Caregiver Knowledge, Community-Related Factors and Utilization of Routine Childhood Immunization in Selected Communities in Anambra State, Nigeria: A Baseline Cross-Sectional Analysis

Background: Routine childhood immunisation remains uneven in Nigeria. Local evidence is needed to understand how caregiver knowledge and perceived community barriers relate to service utilisation in Anambra State. Objectives: To assess caregiver knowledge, describe childhood immunisation utilisation and examine associations with perceived community-related factors in six selected communities. Methods: This baseline cross-sectional survey included 361 caregivers of children aged 0–12 months recruited through multistage sampling. Data were obtained using a structured questionnaire (Cronbach’s alpha = 0.798) and available immunisation records. Eight knowledge items and 15 vaccination and timeliness items informed study-specific categorical scores. Associations were examined using chi-square tests at a significance level of 0.05. Results: Knowledge was poor among 23.8% of caregivers, moderate among 41.3% and good among 34.9%. Immunisation utilisation was low in 15.2%, moderate in 54.3% and high in 30.5%. Timely vaccination was reported for 45.4% of children. High utilisation occurred among 53.2% of caregivers with good knowledge compared with 11.6% of those with poor knowledge (χ² = 66.83, df = 4, p < 0.001). Lack of awareness, cultural beliefs, financial constraints, fear of side effects, vaccine unavailability, poor health-worker attitudes, time constraints and absent reminders were significantly associated with utilisation. Distance and session timing were not significantly associated with utilisation. Conclusion: Caregiver knowledge and selected perceived community-related barriers were associated with immunisation utilisation. The findings identify locally relevant educational and service-delivery priorities but do not establish causal relationships.