Objective
To determine the parents refusal rate, associated factors and the perceptions of refusal parents in routine immunization by using “WHO SAGE Working Group on Vaccine Hesitancy survey tool”.

Material and Methods
A cross sectional survey was conducted by using multi stage cluster sampling at the remote district Bannu Khyber Pakhtunkhwa Province, Pakistan from March 2019 to July 2019.A WHO validated questionaire was used. Our outcome variable was “Ever refusal from routine immunization (yes/No)”.logistic regression was run for association and multi regression was applied to see counfounders.

Result
Out of total 610 parents, the refusal rate was 170(27.9%).Mostly the mother of the children has no education 145(85.3%,P 0.03).Mother has no mobile but the father has 152(89.4%, p=<.001) higher frequency to have mobile. The refusal rate was high in those having secure food 88(51.8%) as compare to minimal 62(36.5%) and highly insecure food 20(11.8%,P=<.05).On multivariate logistic regression, those father who were employee (adjusted OR = 0.59; 95% CI 0.37 to 0.94; p = 0.02) and having higher education (adjusted OR = 0.21; 95% CI 0.08 to 0.50; p=<.001) were less likely to refuse to vaccinate their children while in contrast those having highly insecure food were more likely to refuse (adjusted OR = 2.2; 95% CI 1.0 to 0.50; p = 0.04) as compare to minimal insecure food (adjusted OR = 1.6; 95% CI 1.0 to 2.5; p = 0.02).

Conclusion
Refusal rate among parents was very high while those parents who’s can’t read or write and with no education, having mobile phone, unemployment and secure food were more to be associated with refusal.