Knowledge, attitude, perception of Muslim parents towards vaccination in Malaysia

ABSTRACT

Malaysia is a predominant Muslim country and the recent surge in vaccine-preventable disease enticed us to conduct a survey to measure the Knowledge, Attitude and Perception of Muslim parents toward vaccination process. The data were collected under four segments such as demography, Knowledge, Attitude and Perception. The questionnaire had high internal consistency (0.823) for Cronbach’s alpha. The sociodemographic determinants such as marital status (OR = 1.12; 0.91–1.38;p < .05), education level (college OR = 1.35; 1.12–1.64;p < .05, secondary OR = 1.22; 1.01–1.47;p < .05) and the occupation of parents (OR = 1.25; 1.07–1.45;p < .05) were observed affecting the Knowledge score significantly. Majority of Malaysian Muslim parents believed that “vaccine is not prohibited in Islam” and most of them also rejected the belief that “all vaccines are non halal and hence should be avoided”. None of the sociodemographic determinants significantly affected the Attitude and Perception score of the Muslim parents. It was observed that the Attitude and Perception score did not establish any association with any of the socio-demographic determinants and hence the null hypothesis that Malaysian Muslim parents had positive Attitude and good Perception toward vaccination process was accepted.

KEYWORDS:

• Malaysian
• Muslim
• knowledge
• attitude
• perception
• association
• regression

Introduction

Recent incidence of child death in Malaysia due to vaccine-preventable diseases particularly diphtheria and measles is matter of serious concern for child health and safety. It is undoubtedly a very unbecoming Attitude of parents toward vaccination.¹ The Malaysian vaccination schedule was launched in the early 1950s. Vaccines were provided free of cost in all government hospitals and clinics. Despite such global success and increased life expectancy, it is believed that vaccines are still not properly administered in Malaysia especially in rural areas, and mostly among Malays Muslims. It is believed that the lack of Knowledge and parental misperceptions toward vaccination may be the major barriers for low vaccination coverage especially in the rural areas. Studies have shown that the government has been largely successful in increasing the vaccination coverage by hosting immunization program, the program was to ensure that the parents were imparted adequate Knowledge and understanding for vaccines. There is enough literature to envisage that the knowledge and belief of parents greatly drive the vaccination process of their kids.² Numerous studies have been conducted to unearth the reasons as to why the parents especially the Muslims refuse, delay or hesitate to vaccinate their children. Among all, one of the most pertinent factors cited among Muslim parents is the religious and personal beliefs that source of the vaccine may not be halal. The major reason for this belief may be that the vaccine may have some components from pork. Government in Malaysia has organized forums and talks to eliminate this belief and have encouraged parents to vaccinate their children. Although good coverage of Diphtheria, Pertussis and Tetanus (DPT) has been reported but still minor cases do emerge warranting to check the Attitude and Perception of Muslim parents in Malaysia.³ It is envisaged that the parents will ensure the health and wellbeing of their children, and hence vaccination should be considered an important aspect to ensure that the children are safe from many fatal diseases.⁴ However, for few notable reasons such as poor knowledge, and halal factor may still lead to refusal and hesitancy of few parents toward childhood vaccination in Malaysia. This may cause an increase of vaccine-preventable diseases especially in Muslim families. The aim of this present study is to examine the Knowledge, Attitude and Perception (KAP) of Malaysian Muslim parents toward vaccination process. The study will also examine the possible reason for vaccine hesitancy, if any among the Malaysian Muslim parents toward vaccination process.

Methods

This is a descriptive, explorative cross-sectional study among Malaysian Muslims parents. The study was conducted for 3 months from 1^st March 2019 to 31^st May 2019. The participants selected were Muslims who had children irrespective of their marital status and ethnicity. The participations of the respondents were voluntary as they did not receive any incentive, awards or gifts. The protocol for the study was accordingly approved by the ethical committee of e University Kuala Lumpur Royal College of Medicine Perak.

The questionnaire for the study was designed after a thorough literature review of similar studies conducted in Malaysia.^5,6 Content validity of the questionnaire was ascertained by a panel of three experts in the related field. The sample size was realized by Rao soft, an estimate of 506 samples size was measured with a response ration of 50%, confidence level 95% and margin of error 5%. 444 participants were recruited for the study, a success recruitment of 87.7%. Respondents were conveniently selected regardless of gender, marital status, age occupation, location, income and education level. The responses of the participants were filtered using the inclusion and exclusion criteria.

