Factors Contributing to Refusal of Testing in the Pediatric COVID-19 Suspect Population
DOI:
https://doi.org/10.52206/jsmc.2025.15.2.1144Abstract
Background: Coronavirus has been declared a pandemic, and strategies like vaccination, social distancing, and extensive testing have played crucial roles in controlling its spread. Diagnosing COVID-19 in children is particularly challenging due to their susceptibility to upper respiratory tract infections. Studies have indicated that suspected patients often refuse COVID-19 testing.
Objective: This study aimed to identify pediatric patients whose parents refused COVID-19 testing despite clinical symptoms and physicians' advice and to highlight significant factors contributing to this refusal.
Material and Methods: A cross-sectional descriptive study was conducted at the Department of Pediatrics, Abbasi Shaheed Hospital, Karachi. After consent was obtained, data was collected from the parents of 146 pediatric patients suspected of having COVID-19 using a predesigned proforma. Both quantitative and qualitative data were analyzed.
Results: The study showed that 78% (114) of parents refused COVID-19 testing for their children, while 22% (32) agreed. The primary reasons for refusal were: parents believing their child had another illness despite medical advice, fear of side effects, lack of knowledge, fear of quarantine, illiteracy, viewing COVID-19 as a social taboo, and fear of a positive test result.
Conclusion: Illiteracy and lack of knowledge were major factors contributing to testing refusal and influenced other reasons as well. Through social and electronic media, it is essential to increase awareness and reduce the fear associated with the disease. Clinicians can play a significant role in educating parents. Enhancing awareness and alleviating fear may lead to greater testing acceptance, contributing to accurate disease statistics and benefiting future research.
Keywords: COVID-19, Illiteracy Quarantine, Refusal, Testing.
References
Saqlain M, Munir MM, Ahmed A. Is Pakistan prepared to tackle the coronavirus epidemic? Drugs Ther Perspect. 2020;36(5):213–214. https://doi.org/10.1007/s40267-020-00721-1
Moneshwaran S, Macrin D, Kanagathara N. An unprecedented global challenge, emerging trends and innovations in the fight against COVID-19: a comprehensive review. International Journal of Biological Macromolecules. 2024 Apr 3:131324. http://doi.org/10.1016/j.ijiomac.2024.131324
Kanipakam Y, Nagaraja V, Gandla BM, Arumugam SD. A review on COVID-19 outbreak: An unprecedented threat to the globe. Journal of Scientific Dentistry. 2021 Jul 1;11(1):37-41. https://doi.org/10.5005/jp-journals-10083-0942
Syangtan G, Bista S, Dawadi P, Rayamajhee B, Shrestha LB, Tuladhar R, et al. Asymptomatic SARS-CoV-2 carriers: a systematic review and meta-analysis. Frontiers in public health. 2021 Jan0;8:587374. https://doi.org/10.3389/fpubh.2020.587374
Delikhoon M, Guzman MI, Nabizadeh R, Norouzian Baghani A. Modes of transmission of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) and factors influencing on the airborne transmission: A review. International journal of environmental research and public health. 2021Jan;18(2):395. https://doi.org/10.3390/ijerph18020395
Kordyukova LV, Shanko AV. COVID-19: myths and reality. Biochemistry (Moscow). 2021 Jul;86(7):800- 17. https://doi.org/10.1080/17476348.2022.2030224
Tang JW, Bahnfleth WP, Bluyssen PM, Buonanno G, Jimenez JL, Kurnitski J, et al. Dismantling myths on the airborne transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV- 2). Journal of Hospital Infection. 2021 Apr 1;110:89- 96. https://doi.org/10.1016/j.jhin.2020.12.022
Chan JFW, Yuan S, Kok KH. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. The Lancet. 2020;395(10223):514–523. https://doi.org/10.1016/S0140-6736(20)30154-9
Wang C, Horby PW, Hayden FG. A novel coronavirus outbreak of global health concern. The Lancet. 2020;395(10223):470–473. https://doi.org/10.1016/S0140-6736(20)30185-9
Hui DSC, Zumla A. Severe Acute Respiratory Syndrome. Infectious Disease Clinics of North America. 2019;33(4):869–889. https://doi.org/10.1016/j.idc.2019.07.001
Phan LT, Nguyen TV, Luong QC, Nguyen TV, Nguyen HT, Le HQ, et al. Importation and human-to- human transmission of a novel coronavirus in Vietnam. New England journal of medicine. 2020 Feb 27;382(9):872-4. https://doi.org/10.1056/NEJMc2001272
Azhar EI, Hui DSC, Memish ZA. The Middle East Respiratory Syndrome (MERS). Infectious Disease Clinics of North America. 2019; 33(4):891–905. https://doi.org/10.1016/j.idc.2019.08.001
Pourajam S, Kalantari E, Talebzadeh H, Mellali H, Sami R, Soltaninejad F, et al. Secondary bacterial infection and clinical characteristics in patients with COVID-19 admitted to two intensive care units of an academic hospital in Iran during the first wave of the pandemic. Frontiers in cellular and infection microbiology. 2022 Feb 23;12:784130. https://doi.org/10.3389/fcimb.2022.784130
Flaskerud JH. Myths and conspiracies. Issues in Mental Health Nursing. 2021 Feb 1;42(2):196-200.
