Introduction: Pakistan remains one of the three polio-endemic countries in the world due to Illiteracy, religious beliefs, conflicts and security issues hindering vaccination efforts. Parental refusal or hesitancy towards vaccinating their children along with low coverage of polio vaccination in high conflict areas remain key problem areas.Objectives: To assess the awareness regarding polio vaccination, and to identify the reasons of parental hesitancy towards oral polio vaccination.Materials & Methods: A cross-sectional survey that included 100 participants was conducted in Jamrud (Khyber Agency) from October 2017 to December 2017. Indigenously structured questionnaire was used for recording data in Khyber Agency through convenience sampling. Questions related to awareness, attitude, practice and reasons for hesitancy regarding polio vaccination. SPSS version 16.0 and Microsoft Excel were used for organizing and analyzing data for descriptive statistics.Results: Of the 100 study subjects, 49% were uneducated and only 2% had a positive family history of polio. Overall awareness regarding polio vaccination was poor; only 27% of study participants knew that immunization was effective for prevention and 24% considered vaccine repetition as necessary. The leading reasons given by 24% were that it causes infertility in male children, 16% had lack of trust on quality of vaccine, and 16.6% reported lack of trust on health workers. Religious belief was also one of the reason of hesitancy recorded to be 14.1%. Some participants (10.7%) recorded security issues as their reason of vaccine hesitancy. About 9.5% responded non-compliant spouse as their reason whereas 9.2% considered that vaccination was not necessary. Conclusion: Lack of awareness and education were the main reasons behind misperception of subjects towards polio immunization, followed by fears of infertility and religious beliefs. Keywords: Polio - Global Polio Eradication Initiative (GPEI), Oral Polio Vaccine (OPV), Immunization & Hesitancy.

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