Attitudes of parents towards influenza vaccine in the Eastern Mediterranean Region: A multilevel analysis

Ramy Mohamed Ghazy; Sarah Assem Ibrahim; Sarah Hamed N Taha; Abdelhamid Elshabrawy; Sally Waheed Elkhadry; Suzan Abdel-Rahman; Mahmoud A Hassaan; Noha Fadl

doi:10.1016/j.vaccine.2023.07.005

Attitudes of parents towards influenza vaccine in the Eastern Mediterranean Region: A multilevel analysis

Vaccine. 2023 Aug 14;41(36):5253-5264. doi: 10.1016/j.vaccine.2023.07.005. Epub 2023 Jul 21.

Authors

Ramy Mohamed Ghazy¹, Sarah Assem Ibrahim², Sarah Hamed N Taha³, Abdelhamid Elshabrawy², Sally Waheed Elkhadry⁴, Suzan Abdel-Rahman², Mahmoud A Hassaan⁵, Noha Fadl⁶

Affiliations

¹ Tropical Health Department, High Institute of Public Health, Alexandria University, Egypt.
² Biostatistics and Demography Department, Faculty of Graduate Studies for Statistical Research, Cairo University, Egypt.
³ Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Cairo University, Egypt. Electronic address: snasrtaha@cu.edu.eg.
⁴ Epidemiology and Preventive Medicine Department, National Liver Institute, Menoufia University, Egypt.
⁵ Institute of Graduate Studies & Research, Alexandria University, Egypt.
⁶ Family Health Department, High Institute of Public Health, Alexandria University, Egypt.

PMID: 37481405
DOI: 10.1016/j.vaccine.2023.07.005

Abstract

Background: Seasonal influenza vaccines (SIVs) can protect against influenza and substantially reduce the risk of influenza-related hospitalizations and fatalities in children. This study aimed to assess parental attitudes towards SIVs in the Eastern Mediterranean region (EMR).

Methods: Through an anonymous online survey conducted in 19 countries in the EMR, parents or caregivers over 18 years who had at least one child above 6 months filled out the Parent Attitudes about Childhood Vaccines questionnaire. As data had two levels; country and individual factors, we utilized multilevel binary logistic regression models.

Results: In total, 6992 respondents filled out the questionnaire. Of them, 47.4 % were residents of middle-income countries, 72.4 % of the mothers were between 26 and 45 years old, 56.5 % had at least a university degree, and approximately 51.6 % were unemployed. Nearly 50.8 % of the respondents were hesitant to vaccinate their children against seasonal influenza. Parental attitudes towards seasonal influenza vaccination differed significantly between countries, p < 0.001. The main predictors of parental seasonal influenza vaccine hesitancy (VH) were parents vaccination (odds ratio (OR) = 0.42, 95 % CI = 0.32-0.55, p < 0.001)), the mother's education if mother educated vs. who did not receive any education (OR ranged from 0.48 to 0.64, p < 0.05), living in low-income countries (OR = 0.52, 95 % CI = 0.35-0.77, p < 0.01), mountain residence (0.69, 95 % CI = 0.49-0.99, p < 0.05), health workers as a source of information (OR = 0.70, 95 % CI = 0.58-0.85, p < 0.001), children vaccination against COVID-19 (OR = 0.52, 95 % CI = 0.41-0.65, p < 0.001), not receiving routine vaccinations (OR = 1.93, 95 % CI = 1.09-3.44, p = 0.025), and if parents respondents could not remember whether their child had suffered from seasonal influenza in the previous year (OR = 1.57, 95 % CI = 1.33-1.84, p < 0.001).

Conclusion: A high seasonal influenza VH rate was found in the EMR. Health authorities should implement different interventions targeting the identified modifiable risk factor to increase vaccine uptake among children, especially those at risk of complication from seasonal influenza infection.

Keywords: EMR; Multilevel analysis; PACV; Parental vaccine hesitancy; Seasonal influenza vaccine.

MeSH terms

Adult
COVID-19*
Child
Female
Health Knowledge, Attitudes, Practice
Humans
Influenza Vaccines*
Influenza, Human* / prevention & control
Middle Aged
Multilevel Analysis
Parents / education
Vaccination

Substances

Influenza Vaccines