Childhood Vaccination Among Arab Parents: A Meta-Analysis of Knowledge, Attitudes, and Practices

Authors

  • Sakina Al-Jadd Department of Community Health, College of Health and Medical Technique, Al-Furat Al-Awsat technical University, Kufa, Iraq
  • Mohammed Merzah Department of Community Health, Technical Institute of Karbala, Al-Furat Al-Awsat technical University, Karbala, Iraq

DOI:

https://doi.org/10.55489/njcm.160720255451

Keywords:

Knowledge, Attitudes, Practices, Parents, Vaccination, Immunization, Arab

Abstract

Background: Childhood vaccination is crucial for preventing infectious diseases, yet parental concerns and hesitations persist. Understanding and assessing parental knowledge, attitudes, and practices (KAP) regarding vaccines is essential, as these factors influence confidence in vaccination and adherence to immunization schedules.

Methods: This meta-analysis synthesized evidence on Arab parents' KAP toward childhood vaccination, based on a systematic review of eligible studies and pooled analysis using a random-effects model.

Results: Fifteen studies were included: 14 reported knowledge scores (9,035 participants), 13 reported attitudes (8,523 participants), and 7 reported practices (5,106 participants). The pooled estimates were 0.73 for good knowledge (95% CI: 0.62–0.81), 0.83 for positive attitudes (95% CI: 0.74–0.89), and 0.77 for good practices (95% CI: 0.64–0.86), all with high heterogeneity (I² >97%). Meta-regression showed persistent variability (I² = 92.7%, 99.2%, 98.7%), with no significant link between KAP scores and the proportion of mothers.

Conclusion: This meta-analysis highlights a strong association between good parental knowledge and positive attitudes, which translate into favorable vaccination practices. However, high heterogeneity across studies due to differences in design, populations, and cultural context limits the generalizability of findings. These findings underscore the need for targeted educational interventions to enhance parental vaccine awareness and uptake.

References

Montero DA, Vidal RM, Velasco J, Carreño LJ, Torres JP, Benachi O, et al. Two centuries of vaccination: historical and conceptual approach and future perspectives. Front Public Health. 2024 Jan 9;11:1326154. Doi: https://doi.org/10.3389/fpubh.2023.1326154 PMid:38264254 PMCid:PMC10803505

Meyer H, Ehmann R, Smith GL. Smallpox in the post-eradication era. Viruses. 2020;12(2):138. Doi: https://doi.org/10.3390/v12020138 PMid:31991671 PMCid:PMC7077202

Vigne JD. The origins of mammals and the rise of mammals: a paleontological perspective. C R Biol. 2011;334(3):171-81. Doi: https://doi.org/10.1016/j.crvi.2010.12.009 PMid:21377611

Shattock AJ, Johnson HC, Sim SY, Carter A, Lambach P, Hutubessy RCW, et al. Contribution of vaccination to improved survival and health: modelling 50 years of the Expanded Programme on Immunization. Lancet. 2024;403(10441):2307-2316. Doi: https://doi.org/10.1016/S0140-6736(24)00850-X PMid:38705159 PMCID: PMC11140691

Dejene H, Girma D, Geleta LA, Legesse E. Vaccination timeliness and associated factors among children aged 12-23 months in Debre Libanos district of North Shewa Zone, Oromia Regional State, Ethiopia. Front Pediatr. 2022;10:1-11. Doi: https://doi.org/10.3389/fped.2022.867846 PMid:35967570 PMCid:PMC9363667

Galagali PM, Kinikar AA, Kumar VS. Vaccine hesitancy: obstacles and challenges. Curr Pediatr Rep. 2022;10(4):241-8. Doi: https://doi.org/10.1007/s40124-022-00278-9 PMid:36245801 PMCid:PMC9546747

Randolph HE, Barreiro LB. Herd immunity: understanding COVID-19. Immunity. 2020;52(5):737-41. Doi: https://doi.org/10.1016/j.immuni.2020.04.012 PMid:32433946 PMCid:PMC7236739

Iqbal MS, Khan SUD, Qamer S, Vohra S. Vaccine hesitancy of COVID-19 among parents for their children in Middle Eastern countries: a systematic review. Vaccines. 2023; 11(10): 1556. Doi: https://doi.org/10.3390/vaccines11101556 PMid:37896959 PMCid:PMC10610721

