Knowledge and cultural influences on childhood immunization among caregivers in a rural setting of Umerkot, Sindh, Pakistan: A cross-sectional study

A community-based cross-sectional study was conducted in the rural areas of Umerkot District, Sindh, Pakistan. Using nonprobability purposive sampling, caregivers (n=103) with at least one child aged 0–23 months were enrolled in face-to-face interviews. A structured, pretested questionnaire was administered in the local language (Sindhi). Data were analyzed using descriptive statistics, chi-square tests, and logistic regressions. Participants’ mean age was 27.5 ± 7.3 years. The majority of the population was men (64.1%), illiterate (88.3%), Hindu (82.5%), and employed as unskilled laborers (56.3%). Pneumonia (38.8%) and diarrhea (34%) were the most frequently reported childhood diseases, as reported by respondents in face-to-face interviews. Only 25.2% of the participants considered immunization highly effective, whereas 51.5% trusted spiritual healing. Over 90% participants believed that vaccines caused pain, 55.3% believed that vaccination is associated with future male infertility, and 36.9% believed it impairs female fertility. Trust in Lady Health Workers (LHWs) was relatively high, with 65.9% of the children being vaccinated based on LHW recommendations. Chi-square analysis revealed a significant association between education level and awareness of vaccine benefits (χ 2 = 12.45, p = 0.006). Logistic regression indicated that trust in LHWs (OR=4.23, 95% CI: 1.89–9.45) and literacy (OR=2.89, 95% CI: 1.32–6.33) were significant predictors of vaccine uptake. Misinformation, low health literacy, and persistent cultural beliefs are major barriers to immunization in Umerkot, Sindh, Pakistan. Community-based strategies, particularly those that leverage trusted LHWs, are essential for improving vaccine acceptance and coverage.