Mothers' knowledge, attitude, and behavior regarding child immunization, and the association with child immunization status in Medan City during the COVID-19 pandemic

Background: The COVID-19 pandemic has caused disruption to healthcare access worldwide and has impacted basic childhood immunization services. A decline in immunization coverage can cause immunity gaps and lead to outbreaks of vaccine-preventable diseases. Our study evaluated the association between mothers' knowledge, attitude, and behavior regarding immunization and child immunization status during the COVID-19 pandemic in Medan, Indonesia. Methods: An analytical cross-sectional study was conducted from April to November 2021. Mothers with children aged 0-12 months were interviewed about their knowledge, attitude, and behavior regarding immunization, and their child's immunization status. Results: Of 196 participants, 46.5% had low knowledge on immunization, 41.3% had a negative attitude, and 20.4% had negative behavior. Only 62.8% of participants had children with a complete vaccination status, and mothers with moderate knowledge (OR 2.65, 95% CI 1.08-6.61), negative attitude (OR 5.33, 95% CI 2.71-10.59), and negative behavior (OR 7.88, 95% CI 3.36-19.47) were more likely to not vaccinate their children. Conclusion: Mothers' attitude, behavior, and educational background were associated with child immunization status. Recovery efforts to improve immunization coverage are urgently needed, and should include efforts to reduce mothers' hesitancy regarding child vaccination during the pandemic.