Inclusion criteria:

1. Malaysian Muslim citizens.

2. Married or Divorce but having a child.

Exclusion criteria

1. Those not willing to participate in the survey.

2. Overseas Muslims living in Malaysia.

3. Unmarried Malaysian Muslims citizens.

A pilot test with 20 respondents was conducted and the internal consistency for 20 items measuring Attitude and Perception of the respondents was validated by using Cronbach’s alpha. The structural validity was ascertained by exploratory factor analysis using principal component analysis factoring. Varimax rotation was applied, based on Kaiser-Meyer-Olkin and Bartlett’s test of sphericity.

The questionnaire enclosed sociodemographic determinants denoted as gender, age, marital status, education level, occupation, income, urban/rural, number of children, state/territory, and school going children. The survey was subdivided into four segments containing 39 questions. The first segment of consisted questions related to demographic information of the participants. The second segment ranked the Knowledge of Muslim parents toward vaccination process via dichotomous response (‘Yes’ and ‘No’). The third and the fourth segment adjudicated the Attitude and Perception of the Muslim parents toward vaccination process using a 5-point Likert scale of agreement with 1 for Strongly Disagree, 2 for Disagree, 3 for Neutral, 4 for Agree and 5 for Strongly Agree. This structured interview was carried out using google forms, and it was fully documented.

The data were collected for 444 respondents through google forms in a Microsoft Office Excel spreadsheet. Descriptive statistics were used to define and summarize the characteristics of the variables. One mark was awarded for every correct knowledge answer and zero mark was awarded for incorrect views. The Knowledge score ranged from 0 to 10 with the maximum score of 10 and a minimum score of 0. The mean Knowledge score of the recruited Malaysian Muslim parents was measured as 8.75 and median score was calculated as 9. A cumulative score of <9 was adjudged as poor Knowledge while a score of ≥9 was measured as good Knowledge. The Attitude and Perception of Malaysian Muslim parents toward vaccination process were measured on 5-point Likert scale. The measurement for attitude scale ranged from a score of 45 to 9. The median score was equated as 44 and the average score was calculated as 41.70. Attitude score of <44 was applied as negative and an Attitude score of ≥44 was calculated as positive. The scaled measurement for Perception ranged from maximum 50 to minimum 10. The mean score was calculated as 29.80 and the median value of 30. A score of <30 was considered negative Perception and score of ≥30 were considered positive Perception. Logistic regression analysis was used to determine the association between independent variables (demographic characteristics) and dependent variables (Knowledge, Attitudes and Perception). A P-value of less than 0.05 was reported as statistically significant. Minitab18 Trial version was used to analyze the data. Spearman correlation was used to analyze the association between the variables.

All the respondents were briefed about the aim of the study and personal consent was taken from the participants. The data were dealt with high level of confidentiality and anonymity.

Results

The internal consistency of the questionnaire for Attitude and Perception of Muslim parents toward vaccination process for 20 items was scaled as 0.823 using Cronbach’s alpha. The score indicated high internal consistency. The inter-item correlation matrix was scaled above 0.3 indicating the suitability of factoring. The Kaiser Olkin Measure of sampling adequacy (KMO = 0.938) and Bartlett’s test for sphericity (χ² = 6033.396, df = 190, p < .01) indicates adequate sampling. The Exploratory Factor Analysis (EFA) using PCA with varimax rotation resulted in a two-factor solution (Attitude and Perception) that accounted 57% of the variance (eigenvalues 47.46, 10.04). On the basis of the pilot test the questionnaire, one question was dropped and other questions were modified to meet the compatibility of local settings and to suit the participants.^7–9 The details are listed in Table 1. Knowledge and Perception were not found to be associated with the study (Spearman correlation = −0.022, p-value = 0.641). A strong association between Attitude and Perception (Spearman correlation = 0.132, p-value = 0.005) and Knowledge and Attitude (Spearman correlation = −0.261, p-value = 0.000) was observed depicting that the positive Knowledge may change the negative perception of the people and make them compliant toward the vaccination process .