Temsah MH, Alhuzaimi AN, Aljamaan F, Bahkali F, Al-Eyadhy A, Alrabiaah A, et al. Parental attitudes and hesitancy about COVID-19 vs. routine childhood vaccinations: a national survey. Front Public Health. 2021;9:1-11. Doi: https://doi.org/10.3389/fpubh.2021.752323 PMid:34722451 PMCid:PMC8548678

Qunaibi EA, Helmy M, Basheti I, Sultan I. A high rate of COVID-19 vaccine hesitancy in a large-scale survey on Arabs. Elife. 2021;10:e68038. Doi: https://doi.org/10.7554/eLife.68038 PMid:34042047 PMCid:PMC8205489

Alsuwaidi AR, Elbarazi I, Al-Hamad S, Aldhaheri R, Sheek-Hussein M, Narchi H. Vaccine hesitancy and its determinants among Arab parents: a cross-sectional survey in the United Arab Emirates. Hum Vaccin Immunother. 2020;16(12):3163-9. Doi: https://doi.org/10.1080/21645515.2020.1753439 PMid:32401612 PMCid:PMC8641603

World Health Organization. Immunization and vaccine-preventable communicable diseases [Internet]. Geneva: WHO; [cited 2025 Jan 10]. Available from: https://www.who.int/data/gho/data/themes/immunization

World Health Organization. Immunization coverage [Internet]. Geneva: WHO; 2024 [cited 2025 Jan 10]. Available from: https://www.who.int/en/news-room/fact-sheets/detail/immunization-coverage

Matta P, El Mouallem R, Akel M, Hallit S, Fadous Khalife MC. Parents' knowledge, attitude and practice towards children's vaccination in Lebanon: role of the parent-physician communication. BMC Public Health. 2020;20(1):1439. Doi: https://doi.org/10.1186/s12889-020-09526-3 PMid:32962689 PMCid:PMC7510257

Alghamdi AA, Alghamdi HA. Knowledge, attitude, and practice of vaccination among parents in Jeddah City, Saudi Arabia. Cureus. 2023;15(7):e41721. Doi: https://doi.org/10.7759/cureus.41721

Al-lela OQB, Bahari MB, Al-Qazaz HK, et al. Are parents' knowledge and practice regarding immunization related to pediatrics' immunization compliance? A mixed-method study. BMC Pediatr. 2014;14:20. Doi: https://doi.org/10.1186/1471-2431-14-20 PMid:24460878 PMCid:PMC3904208

Alshammari TM, Alsubaie YSR, Ali SS, Alajmi NM, Alanazi KKM, Alamir MA, et al. Assessment of knowledge, attitude and practice of parents about immunization in Hail City, 2018. Egypt J Hosp Med. 2018;73(3):6377-81. Doi: https://doi.org/10.21608/ejhm.2018.14358

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. Doi: https://doi.org/10.1136/bmj.n71 PMid:33782057 PMCid:PMC8005924

Alqassim AY, El-Setouhy MA, Mahfouz MS, et al. Knowledge and behaviors of parents towards child vaccination in Jazan, Saudi Arabia. Trop J Pharm Res. 2022;21(1):151-7.

Alruwaili AAS, Abo El-fetoh NM, Alruwaili TAS, Alanazi WAS, Alhazmi HHR, Alanazi NAB, et al. Knowledge, attitude and practice of the parents regarding child vaccinations in Arar, northern Saudi Arabia. Egypt J Hosp Med. 2018;72(9):5178-82. Doi: https://doi.org/10.21608/ejhm.2018.10738

Abuharba WA, Algarni AM. Knowledge and attitude of mothers towards childhood vaccination in Taif, Saudi Arabia. J Med Law Public Health. 2022;2(2):98-107. Doi: https://doi.org/10.52609/jmlph.v2i2.46

AlTuwayjiri A, Almutairi A. Knowledge, attitude, and practice of the parents regarding childhood vaccinations in Saudi Arabia 2021. Int J Med Dev Ctries. 2021;5(1):2055-62. Doi: https://doi.org/10.24911/IJMDC.51-1633031645

