Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 51739

AbstractMaterial and MethodsResultsDiscussionConclusionAcknowledgementReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : March | Volume : 17 | Issue : 3 | Page : LC01 - LC05 Full Version

COVID-19 Vaccine Acceptance and its Associated Factors among Pregnant and Lactating Women in Coastal Karnataka, India: A Cross-sectional Study

Published: March 1, 2023 | DOI:
Shahul Hameed, K Chethana, Shahla Ahmed Shaffi, Thouseep, KG Kiran

1. Professor, Department of Community Medicine, Kanachur Institute of Medical Sciences, Mangaluru, Karnataka, India. 2. Associate Professor, Department of Community Medicine, Kanachur Institute of Medical Sciences, Mangaluru, Karnataka, India. 3. Tutor, Department of Community Medicine, Kanachur Institute of Medical Sciences, Mangaluru, Karnataka, India. 4. Tutor, Department of Community Medicine, Kanachur Institute of Medical Sciences, Mangaluru, Karnataka, India. 5. Professor, Department of Community Medicine, Kanachur Institute of Medical Sciences, Mangaluru, Karnataka, India.

Correspondence Address :
K Chethana,
Associate Professor, Department of Community Medicine, Kanachur Institute of Medical Sciences, Natekal, Mangaluru, Karnataka, India.


Introduction: Coronavirus Disease 2019 (COVID-19) has become a global threat. Despite the hazard of the pandemic and availability of COVID-19 vaccines, a major hindrance exists related to vaccine hesitancy. The acceptance of vaccine among pregnant and lactating women widely differs in countries.

Aim: To assess the COVID-19 vaccine acceptance and the factors influencing it among pregnant and lactating women.

Materials and Methods: A cross-sectional study was conducted at four selected Primary Health Centres (PHCs) of Dakshina Kannada district, Karnataka, South India, from October 2021 to December 2021 among pregnant and lactating women. Sample size estimated was 350. Study subjects were selected by simple random sampling method. A questionnaire was developed based on the literature review and validated by two subject experts regarding knowledge of COVID-19 vaccines, perceptions, attitude and their vaccination status and information was collected using questionnaire. Perceptions and attitude were scored based on Likert scale. Predictors of COVID-19 vaccine acceptance were identified using univariate analysis. Further, multivariate regression model was used to obtain the Adjusted Odds Ratios (AOR) and Confidence Intervals (CI) using Statistical Package for the Social Sciences (SPSS) software version 27.0.

Results: Study participants included 247 (70.6%) pregnant women and 103 (29.4%) lactating women. Among them 218 (62.3%) were aware that pregnant women can take the vaccine and 184 (52.6%) were aware that lactating women can take the vaccines. Overall vaccine acceptance among the study participants was 208 (59.4%). Vaccine acceptance was significantly higher among pregnant women (AOR: 3.02; CI: 1.58-5.77), women living in nuclear families (AOR: 4.27; CI: 2.31-7.89) and those with a positive attitude (AOR: 17.48; CI: 9.52-32.09) as compared to their counterparts.

Conclusion: The study highlights that vaccine acceptance was higher in pregnant women as compared to lactating mothers. Improving the awareness and acceptance of COVID-19 vaccination to overcome the fear of vaccination would help control the disease.


Attitude, Lactation, Pregnancy, Pandemics, Vaccination, Vaccine-hesitancy

Coronavirus Disease 2019 (COVID-19), the outbreak of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was declared as a Public Health Emergency of International Concern (PHEIC) in January, 2020 (1). Since then it has become a global threat and has been crippling the health system worldwide. On 2nd December 2021, the cumulative number of confirmed cases had reached approximately 26.3 crore, with more than 52.2 lakh deaths worldwide (2).

Coronavirus disease 2019 infection during pregnancy may rapidly deteriorate the health of pregnant women and increase the risk for preterm deliveries and caesarean section. In addition to these, it has brought about an increase in the incidence of Intensive Care Unit (ICU) admissions, mechanical ventilations and even deaths due to COVID-19. Besides the rise in maternal morbidity and mortality, there has been an increase in Neonatal ICU (NICU) admissions, intrauterine foetal deaths, perinatal and neonatal deaths among children born to pregnant women with COVID-19 infection (3).