Table 1. Factor analysis and internal consistency of 19 items on attitude and perception toward immunization

Questions	Components		Corrected Item-Total Correlation	Cronbach’s Alpha if Item Deleted
	1	2
A1. Do you agree with the vaccination program of the government?	0.872		0.84	0.929
A2. Do your children completed the vaccination schedule?	0.754		0.716	0.933
A3. Vaccine administration in infants and children is important.	0.868		0.841	0.93
A4. All vaccines are safe for children.	0.809		0.791	0.93
A5. It is important to follow the vaccination schedule.	0.784		0.748	0.932
A6.Vaccine are more beneficial than harmful to the children.	0.871		0.858	0.929
A7. Immunization can keep your children healthy.	0.864		0.847	0.929
A8.Vaccination can trigger children’s immune system to fight the diseases.	0.848		0.808	0.93
A9. Children with no vaccines tends to infect with the serious diseases.	0.668		0.629	0.935
P1. You totally accept childhood vaccination process.	0.812		0.782	0.931
P2. You totally refuse childhood vaccination process.		0.562	0.518	0.802
P3. Immunization should be given at the early stage of birth.	0.720		0.712	0.932
P4. Vaccination is prohibited in Islam.		0.757	0.625	0.772
P5. There is no side effect after administered vaccine to your children.	0.576		0.52	0.941
P6. Your children have showed a good attitudes after getting vaccination.	0.704		0.682	0.933
P7. Your children experienced critical diseases after getting vaccination.		0.697	0.574	0.786
P8. In case of emergence of vaccine preventable diseases, non-vaccinated children should be quarantined as they seriously infected.	0.471		0.436	0.944
P9. All vaccines are non halal and hence should be avoided.		0.776	0.626	0.772
P10. Vaccine may cause impotency and hence should not be used.		0.785	0.679	0.754

Factor loading with absolute values less than 0.3 has been omitted. Extraction by principal component analysis; rotation method by varimax with kaiser normalization

Majority of the respondents were females (71.85%) and as most of them were married (89.41%), majority of the respondents were above the age of 25 (89.86%). Most of the respondents were working (75.68%), living in urban area (76.08%) and had a university degree (84.91%). The details of the demographic determinants are listed in Table 2. Binomial and multivariate regression analysis was used to predict whether the selected variable significantly affected the Knowledge, Attitude and Perception of Muslim parents toward vaccination process. Marital status, education level, occupation, number of children and the parents to school going children were found to be significant predictor of knowledge. Those having university degree had good Knowledge than secondary school certificates (OR = 1.22; 1.01–1.47, p < .05). Parents living in the town had good Knowledge than those living in the villages (OR = 1.97; 1.63–2.39, p < .05). The details of the variable significantly affecting knowledge have been listed in Table 2. Majority of the respondents had a very positive Attitude as 85.4% of the Muslim parents strongly agree with the idea of vaccine administration in infants. 82% of the respondents also strongly agreed to follow the vaccination schedule. Majority of the respondents have a good perception toward vaccination schedule, 71.4% of the Muslim parents strongly disagreed that the vaccines are not halal. It was observed that 64% of the parents also rejected the rumored theory that vaccines may cause impotency. A substantive number of the respondents (74.5%) strongly agreed that vaccination should be started right after the childbirth. None of the variables describing Attitude and Perception toward vaccination was associated with the sociodemographic determinants and hence the null hypothesis that the “Muslim parents are aware, and they have a positive Attitude and Perception for vaccination process” was accepted. The details are listed in Tables 3-5.

Table 2. Socio-demographic distribution and association of demographics characteristics and Knowledge of Malaysians Muslim parents toward immunization

