ABSTRACT
Background: Parents/caregivers are the key decision-makers for childs health care including vaccination. Vaccine hesitancy along with lagging full immunization coverage for childhood vaccination in India, affect child health outcome and will affect covid-19 vaccine uptake in children. It is important to understand behavioral and social factors surrounding childhood COVID-19 vaccination to design appropriate interventions to improve uptake. Methods: A mixed-method approach combining quantitative and qualitative method was undertaken. A cross sectional survey of parents/caregivers of children aged less than 18 years residing in the state was carried out to find the prevalence and predictors of parent/ caregivers intention to vaccinate against COVID-19 disease. Semi-structured interviews were carried out to find facilitating and barrier factors for childhood COVID-19 vaccination. Result: Out of 9904 study participants, 73.4% had intention to vaccinate. Parent/caregivers education and occupation, marital status, family type, family income, co-morbidity and previous COVID-19 infection in family, childhood vaccination under NIS, were found to be significantly associated. The likelihood of intention to vaccinate children against COVID-19 disease was greater among parents/caregivers aged 18-29 years (OR=2.631, 95% CI [1.733-3.995], illiterate parents/caregivers (OR=3.037, 95% CI [2.319-3.977], prior COVID-19 infection in family (OR=1.595, 95% CI [1.432-1.821], and childrens prior vaccinations under NIS (OR=1.251, 95% CI [1.218-1.289]. In qualitative part, forty-five semi-structured interviews were conducted. The majority of intending parents gave vaccine effectiveness, increased immunity, high infection risk, herd immunity, and medical recommendations as reasons. Parents who refused mentioned inadequate data, adverse effects, beliefs, safety, and inconvenience as reasons. Effectiveness, and safety, long-term effects, and the short testing period were among the concerns of hesitant parents. Conclusion: In order to promote COVID-19 vaccination among children, we need to address barriers, facilitators and behavioral determinants of parents/caregivers identified in this study and have targeted strategies for them.