In order to curb the pandemic, major efforts by the scientific research and pharmaceutical industry backed by political will were directed towards developing safe and efficacious vaccines (4). These efforts led to the approval of three COVID-19 vaccines for emergency use in India (5). Further, vaccination for pregnant and lactating women with two of the vaccines namely, Covishield and Covaxin were introduced from 25th June 2021 (6). The country had successfully vaccinated over 2,30,000 such women with their first dose by first week of December, 2021 (7). The most common adverse effect of vaccination among pregnant women was injection site pain, which was reported in 90% of cases, while some others experienced fatigue, headache and myalgia (8). Breastfeeding women showed similar side-effects as non breastfeeding women. The infants of the breastfeeding women who got vaccinated did not show any serious side-effects, though some breastfed infants showed irritability and poor sleep for short period (9).

Despite the hazard of the pandemic and availability of COVID-19 vaccines, a major hindrance may exist related to vaccine hesitancy (10). The various barriers of vaccine acceptance in the previous studies included worrying about COVID-19, misinformation about the benefits, lack of confidence in vaccine effectiveness and safety, and persistent compliance to infection prevention guidelines even after vaccination (11),(12). COVID-19 acceptance rates across Low and Middle-income Countries (LMIC) according to surveys ranged between 66.5% and 96.6% (13). Similarly, the acceptance of COVID-19 vaccine among pregnant and lactating women widely differs in countries (14).

Acceptance of COVID-19 vaccine among pregnant and lactating women is not well established in India, particularly in the study area (15),(16). Understanding the acceptance of COVID-19 vaccine and the reasons for refusal would help to design a strategy to overcome the vaccine hesitancy. Therefore, this study was aimed to assess the COVID-19 vaccine acceptance and the factors influencing it among such women residing in coastal Karnataka in India.

Material and Methods

A cross-sectional study was conducted in four selected Primary Health Care (PHC) Centres of Dakshina Kannada district of Karnataka, South India, which was under the field practice areas of a teaching hospital, Kanachur Institute of Medical Sciences, Natekal, Mangaluru, Karnataka, India, from October 2021 to December 2021. The study was commenced after obtaining ethical clearance from Institutional Ethics Committee (IEC no. KIMS/IEC/A017/2021).

Sample size calculation: Sample size was calculated based on the findings of the study by Mose A et al., where 70.9% acceptance to COVID-19 vaccine was seen (17). Hence, considering 70.9% as p with 95% CI using formula, n=(1.96)2pq/d2 with 5% margin of error and 10% non response rate. Total sample size was 350.

Inclusion criteria: All pregnant and lactating women who attended the Outpatient Department (OPD) from selected PHCs under the teaching hospital, selected by simple random sampling method using the table of random numbers were included in the study.

Exclusion criteria: Emergency obstetric cases and women with serious illnesses were excluded from the study.

After taking informed consent from the study participants, the information was collected on a questionnaire which was developed based on the literature review and validated by two subject experts [18-21]. Questionnaire was initially prepared in English language and translated to local language which was back translated to ensure the accuracy of the translation. Further, the questionnaire was pilot tested and suitable modifications were done before its use in the study. The Cronbach’s alpha coefficient for reliability was 0.768. Each study participant was informed about the purpose, aims and objectives of the study and confidentiality of the information was assured.

The questionnaire was divided into four sections. The first section included socio-demographic details like age, educational status, religion, occupation, family status, socio-economic status, whether pregnant or lactating women, trimester of pregnancy or age of the infant in lactating women. Socio-economic status was classified based on Modified BG Prasad updated for the year 2021 (22).

The second section included knowledge related questions such as, whether they were aware of the COVID-19 vaccines, whether they were aware that pregnant and lactating women could take the vaccines and awareness regarding continuing wearing a mask and physical distancing after vaccination. A total of six questions were knowledge related and their response was recorded as ‘yes’ or ‘no’.

The third section assessed the perceptions and attitude about COVID-19 vaccines in which participants answered six questions and it was based on five item Likert scale from strongly agree to strongly disagree. The attitude was scored from six to one for positive response questions (six for strongly agreed) and in the reverse order for negative questions (one for strongly agreed). The highest score was 30 and the least was six. A score of less than 18 (the median value) was considered to be negative attitude while a score of 18 or more is considered as positive attitude.

