Fear, trust, and safety perceptions as key drivers of parental acceptance of typhoid conjugate vaccine uptake among urban slum parents in Dhaka City Corporation,Bangladesh: a cross-sectional study

Abstract Background Typhoid fever is a public health concern in Bangladesh; among children younger than 15 years old, it contributes to two-thirds of the fatality rate. Studies show that the burden of typhoid fever is substantially higher in densely populated low-income urban settlements (slums). To address this situation, the Government of Bangladesh conducted nationwide typhoid conjugate vaccine (TCV) campaigns in October and November 2025. This study aimed to evaluate the role of parental knowledge, trust, and the relationship between immunization status and social or personal perspectives to strengthen routine immunization in the urban slum population in Dhaka city. Methods This cross-sectional study was conducted among slum dwellers, parents, and caregivers of children aged nine months to fourteen years in two city corporations of Dhaka using a structured questionnaire. The questionnaire consisted of two sections: demographic information, awareness, parental attitude, vaccination status, and Vaccine Attitude Scale (VAS). Bivariate and multivariate logistic regression analyses were conducted to investigate the relationship. Results A total of 446 parents/caregivers participated in the study. Among these participants, 69% of the children were vaccinated. Most participants believed that the TCV was safe (91%). Approximately 36% of parents expressed fear about the vaccine, with 33% fearing the side effects. In the 14-item VAS, 53% of the parents had a low score, between 0 and < 31. Participants with a low VAS score (< 31) were significantly more likely to have their children vaccinated than those with high scores. Comprehensive parental knowledge was significantly associated with higher odds of TCV uptake (aOR = 3.36; 95%CI: 1.25-9.00). Participants with the belief that the vaccine was safe (aOR = 17.3; 95% CI: 1.89-159.86) and trust in the campaign information (aOR = 15.49; 95% CI: 1.85–29.47) were significantly more likely to vaccinate their children. Conclusions Despite relatively high TCV uptake, fears and concerns related to vaccination remained important barriers among the parents and caregivers. To enhance both TCV acceptance and coverage among the underserved urban population, we need to focus on strengthening vaccine confidence through targeted risk communication and improving trust in vaccine campaigns.