Particulars	Description	Numbers	Percentage	Good (%)	Poor (%)	odd ratio	p
Gender	Male	125	28.15	67.20	32.80	0.8777 (0.7582, 1.0161)	0.082
	Female	319	71.85	65.83	34.17	Reference
Age	>25	45	10.14	66.67	33.33	0.9343 (0.7537, 1.1582)	0.054
	<25	399	89.86	66.17	33.83	Reference
Marital	Married	397	89.41	59.45	33.75	1.1280 (0.9183–1.3856)	0.026
	Single	47	10.59	65.96	34.04	Reference
Education Level	College	67	15.09	61.40	38.60	1.35(1.12–1.64)	0.002
	Secondary	377	84.91	53.73	46.27	1.22 (1.01–1.47)	0.038
	University	336	75.68	69.69	30.31	Reference
Occupation	Working	108	24.32	66.67	33.33	1.2513 (1.0740–1.4578)	0.004
	Not working	31	6.98	64.81	35.19	Reference
Income	Below than RM 1000	413	93.02	74.19	25.81	0.9115 (0.7100–1.1702)	0.475
	RM 1000 and more	341	76.80	65.62	34.38	Reference
Urban/rural	Town	103	23.20	67.45	32.55	1.9788 (1.6326, 2.3984)	0
	Village	137	30.86	62.14	37.86	Reference
Number of children	More than 2	307	69.14	67.15	32.85	1.4443 (1.2169, 1.7143)	0
	Less than 2	339	76.35	62.54	37.46	Reference
Children gping to school	Yes	105	23.65	65.78	34.22	1.3343 (1.1416, 1.5596)	0
	No	18	4.05	67.62	32.38	Reference
States wise sample distribution	Terenganu	157	35.36	55.56	44.44	1.06 (0.69–1.63)	1.06
	Selangor	3	0.68	64.33	35.67	0.82 (0.58–1.17)	0.82
	Sarawak	3	0.68	33.33	66.67	0.85 (0.28–2.54)	0.85
	Sabah	12	2.70	33.33	66.67	1.08 (0.42–2.77)	1.08
	Penang	4	0.90	83.33	16.67	0.52 (0.28–0.99)	0.52
	Perlis	54	12.16	50.00	50.00	0.73 (0.31–1.72)	0.73
	Perak	18	4.05	70.37	29.63	0.96 (0.66–1.40)	0.96
	Negeri Sembilan	77	17.34	66.67	33.33	0.98 (0.63–1.54)	0.98
	Johor	18	4.05	70.13	29.87	0.83 (0.58–1.20)	0.83
	Kedah	31	6.98	77.78	22.22	0.77 (0.47–1.25)	0.77
	Kelantan	24	5.41	54.84	45.16	1.14 (0.77–1.67)	1.14
	Kuala Lumpur	6	1.35	62.50	37.50	0.83 (0.53–1.29)	0.83
	Mealak	19	4.28	50.00	50.00	0.74 (0.38–1.47)	0.74
	Pahang	125	28.15	73.68	26.32	Reference

Table 3. Association of demographics characteristics and Attitude of Malaysians Muslims toward immunization process

Particulars	Description	Good (%)	Poor (%)	odd ratio	p
Gender	Male	67.20	32.80	1.0269(0.9928–1.0623)	0.129
	Female	65.83	34.17	Ref
Age	>25	66.67	33.33	1.0287(0.9810–1.0787)	0.265
	<25	66.17	33.83	Ref
Marital	Married	59.45	40.55	0.9669 (0.9228–1.03)	0.181
	Single	65.96	34.04	Ref
	College	61.40	38.60	0.97 (0.93–1.011)	0.161
Education Level	Secondary	53.73	46.27	0.97 (0.93–1.011)	0.148
	University	69.69	30.31	Ref
Occupation	Working	66.67	33.33	0.9840 (0.9492–1.0201)	0.388
	Not working	64.81	35.19	Ref
Income	Below than RM 1000	74.19	25.81	1.0350 (0.9833–1.0894)	0.216
	RM 1000 and more	65.62	34.38	Ref
Urban/rural	Town	67.45	32.55	0.977 (0.9438–1.0128)	0.218
	Village	62.14	37.86	Ref
Number of children	More than 2	67.15	32.85	0.9785 (0.9329–1.0095)	0.12
	Less than 2	62.54	37.46	Ref
Children gping to school	Yes	65.78	34.22	1.092 (0.9707–1.0492)	0.641
	No	67.62	32.38	Ref
States wise sample distribution	Terenganu	55.56	44.44	Ref
	Selangor	64.33	35.67	1.05 (0.95–1.15)	0.371
	Sarawak	33.33	66.67	1.04 (0.91–1.12)	0.298
	Sabah	33.33	66.67	1.35 (0.75–2.43)	0.314
	Penang	83.33	16.67	1.23 (0.74–2.02)	0.423
	Perlis	50.00	50.00	1.08 (0.93–1.26)	0.319
	Perak	70.37	29.63	1.15 (0.84–1.57)	0.373
	Negeri Sembilan	66.67	33.33	1.02(0.94–1.10)	0.094
	Johor	70.13	29.87	1.03(0.93–1.14)	0.13
	Kedah	77.78	22.22	1.05(0.97–1.13)	0.277
	Kelantan	54.84	45.16	1.05(0.094–1.17)	0.36
	Kuala Lumpur	62.50	37.50	1.01(0.93–1.09)	0.85
	Mealak	50.00	50.00	1.03 (0.93–1.14)	0.536
	Pahang	73.68	26.32	1.00(0.88–1.14)	0.995