In the last section the vaccination status with first and second dose of the vaccine were assessed and reasons for not taking the vaccine were also assessed among those who were not vaccinated even with a single dose. In this study the participants who were vaccinated with atleast one dose of COVID-19 vaccine were considered to have vaccine acceptance.

Statistical Analysis

Data collected was entered and coded in Microsoft Excel software and analysed using a Statistical Package for the Social Sciences (SPSS) software version 27.0. Descriptive statistics was presented for continuous variables and, frequency and percentage for categorical variables. Predictors of COVID-19 vaccine acceptance were identified using univariate analysis which evaluated the association between vaccine acceptance and its determinants like type of family, educational status, employment status, whether pregnant or lactating, socio-economic status and attitude towards vaccination. A p-value <0.05 was considered statistically significant. Further, explanatory variables from univariate analysis were entered into multivariate regression model to obtain the Adjusted Odds Ratio (AOR).


Among 350 study participants, 247 (70.6%) were pregnant women and 103 (29.4%) were lactating women. Majority of them,161 (46%) were in the age group of 23-27 years, followed by 28-32 years age group, that is 121 (34.5%) participants. The educational status of 161 (46%) participants was up to 10th standard and 118 (33.7%) women were working. Majority, 220 (62.9%) women lived in nuclear families. With regard to socio-economic class, according to modified BG Prasad classification for the year 2021, 146 (41.7%) and 118 (33.7%) participants belonged to class IV and class V, respectively (Table/Fig 1).

Further, among the 247 pregnant women, 50 (20.3%), 149 (60.3%) and 48 (19.4%) were in first, second and third trimesters, respectively. Also, among the 103 lactating women, 72 (69.9%) had infants less than six months and remaining 31 (30.1%) had infants above six months of age.

All the study subjects had heard about the vaccine Covishield and 319 (91.1%) participants had heard about the vaccine Covaxin against COVID-19. When enquired about vaccinating pregnant and lactating women, 218 (62.3%) were aware that pregnant women can take the vaccine and 182 (52.6%) were aware that lactating women can take the vaccines. Majority, which is 280 (80%) women were aware that they need to continue wearing mask and 278 (79.4%) of them were aware that they need to continue physical distancing after vaccination (Table/Fig 2).

Among the participants, 229 (65.5%) and 233 (66.5%) agreed that pregnant women and lactating women should be vaccinated against COVID-19, respectively. When the participants were asked regarding health education about vaccination, 242 (69.1%) agreed that it was necessary, further 281 (80.3%) participants agreed that motivation by healthcare workers would lead to better acceptance.

With regard to vaccine side-effects, 103 (29.4%) women perceived as not dangerous and 176 (50.3%) gave a neutral response. It may be noted that, 213 (60.9%) women were of the opinion that compliance to vaccination schedule was important (Table/Fig 3). Lowest and highest total score of attitude were nine and 25, respectively; with a mean score of 18.45±3.30. Overall, 203 (58%) women had a positive attitude towards vaccination.

Overall vaccine acceptance among the study participants was 208 (59.4%) (that is vaccinated with atleast one dose of COVID-19 vaccine). Further, 165 (47.1%) women had taken their 1st dose and 43 (12.3%) women completed both the doses of vaccination. Also, of the 247 pregnant women, 165 (66.8%) women were vaccinated and out of the 103 lactating mothers, 43 (41.7%) women were vaccinated.

Out of the 142 women who had not received the vaccine, the most common reasons for refusal of vaccine were fear of harm to the baby because of the vaccine 68 (47.9%) and fear of adverse effects of vaccine 53 (37.3%) (Table/Fig 4).

Univariate analysis showed that pregnant women, women with higher education, residing in nuclear families, working women and those with positive attitude had statistically significant association (p-value<0.05) with vaccine acceptance than their counterparts (Table/Fig 5).

