Knowledge, Attitudes and Hesitancy Toward Routine Immunization Among Caregivers in Ilorin South, Nigeria

Background: Vaccine hesitancy contributes to incomplete childhood immunization in Nigeria. Local evidence on caregivers' knowledge, attitudes and reasons for hesitancy is limited for Ilorin South Local Government Area (LGA), Kwara State. Objective: To assess knowledge, attitudes and factors contributing to hesitancy toward routine immunization among mothers and caregivers of children aged 0–23 months attending primary healthcare centers (PHCs) in Ilorin South LGA. Methods: A facility-based, descriptive cross-sectional survey was conducted among 384 caregivers recruited from five randomly selected PHCs using an interviewer-administered structured questionnaire (pre-test Cronbach's alpha = 0.71). Data were analyzed in SPSS version 23 using frequencies and percentages. All participants gave informed consent and no identifying information was collected. Results: Most respondents agreed that routine immunization is essential for protecting children (97.1%) and that vaccines prevent targeted diseases (92.2%). Knowledge gaps were evident: only 29.4% agreed that side effects such as fever are usually mild and temporary, and 44.5% agreed that PHC immunization services are free. Trust in health workers was high (81.5%), but only 38.3% were comfortable with service delivery and 35.2% were satisfied with provider communication. The most frequently endorsed hesitancy-related factors were concern about side effects (90.9%), negative experiences with providers (69.5%), doubts about vaccine effectiveness (63.0%), limited time (62.5%) and cultural beliefs (60.4%). Community education (44.8%) and improved PHC accessibility (41.7%) were endorsed as strategies. Conclusion: Hesitancy in Ilorin South is driven mainly by safety concerns and by the quality of caregivers' experience at PHCs rather than by lack of general awareness. Interventions should prioritize vaccine-safety communication, provider communication skills, and shorter, more convenient service delivery.