Perceived Susceptibility to Viral Illnesses and School Absenteeism Among Children Aged 3.5 to 12 Years: A Health Belief Model-Based Cross-Sectional Study in Karachi, Pakistan

Abstract

Background: Viral illnesses are an important contributor to school absenteeism among children, yet the role of parental health beliefs in attendance decisions remains insufficiently explored in Karachi, Pakistan. Objective: This study aimed to determine the prevalence of viral illness-related school absenteeism among children aged 3.5–12 years and examine its association with parental perceived susceptibility and other Health Belief Model constructs. Methods: A cross-sectional, school-based survey was conducted among 616 parent–child pairs from selected private schools in urban Karachi. Parents completed a structured questionnaire assessing sociodemographic characteristics, viral illness-related absenteeism during the preceding 3–6 months, and Health Belief Model constructs, including perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action. Descriptive statistics, chi-square tests, and binary logistic regression were used to evaluate associations. Results: Overall, 237 children (38.5%) experienced at least one viral illness-related absenteeism episode, with a mean absence duration of 4.2 ± 3.1 days. Respiratory illness was the most common reported cause, followed by gastroenteritis and dengue-like illness. In adjusted analysis, higher perceived susceptibility (aOR = 1.86, 95% CI: 1.41–2.45), perceived severity (aOR = 1.32, 95% CI: 1.03–1.69), and perceived barriers (aOR = 1.72, 95% CI: 1.32–2.23) were associated with higher odds of absenteeism, whereas perceived benefits were protective (aOR = 0.66, 95% CI: 0.51–0.85). Conclusion: Viral illness-related absenteeism was common among children in Karachi and was significantly associated with parental Health Belief Model constructs, particularly perceived susceptibility and barriers. Parent-focused school health interventions should provide clear illness and return-to-school guidance to reduce avoidable absenteeism while maintaining infection control.