Phan LT, Nguyen TV, Luong QC. Importation and Human-to-Human Transmission of a Novel Coronavirus in Vietnam. N Engl J Med. 2020;382(9): 872-874. https://doi.org/10.1056/NEJMc2001272
Miah MR, Hasan MM, Hannan MA, Parisa JT, Uddin MJ, Uddin MB, et al. Myths about Coronavirus: A Research Defense. Global Journal of Health Science. 2022;14(2):1-63. https://doi.org/10.1080/01612840.2020.1806967
Sadiq M, Aziz OA, Kazmi U. Multisystem inflammatory syndrome associated with COVID-19 in children in Pakistan. The Lancet Child & Adolescent Health 2020;4(10): e36–e37. https://doi.org/10.1016/S2352-4642(20)30256-X
Kurhade C, Xie X, Shi PY. Reverse genetic systems of SARS-CoV-2 for antiviral research. Antiviral research. 2023 Feb 1;210:105486Rubin R. First It Was Masks; Now Some Refuse Testing for SARS- CoV-2. JAMA. 2020;324(20):2015. https://doi.org/10.1001/jama.2020.22003
McElfish PA, Purvis R, James LP, Willis DE, Andersen JA. Perceived barriers to COVID-19 testing. International journal of environmental research and public health. 2021 Mar;18(5):2278. https://doi.org/10.3390/ijerph18052278
Ukwenya VO, Fuwape TA, Ilesanmi OS, Afolabi AA. Willingness to participate in testing, contact tracing, and taking the COVID-19 vaccine among community members in a Southwestern state in Nigeria. Global Biosecurity. 2021 May 31;3. https://doi.org/10.31646/gbio.106
Li X, Wu X. Psychological characteristics of parents in a Paediatric Outpatient during the SARS-CoV-2 Epidemic. Psychology, Health & Medicine 2021;26(1):114–118. https://doi.org/10.1080/13548506.2020.1849747
Afzal MS, Khan A, Qureshi UU, Saleem S, Saqib MA, Shabbir RM, et al. Community-based assessment of knowledge, attitude, practices and risk factors regarding COVID-19 among Pakistanis residents during a recent outbreak: a cross-sectional survey. Journal of community health. 2021 Jun;46:476-86. https://doi.org/10.1007/s10900-020-00875-z
Kurhade C, Xie X, Shi PY. Reverse genetic systems of SARS-CoV-2 for antiviral research. Antiviral research. 2023 Feb 1;210:105486
Rubin R. First It Was Masks; Now Some Refuse Testing for SARS-CoV-2. JAMA. 2020;324(20): 2015. https://doi.org/10.1001/jama.2020.22003
McElfish PA, Purvis R, James LP, Willis DE, Andersen JA. Perceived barriers to COVID-19 testing. International journal of environmental research and public health. 2021 Mar;18(5):2278. https://doi.org/10.3390/ijerph18052278
Ukwenya VO, Fuwape TA, Ilesanmi OS, Afolabi AA. Willingness to participate in testing, contact tracing, and taking the COVID-19 vaccine among community members in a Southwestern state in Nigeria. Global Biosecurity. 2021 May 31;3. https://doi.org/10.31646/gbio.106
Li X, Wu X. Psychological characteristics of parents in a Paediatric Outpatient during the SARS-CoV-2 Epidemic. Psychology, Health & Medicine 2021;26(1):114–118. https://doi.org/10.1080/13548506.2020.1849747
Afzal MS, Khan A, Qureshi UU, Saleem S, Saqib MA, Shabbir RM, et al. Community-based assessment of knowledge, attitude, practices and risk factors regarding COVID-19 among Pakistanis residents during a recent outbreak: a cross- sectional survey. Journal of community health. 2021 Jun;46:476-86. https://doi.org/10.1007/s10900-020-00875-z
Additional Files
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 The authors retain the copyrights. Authors are permitted and encouraged to post their work online (e.g. in institutional repositories or on their website), as it can lead to productive exchanges, as well as greater citation of published work.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Readers may “Share-copy and redistribute the material in any medium or format” and “Adapt-remix, transform, and build upon the material”. The readers must give appropriate credit to the source of the material and indicate if changes were made to the material. Readers may not use the material for commercial purpose. The readers may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