Further, unadjusted associations of the factors influencing vaccination status were analysed. It was observed that pregnant women {Crude Odds Ratio (COR): 2.81; 95% CI: 1.75-4.51} were associated with the higher odds ratio of getting atleast one dose of vaccine as compared to lactating women. Vaccination status was considerably better in women with higher education (COR: 2.35; 95% CI: 1.52-3.63), those residing in nuclear families (COR: 3.86; 95% CI: 2.44-6.10) and working women (COR: 1.62; 95% CI: 1.02-2.57). Participants who had a positive attitude had significantly higher odds of getting vaccinated. (OR: 15.89, 95% CI: 9.35-27.00) (Table/Fig 6).

Multivariate analysis revealed that vaccine acceptance was significantly higher among pregnant women (AOR: 3.02; CI: 1.58-5.77), women living in nuclear families (AOR: 4.27; CI: 2.31-7.89) and those with a positive attitude (AOR: 17.48; CI: 9.52-32.09) as compared to their counterparts (Table/Fig 6).


With introduction of a vaccine, hesitancy towards vaccination has been reported previously and the main reasons for the same may include the compulsory nature of immunisation with vaccines, their coincidental temporal relationships to adverse health outcomes, religious reasons and unfamiliarity (23). This multifaceted vaccine hesitancy is a major obstacle that needs to be overcome for controlling a pandemic such as COVID-19.

This study assessed the COVID-19 vaccine acceptance and factors influencing vaccination among pregnant and lactating women. Among the participants, approximately 66% agreed that pregnant women and lactating women should be vaccinated against COVID-19. Overall, atleast one dose of the vaccine was received by 59.4% of the participants. Findings were similar to a study by Mose A and Yeshaneh A, where willingness to receive COVID-19 vaccine was found to be 61% and study by Riad A et al., where two-thirds of the participants (66.6%) indicated their acceptance (17),(24).

This study also showed that pregnant women had higher acceptance of vaccine (66.8%) as compared to lactating women (41.7%). Similar results were observed in studies by Riad A et al., where acceptance among pregnant women (76.6%) was higher than lactating women (48.8%) (24). Vaccine acceptance was much lower in the study by Jayagobi A et al., (30.3% in pregnant and 16.9% in lactating women), however acceptance was higher in pregnant women (18). The acceptance of COVID-19 vaccine among pregnant and lactating women widely differs in countries as stated by Skjefte M et al., (range: 28.8-84.4%) (14). The discrepancy in the different studies may be attributed to the differences in study population, awareness of COVID-19, access to healthcare services in different regions and the study period. Further, this study assessed acceptance after the expert committee approved the vaccination of pregnant and lactating women, as the vaccination programme is ongoing. Majority (80%) were aware that they need to continue COVID-19 protocols and appropriate behaviours after vaccination. Similar findings were observed in a study by Anil A et al., where 98% were ready to follow COVID-19prevention protocols even after vaccination (25).

Studies have reported that public perception of the benefits and risks of vaccination is a major obstacle for vaccine acceptance (15),(18),(24). Studies done in Singapore by Jayagobi PA et al., and Germany by Schaal NK et al., state that limited vaccination-specific information, limited scientific evidence on vaccination safety were the major concerns (18),(19). However, these studies assessed the vaccine hesitancy reasons prior to the approval of its use among pregnant and lactating women. Anxiety about adverse reactions appears to be the most common reason for hesitancy in the majority of the studies as stated by Sharun K et al., (26). This was supported by these study findings which showed that fear of vaccine associated harm to the baby (47.9%) and adverse effects of vaccine (37.3%) were major hindrances for vaccine acceptance. Report of Ayhan SG et al., stated that 41.7% perceived that the vaccine will harm the baby (20). Further report of Sutton D et al., showed similar findings (21).

Vaccination acceptance was considerably better in women with higher education (COR: 2.35; 95% CI: 1.52-3.63) and women who were employed (COR: 1.62; 95% CI: 1.02-2.57), however multivariate analysis did not show statistical significance. Studies done across different countries project the association of education and employment status with vaccine acceptance (17),(18),(20),(24). This could possibly be explained that having higher educational status and being employed makes them have better awareness regarding the benefits of vaccination. This study also found that, those who had a positive attitude towards vaccination had significantly higher odds of getting vaccinated (AOR: 17.48; CI: 9.52-32.09). Similar were the findings of Skjefte M et al., and Mose A and Yeshaneh A (14),(17). This study also found that women in nuclear families had higher vaccination rates (AOR: 4.27; CI: 2.31-7.89). It could be seen that over two-third of the participants lived in nuclear families, also as the onus of decision making in nuclear families lies in the couple there may be better chance of acceptance.