Mobark MA, Alhazmi HE, Altowayan WM. Parents' knowledge and attitude toward childhood vaccination in Qassim, Saudi Arabia. J Pharm Res Int. 2022;34(6):54-62. Doi: https://doi.org/10.9734/jpri/2022/v34i40A36256

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. Doi: https://doi.org/10.12816/0045660

Alshammari SZ, Alfayyad I, Altannir Y, Al-Tannir M. Parental awareness and attitude about childhood immunization in Riyadh, Saudi Arabia: a cross-sectional study. Int J Environ Res Public Health. 2021;18(16):8685. Doi: https://doi.org/10.3390/ijerph18168455 PMid:34444205 PMCid:PMC8393381

Almutairi WM, Alsharif F, Khamis F, Sallam LA, Sharif L, Alsufyani A, et al. Assessment of mothers' knowledge, attitudes, and practices regarding childhood vaccination during the first five years of life in Saudi Arabia. Nurs Rep. 2021;11(3):506-16. Doi: https://doi.org/10.3390/nursrep11030047 PMid:34968325 PMCid:PMC8608048

Yousif MA, Albarraq AA, Abdallah MAA, Elbur AI. Parents' knowledge and attitudes on childhood immunization, Taif, Saudi Arabia. J Vaccines Vaccin. 2014;5(1):1-5.

Bamatraf FF, Jawass MA. Knowledge and attitude towards childhood immunization among parents in Al-Mukalla, Yemen. World Fam Med J Middle East J Fam Med. 2018;16(2):24-31. Doi: https://doi.org/10.5742/MEWFM.2018.93239

Mohammed MB, Al-Zahrani A. Knowledge, attitude and practice of mothers toward children's vaccination at Alfatih One in Sudan. Open J Nurs. 2021;11(7):557-65. Doi: https://doi.org/10.4236/ojn.2021.117047

Al-Marshoudi S, Al-Balushi H, Al-Wahaibi A, et al. Knowledge, attitudes, and practices (KAP) toward the COVID-19 vaccine in Oman: a pre-campaign cross-sectional study. Vaccines. 2021;9(6):602. Doi: https://doi.org/10.3390/vaccines9060602 PMid:34200001 PMCid:PMC8228881

Patel TB, Pathak R, Singh R, Alves V, Mahesh NM, Chaluvaraj TS, et al. Assessment of parents' knowledge, attitude and practice about child vaccination in rural areas. J Pharm Res. 2017;16(3):229-34. Doi: https://doi.org/10.18579/jpcrkc/2017/16/3/118764 PMid:34848301

Voo JYH, Lean QY, Ming LC, Hanafiah NHM, Al-Worafi YM, Ibrahim B. Vaccine knowledge, awareness and hesitancy: a cross-sectional survey among parents residing at Sandakan district, Sabah. Vaccines. 2021;9(11):1263. Doi: https://doi.org/10.3390/vaccines9111348 PMid:34835279 PMCid:PMC8624080

Islam MS, Mondal AK, Auwul MR, Islam T, Islam O, Yasmin A, et al. Assessment of knowledge, attitudes, and practices on vaccine usage among small ruminant farmers in the Northern Region of Bangladesh. Vet World. 2024;17(7):1435-48. Doi: https://doi.org/10.14202/vetworld.2024.1435-1448 PMid:39185055 PMCid:PMC11344116

Asghar K, Shehazadi I, Naseem S, Shamim I. Assessment of parent's attitude, knowledge and practices regarding their child vaccination. Int J Health Sci. 2025;14(1):1373-83. Doi: https://doi.org/10.62345/jads.2025.14.1.109

Nassar O, Alshahwan S, Alshahwan R, Halasa S, Alashhab S, Alnajar M. Determinants of parents' knowledge, attitudes, and practice toward childhood vaccination: a national study. Open Nurs J. 2023;17:e187443462302090. Doi: https://doi.org/10.2174/18744346-v17-230223-2022-88

Published

2025-07-01

How to Cite

1.
Al-Jadd S, Merzah M. Childhood Vaccination Among Arab Parents: A Meta-Analysis of Knowledge, Attitudes, and Practices. Natl J Community Med [Internet]. 2025 Jul. 1 [cited 2025 Jul. 1];16(07):733-41. Available from: https://njcmindia.com/index.php/file/article/view/5451

Issue

Section

Systematic Review/ Meta Analysis