Table 4. Association of demographics characteristics and Perception of Malaysians Muslims toward immunization process

Particulars	Description	Good	Poor	odd ratio	p
Gender	Male	54.40	45.60	0.9641(0.9180–1.0125)	0.147
	Female	54.55	45.45	Ref
Age	>25	53.33	46.67	0.9396(0.880–1.0031)	0.074
	<25	54.64	45.36	Ref
Marital	Married	54.91	45.09	1.093 (1.0286–1.16)	0.06
	Single	51.06	48.94	Ref
Education Level	College	52.63	47.37	0.96(0.89–1.03)	0.247
	Secondary	55.22	44.78	0.99 (0.92–1.03)	0.689
	University	54.69	45.31	Ref
Occupation	Working	52.68	47.32	1.0481 (0.9966–1.223)	0.071
	Not working	60.19	39.81	Ref
Income	Below than RM 1000	45.16	54.84	0.9822 (0.9014–1.074)	0.687
	RM 1000 and more	55.21	44.79	Ref
Urban/rural	Town	54.55	45.45	1.0115 (0.9591–1.0668)	0.676
	Village	54.37	45.63	Ref
Number of children	More than 2	54.01	45.99	0.9697(0.9238–1.0178)	0.9697
	Less than 2	54.72	45.28	Ref
Children gping to school	Yes	55.16	44.84	0.086 (0.72–1.03)	0.996
	No	52.38	47.62	Ref
States wise sample distribution	Terenganu	27.78	72.22	Ref
	Selangor	51.59	48.41	0.86 (0.72–1.03)	0.112
	Sarawak	33.33	66.67	0.97 (0.86–1.10)	0.679
	Sabah	33.33	66.67	0.89(0.56–1.11)	0.619
	Penang	33.33	66.67	1.02(0.76–1.37)	0.902
	Perlis	50.00	50.00	0.99 (0.82–1.19)	0.918
	Perak	61.11	38.89	1.05 (0.85–1.30)	0.635
	Negeri Sembilan	66.67	33.33	0.97 (0.85–1.11)	0.666
	Johor	62.34	37.66	0.98 (0.84–1.16)	0.836
	Kedah	44.44	55.56	1.02 (0.90–1.15)	0.782
	Kelantan	45.16	54.84	0.91 (0.76–1.09)	0.308
	Kuala Lumpur	54.17	45.83	0.093 (0.80–1.08)	0.348
	Mealak	83.33	16.67	1.05 (0.91–1.21)	0.51
	Pahang	63.16	36.84	1.07 (0.89–1.28)	0.474

Table 5. Malaysian Muslim parents Attitude and Perception immunization process

Perception		SD (%)	D(%)	N(%)	A(%)	SA(%)
		1	2	3	4	5
P1	You accept the childhood vaccination process.	6 (1.4)	5 (1.1)	17(3.8)	52(11.7)	364(82)
P2	You refuse childhood vaccination process	347(78.2)	46(10.4)	22(5.0)	7(1.6)	22(5.0)
P3	Immunization should be given at the early stage of birth.	12(2.7)	3(0.7)	26(5.9)	72(16.2)	331(74.5)
P4	Vaccination is prohibited in Islam.	317(71.4)	51(11.5)	43(9.7)	16(3.6)	17(3.8)
P5	There is no side effect after administered vaccine to your children.	22(5)	30(6.8)	90(20.3)	116(26.1)	186(41.9)
P6	Your children have showed a good attitude after getting vaccination.	13(2.9)	1(0.2)	71(16)	134(30.2)	225(50.7)
P7	Your children experienced critical diseases after getting vaccination.	303(68.2)	71(16)	30(6.8)	19(4.3)	21(4.7)
P8	In case of emergence of vaccine preventable diseases, non-vaccinated children should be quarantined as they seriously infected.	24(5.4)	18(4.1)	76(17.1)	92(20.7)	234(52.7)
P9	All vaccines are non halal and hence should be avoided.	260(58.6)	69(15.5)	68(15.3)	15(3.4)	32(7.2)
P10	Vaccine may cause impotency and hence should not be used.	284(64)	61(13.7)	69(15.5)	6(1.4)	24(5.4)
Attitude		SD (%)	D(%)	N(%)	A(%)	SA(%)
		1	2	3	4	5
A1	Do you agree with the vaccination program of the government?	7(1.6)	2(0.5)	17(3.8)	69(15.5)	349(78.9)
A2	Have you completed the vaccination schedule for your child/children?	8(1.8)	2(0.5)	14(3.2)	56(12.6)	364(82)
A3	Vaccine administration in infants and children is important.	5(1.1)	4(0.9)	11(2.5)	45(10.1)	379(85.4)
A4	All vaccines are safe for children.	8(1.8)	6(1.4)	50(11.3)	90(20.3)	290(65.3)
A5	It is important to follow the vaccination schedule.	6(1.4)	1(0.2)	15(3.4)	58(13.1)	364(82)
A6	Vaccines are more beneficial than harmful to the children.	7(1.6)	2(0.5)	26(5.9)	73(16.4)	336(75.7)
A7	Immunization can keep your children healthy.	6(1.4)	5(0.5)	25(5.6)	93(20.9)	318(71.6)
A8	Vaccination can trigger children’s immune system to fight the diseases.	7(1.6)	3(0.7)	16(3.6)	96(21.6)	322(72.5)
A9	Children with no vaccines tends to infect with the serious diseases.	14(3.2)	6(1.4)	44(9.9)	91(20.5)	289(65.1)