This study has identified the possible determinants of COVID-19 vaccine acceptance. Further, it is the first of its kind in the setup after the rolling out of COVID-19 vaccine for pregnant and lactating women and thus provides good information for different stakeholders. The determinants of vaccine acceptance studied are of interest as they may influence introduction of any new vaccine like COVID-19 vaccine for this segment of vulnerable population.


This study was a health institution based, conducted in PHCs, hence possibility of inflation of the findings cannot be ruled out due to on-going mitigation measures. This study was conducted in selected PHCs in a single district which may limit the generalisability of the study. Similar large scale community-based study across different districts to understand the factors for vaccine hesitancy among pregnant women and lactating women may help to address them.


The study highlights that COVID-19 vaccine acceptance was higher in pregnant women as compared to lactating mothers. Higher education status, being working women, residing in nuclear families and having a positive attitude towards vaccination were the major determinants of vaccine acceptance. Fear of vaccine associated harm to the baby and adverse effects of vaccine were found to be the major hindrances for vaccine acceptance. Increasing the awareness and acceptance of vaccination is essential especially for this segment of vulnerable population so as to control the pandemic.


Authors would like to thank the Dean of the institution for his encouragement and support. Authors would like to acknowledge the interns Dr. Shabnam Bano, Dr. Uzma MB, Dr. Vardhan M B and Dr. Ashith M V for their contribution and lastly authors would also like to acknowledge all the study participants.


