Background: Although vaccination is a fundamental component of public health, vaccine preventable diseases (VPDs) persist in low-resource environments due to differences in immunization coverage. The northwest Pakistani city of Peshawar is still at high risk of outbreaks because of sociopolitical unrest, vaccine hesitancy, and problems with access to healthcare. Objective: To evaluate vaccination rates among Peshawar's under-five population and investigate how they relate to the prevalence of prevalent infectious diseases. Methods: From January to June 2024, 800 households in Peshawar's urban, semi-urban, and peri-urban areas participated in a community-based cross-sectional survey. A standardized WHO-based questionnaire was used to gather data, and caregiver recollection and EPI vaccination cards were used for verification. Measles, polio, diarrhea, pneumonia, hepatitis B, and tuberculosis disease incidences throughout the previous 12 months were documented. After correcting for sociodemographic and healthcare access factors, logistic regression models were used to find correlations between vaccination status and disease outcomes. Results: Of the 800 children surveyed, 62.5% were fully vaccinated, 24% partially vaccinated, and 13.5% not vaccinated. Full immunization was significantly associated with reduced odds of measles (OR=5.8; p<0.001), diarrhea (OR=2.1; p=0.002), pneumonia (OR=0.6; p=0.03), and hepatitis B (OR=0.4; p=0.01). Higher maternal education (OR=2.3; p<0.01), household income (OR=1.7; p=0.02), and proximity to healthcare (OR=1.9; p=0.004) were significant predictors of complete vaccination. Despite national efforts, substantial gaps remain, particularly in peri-urban and semi-urban zones. Conclusion: Vaccination coverage in Peshawar is suboptimal and directly correlated with increased incidence of preventable childhood infections. Targeted, community sensitive strategies focusing on education, accessibility, and public trust are essential for improving vaccine uptake and reducing disease burden in the region