Factors Associated with Childhood Vaccine Hesitancy or Refusal in Malaysia: A Systematic Review

Abstract

Vaccine hesitancy and refusal have emerged as a significant public health concern worldwide. In Malaysia, despite the long establishment of the National Immunization Programme (NIP) since the early 1950s, childhood vaccine refusal cases are showing an upgoing trend. This has led to resurgence of vaccine-preventable diseases like measles and diphtheria in recent years. This systematic review aims to synthesize existing evidence on the prevalence and factors associated with childhood vaccine hesitancy or refusal in Malaysia. A comprehensive literature search was conducted across electronic databases including Scopus, ScienceDirect, and PubMed. The review followed PRISMA 2020 guidelines. Eligibility criteria included English-language articles published between 2015 and 2025, focusing on parental hesitancy or refusal on childhood vaccination in Malaysia. The quality of included studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal tool. The review included six high-quality studies done in Malaysia. Prevalence of childhood vaccine hesitancy in the studies ranged from 6.8% - 11.6%. Key risk factors identified included sociodemographic characteristics (parental employment status, education level, religion and parity), concern about vaccine safety, knowledge and awareness about vaccines, cultural and religious belief, mistrust in healthcare system / modern medicine, external influence and risk perception. In order to sustain high immunisation coverage in the country, implementation of culturally sensitive, evidence-based strategies that strengthen public trust, enhance provider communication and counter misinformation is essential.