Heath PT, Galiza EP, Baxter DN, Boffito M, Browne D, Burns F, et al. Safety and efficacy of NVX-CoV2373 COVID-19 vaccine. N Engl J Med. 2021;385(13):1172-83. [crossref] [PubMed]
The Times of India. Corona-virus cases in India and world live: COVID-19 India tracker live, state wise corona cases in India and world [homepage on the Internet]. [cited 2021 Dec 03]. Available from URL:
Wang CL, Liu YY, Wu CH, Wang CY, Wang CH, Long CY. Impact of COVID-19 on pregnancy. Int J Med Sci. 2021;18(3):763-67. [crossref] [PubMed]
Conte C, Sogni F, Affanni P, Veronesi L, Argentiero A, Esposito S. Vaccines against coronaviruses: The state of the art. Vaccines. 2020;8 (2):1-21. [crossref] [PubMed]
The world’s largest vaccination drive. Ministry of health and family welfare. Government of India. [cited 2021 Dec 04]. Available from URL:
Gaur A. The Times of India. Finally, pregnant women in India can take COVID shots. [cited 2021 Dec 04]. Available from URL:
New Delhi Television. Over 2.27 lac pregnant women given 1st dose of vaccine so far: Centre. [cited 2021 Nov 03]. Available from URL:
Kaur TP, Rana A, Perumal V, Sharma A, Dadhwal V, Singhal S, et al. A cross-sectional analysis to evaluate knowledge, attitude and practices among pregnant women during COVID-19 pandemic. J Obstet Gynaecol India. 2021;71(1):18-27. [crossref] [PubMed]
The Times of India. COVID vaccine for breastfeeding moms: No serious side- effects seen. [cited 2021 Dec 04]. Available from URL: https://m.timesofindia. com/life-style/parenting/pregnancy/COVID-vaccine-for-breastfeeding-moms-no-serious-side-effects-seen/amp_etphotostory/86093325.cms
Harrison EA, Wu JW. Vaccine confidence in the time of COVID-19. Eur J Epidemiol. 2020;35(4):325-30. [crossref] [PubMed]
Lazarus JV, Ratzan SC, Palayew A, Gostin LO, Larson HJ, Rabin K et al. A global survey of potential acceptance of a COVID-19 vaccine. Nat Med. 2020;27(2):225-28. [crossref] [PubMed]
Zhang J, Dean J, Yin Y, Wang D, Sun Y, Zhao Z, et al. Determinants of COVID-19 vaccine acceptance and hesitancy: A healthcare student-based online survey in Northwest China. Front Public Health. 2022;9:777565. [crossref] [PubMed]
Solis Arce JS, Warren SS, Meriggi NF, Scacco A, McMurry N, Voors M, et al. COVID-19 vaccine acceptance and hesitancy in low- and middle-income countries. Nat Med. 2021;27(8):1385-94. [crossref] [PubMed]
Skjefte M, Ngirbabul M, Akeju O, Escudero D, Diaz SH, Wyszynski DF, et al. COVID- 19 vaccine acceptance among pregnant women and mothers of young children: Results of a survey in 16 countries. Eur J Epidemiol. 2021;36(2):197-211. [crossref] [PubMed]
Gupta A, Christina S, Umar AY, Laishram J, Akoijam BS. COVID-19 vaccine hesitancy among pregnant women: A facility-based cross-sectional study in Imphal, Manipur. Indian J Public Health. 2022;66:98-103.
Kumari A, Kumari S, Kujur M, Tirkey S, Singh SA. Acceptance rate of COVID-19 vaccine and its determinants among Indian pregnant women: A hospital-based cross-sectional analysis. Cureus. 2022;14(10):e30682. [crossref]
Mose A, Yeshaneh A. COVID-19 vaccine acceptance and its associated factors among pregnant women attending antenatal care clinic in Southwest Ethiopia: Institutional-based cross-sectional study. Int J Gen Med. 2021;14:2385-95. [crossref] [PubMed]
Jayagobi PA, Ong C, Thai YK, Lim CC, Jiun SM, Koon KL, et al. Perceptions and acceptance of COVID-19 vaccine among pregnant and lactating women in Singapore: A cross-sectional study. Med Rxiv. 2021[Advance online publication]. [cited 2021 Jan 05]. Available from URL: [crossref] [PubMed]
Schaal NK, Zollkau J, Hepp P, Fehm T, Hagenbeck C. Pregnant and breastfeeding women’s attitudes and fears regarding the COVID-19 vaccination. Arch Gynecol Obstet. 2021; 27:1-8. [crossref] [PubMed]
Ayhan SG, Oluklu D, Atalay A, Beser DM, Tanacan A, Tekin OM, et al. COVID-19 vaccine acceptance in pregnant women. Int J Gynecol Obstet. 2021;154(2):291-96. [crossref] [PubMed]
Sutton D, D’Alton M, Zhang Y, Kahe K, Cepin A, Goffman D, et al. COVID- 19 vaccine acceptance among pregnant, breastfeeding, and non pregnant reproductive-aged women. Am J Obstet Gynecol MFM. 2021;3(5):100403. [crossref] [PubMed]
Khairnar MR, Kumar PG, Kusumakar A. Updated B.G. Prasad socioeconomic status classification for the year 2021. J Indian Assoc Public Health Dent. 2021;19:154-55. [crossref]
Salmon DA, Dudley MZ, Glanz JM, Omer SB. Vaccine hesitancy: Causes, consequences, and a call to action. Am J Prev Med. 2015;49(6):S391-98. [crossref] [PubMed]
Riad A, Jouzova A, Ustun B, Lagova E, Hruban L, Janku P et al. COVID-19 Vaccine acceptance of pregnant and lactating women (PLW) in Czechia: An analytical cross-sectional study. Int J Environ Res Public Health. 2021;18(24):13373. [crossref] [PubMed]
Anil A, Sharafudeen S, Krishna A, Rajendran R, James JM, Kuruvilla S, et al. Acceptance and concerns regarding COVID-19 vaccination in Kerala, India. Public Health Toxicol. 2021;1(1):5. [crossref]
Sharun K, FasluRahman CK, Haritha CV, Jose B, Tiwari R, Dhama K. COVID- 19 vaccine acceptance: Beliefs and barriers associated with vaccination among the general population in India. J Exp Biol Agric Sci. 2020;8(Spl-1- SARS-CoV- 2):S210-18. [crossref]

DOI and Others

DOI: 10.7860/JCDR/2023/61892.17568

Date of Submission: Nov 26, 2022
Date of Peer Review: Jan 17, 2023
Date of Acceptance: Feb 16, 2023
Date of Publishing: Mar 01, 2023

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: Nov 20, 2022
• Manual Googling: Feb 03, 2023
• iThenticate Software: Feb 14, 2023 (16%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)