Discussion

Lately a surge in vaccine-preventable disease in Malaysia has warranted the need to understand the KAP of the majority Muslim population in Malaysia.¹⁰ Many research have been conducted to analyze the reasons for vaccine refusal especially among Malaysian citizens but limited studies have addressed the status of Malaysian Muslim parents toward vaccination process.¹¹ Single or divorced parents had comparatively better Knowledge and belief of childhood vaccination. The study was in contrast with the previous study that marital status is not associated with the child vaccination process.¹² Parents education was associated with the Knowledge of vaccination process, poor Knowledge may contribute to build a negative Attitude and Perception toward vaccination. Similar results were exhibited in Senegal and Eritrea where mothers who were educated till secondary level and attended minimum four antenatal classes showed compliance toward vaccination.^13,14 Low education level may contribute to the low vaccination coverage in rural areas. Similar pattern of vaccination was observed in Peshawar which was attributed to low Knowledge and awareness of the vaccination process.¹⁵ Our study also indicated that parents living in urban areas have better Knowledge and awareness than the rural areas and hence may comply with the recommended vaccination process.¹⁶ Parents of school going children may improve vaccination process as the awareness program in the school may improve vaccination coverage as was also observed among migrants children going to school in Tibet Myanmar border.¹⁷ Socio economic status may be a reason for limited coverage among school going children.¹⁸ A study contributed that parent’s Knowledge may be important contributor for positive Attitude and good Perception about immunization and vaccination. The Spearman correlation showed significant association between knowledge and attitude, assuring that good Knowledge will directly affect the Attitude of parents toward vaccination.¹⁹

Our study imputed that Malaysian Muslim parents exhibited a positive Attitude and a good Perception toward vaccination process which coincided with the previous studies.²⁰ A 15% negative Perception toward the safety and efficacy toward vaccine was measured among the Indonesians citizens. Our study also comprised items such as “vaccines may cause impotency and hence should be used” and “all vaccines are safe for children” which measured disagreement at 6.8% and 3.2%, respectively. Only 9% of the total respondents agreed that children experienced critical disease after vaccination.²¹ 82% of Muslim Parents accepted to immunize their children early whereas only 5% hesitate to vaccinate. 71.4% of the respondents rejected the belief that “vaccine is not permissible in Islam due to halal issue”. Neither Attitude nor Perception was significantly associated with any of the sociodemographic determinants and hence it was concluded that the Malaysian Muslims comply with the vaccination process.²²

Even though our study has addressed a major opinion of the Malaysian Muslim parents, but the study was still limited as the opinion of the current study cannot be generalized. The study may be more be robust if participants from east Malaysia are also included, as west Malaysia is considered more developed than the east Malaysia. Our data included parents only from west Malaysia. The data presented are more applicable to urban parents. Further studies consisting of bigger sample size may be more representable, albeit our study addresses a major opinion of Malaysian Muslims toward vaccination process.

Conclusion

Our research study rejects the popular belief that Muslim parents are vaccine hesitant due to negative Attitude and Perception and limited Knowledge and invalid religious belief. Our study proves that majority of the Malaysian Muslim parents have positive Attitude and Perception toward childhood vaccination process. However, there is still a need to educate people that vaccine is safe and halal as a minority of the parents believe that it should not be recommended due to halal issues.

Disclosure of potential conflicts of interest

No potential conflicts of interest were disclosed.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.