al. Impact of COVID-19 pandemic on the utilization of routine immunization services in Lebanon. PLoS One. 2021;16(2):e0246951.

MacDonald N, Mohsni E, Al-Mazrou Y, Kim Andrus J, Arora N, Elden S et al. Global vaccine action plan lessons learned I: Recommendations for the next decade. Vaccine. 2020;38(33):5364-71.

Sharma S, Kohli C, Sharma N, Mehra D. Incomplete Immunization Coverage in Delhi: Reasons and Solutions. Prim Heal Care Open Access. 2016;6(4):1-3.

Kindie YM. Factors Associated With Incomplete Childhood Vaccination among Children 12-23 Months of Age in Machakel Woreda, East Gojjam Zone: A Case Control Study. J Pregnancy Child Heal. 2015;2(4):180.

MacDonald NE, Eskola J, Liang X, Chaudhuri M, Dube E, Gellin B et al. Vaccine hesitancy: Definition, scope and determinants. Vaccine. 2015;33(34):4161-4.

Rashid T, McGrath RE. Strengths-based actions to enhance wellbeing in the time of COVID-19. Int J Wellbeing. 2020;10(4):113-32.

Ghatak N, Marzo RR, Saleem SM, Sharma N, Bhattacharya S, Singh A. Impact on Routine Immunization Services During the Lockdown Period in India: Implications and Future Recommendations. Ann Trop Med Public Heal. 2020;23(19):35-40.

Lancet T. COVID-19 in India: the dangers of false optimism. Lancet. 2020;396(10255):867.

Laxminarayan R, Jameel S, Sarkar S. India’s Battle against COVID-19: Progress and Challenges. Am J Trop Med Hyg. 2020;103(4):1343-7.

Santoli JM, Lindley MC, DeSilva MB, Kharbanda EO, Daley MF, Galloway L et al. Effects of the COVID-19 Pandemic on Routine Pediatric Vaccine Ordering and Administration-United States, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(19):591-3.

Nelson R. COVID-19 disrupts vaccine delivery. Lancet Infect Dis. 2020;20(5):546.

Manjunath U, Pareek RP. Maternal knowledge and perceptions about the routine immunization programme-A study in a semiurban area in rajasthan. Indian J Med Sci. 2003;57(4):158-63.

Shet A, Dhaliwal B, Banerjee P, Carr K, DeLuca A, Britto C et al. COVID-19-related disruptions to routine vaccination services in India: a survey of pediatric providers. BMJ Paediatr open. 2021;5(1):e001060.

IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.

Ahmed SM, Abd-El Rahman TA, Masoed ES. Mothers’ awareness and knowledge of under five years children regarding immunization in Minia city Egypt. Life Sci J. 2013;10(4):1224-32.

Mapatano M, Kayembe K, Piripiri L, Nyandwe K. Immunisation-related knowledge, attitudes and practices of mothers in Kinshasa, Democratic Republic of the Congo. South African Fam Pract. 2008;50(2):61.

Habib RF, Alsubhi RA, Saadawi DW. Assessment of Knowledge, Attitude and Practice of Parents towards Immunization of Children in Saudi Arabia, 2018. Egypt J Hosp Med. 2018;71(2):2585-9.

Herath NC, Kudagammana T, Sanathchandra TT, Gamage HK, Razik IM, Liynapathirana V. Brief report: Parental attitudes and knowledge on routine childhood immunization: an experience from Central Sri Lanka. BMC Res Notes. 2018;11(1):402.

Adeyinka DA, Adedayo D, Mbbs A, Mbbs OO, Esther F, Rn A et al. Uptake Of Childhood Immunization Among Mothers Of Under-Five In Southwestern Nigeria. Internet J Epidemiol. 2012;7(2):1-5.

Adefolalu OA, Kanma-Okafor OJ, Balogun MR. Maternal knowledge, attitude and compliance regarding immunization of under five children in Primary Health Care centres in Ikorodu Local Government Area, Lagos State. J Clin Sci. 2019;16(1):7.

Alzaher OA, Almutairi GA, AlModhayan SM, Khojah AA, Almutairi GA. Public Attitudes Toward Pediatric Routine Immunization During the COVID-19 Pandemic in Saudi Society. Cureus. 2021;13(9):e17899.

Raja TK, Buvnesh Kumar M, Sasithra S, Divyaparvathy J. COVID-19 and Adolescents of Chengalpattu District: A Cross-sectional Study. COVID-19 Other Communicable Dis. 2022;56-61

Alsuhaibani M, Alaqeel A. Impact of the COVID-19 Pandemic on Routine Childhood Immunization in Saudi Arabia. Vaccines. 2020;8(4):581.

Billon-Denis E, Tournier J-N. COVID-19 and vaccination: a global disruption. Med Sci (Paris). 2020;36(11):1034-7.

Chandir S, Siddiqi DA, Mehmood M, Setayesh H, Siddique M, Mirza A et al. Impact of COVID-19 pandemic response on uptake of routine immunizations in Sindh, Pakistan: An analysis of provincial electronic immunization registry data. Vaccine. 2020;38(45):7146-55.

WHO. At least 80 million children under one are at risk of diseases such as diphtheria, measles and polio as COVID-19 disrupts routine vaccination efforts, warn Gavi, WHO and UNICEF. World Health Organization. Published 2020. Available at: Accessed on Dec, 21, 2021.

Masresha BG, Luce RJ, Shibeshi ME, Ntsama B, N’Diaye A, Chakauya J et al. The performance of routine immunization in selected African countries during the first six months of the COVID-19 pandemic. Pan Afr Med J. 2020;37(1):12.

Chandir S, Siddiqi DA, Setayesh H, Khan AJ. Impact of COVID-19 lockdown on routine immunisation in Karachi, Pakistan. Lancet Glob Heal. 2020;8(9):e1118-20.

Russo R, Bozzola E, Palma P, Corsello G, Villani A. Pediatric routine vaccinations in the COVID 19 lockdown period: the survey of the Italian Pediatric Society. Ital J Pediatr. 2021;47(1):72.

Teasdale CA, Borrell LN, Shen Y, Kimball S, Rinke ML, Fleary SA et al. Parental plans to vaccinate children for COVID-19 in New York city. Vaccine. 2021;39(36):5082-6.

Ambike D, Tambade V, Poker F, Ahmed K. Parental knowledge on the optional vaccines and the barriers in their use: A rural hospital-based study. Indian J Child Health. 2017;4(1):88-90.

Health Mukherjee P. Awareness and attitudes of mothers towards new vaccines in the childhood vaccination programme in delhi state: a cross sectional study Seroprevalence of H1N1 infection View project Hepatitis A and E scenario in India View project Awareness and attitudes of mothers towards new vaccines in the childhood vaccination programme in Delhi state: a cross sectional study. Int J Community Med Public Heal. 2017;4(10):3859-63.

Munshi VA, Makkad M. A study on factors determining penetration of optional pediatric vaccines in urban India. Indian J Public Heal Res Dev. 2015;6(1):213-9.