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Objectives: To identify the reasons for non-vaccination of children under five years of age coming to tertiary care hospital from various districts of KPK and FATA. Material and Methods: This observational, cross sectional study was conducted from January 2012 to December 2014 at inpatient and outpatient setting, department of child health, Khyber teaching hospital Peshawar through a questionnaire prepared according to objectives of the study. Convenience sampling was employed, as the parents coming with children 1-5 years ages were interviewed regarding reasons fornon-vaccination of their children. Results: Total 432 children ages 1-5 years were included in the study. 276(63.8%) were male and 156(36.1%) were female. Most of the children i.e.373(86.3%) were from rural areas while 59 children (13.6%) belonged to urban areas. Out of 432 children only 205(47.4%) were fully vaccinated, 227(52.6%) children were under vaccinated (non-vaccinated + partially vaccinated). The main reason given by most of the parents 128(56.4%)was lack of knowledge about vaccination and its benefits followed by accessibility to vaccine centers 76(33.5%). The third common reason[58(25.6%)] was inability of the parents to take out time from their busy schedule and lastly 53(23.3%) was non-availability of vaccines in nearest center. Conclusion: The most common reason of Pediatric under-vaccination is 1) Decrease awareness of parents about the preventive benefits of vaccination followed by; 2) Decrease accessibility to health facility (and vaccination centers); 3) Parents could not spare time from busy schedule and 4) Non-availability of vaccines in the nearest center. [ABSTRACT FROM AUTHOR]