Knowledge, Attitudes, and Practices Toward Childhood Vaccination Among Caregivers in Buea Urban Setting: A Cross-Sectional Study
Authors
Faculty of Health Sciences, University of Buea, Buea P.O. Box 63 (Cameroon)
Faculty of Health Sciences, University of Buea, Buea P.O. Box 63 (Cameroon)
Faculty of Health Sciences, University of Buea, Buea P.O. Box 63 (Cameroon)
Faculty of Health Sciences, University of Buea, Buea P.O. Box 63 (Cameroon)
Joe-Wruthia Mesode Lyonga Etutu
Faculty of Health Sciences, University of Buea, Buea P.O. Box 63 (Cameroon)
Faculty of Health Sciences, University of Buea, Buea P.O. Box 63 (Cameroon)
Faculty of Health Sciences, University of Buea, Buea P.O. Box 63 (Cameroon)
Faculty of Health Sciences, University of Bamenda (Cameroon)
Article Information
DOI: 10.51244/IJRSI.2025.1210000072
Subject Category: Public Health
Volume/Issue: 12/10 | Page No: 813-824
Publication Timeline
Submitted: 2025-10-02
Accepted: 2025-10-08
Published: 2025-11-04
Abstract
Objectives: Understanding caregivers' knowledge, attitudes, and practices (KAP) toward childhood vaccination is crucial for improving immunization coverage and addressing vaccine hesitancy. This study utilized the World Health Organization Behavioral and Social Drivers (WHO BeSD) framework to assess KAP regarding childhood vaccination among caregivers in Buea urban setting.
Methods: A cross-sectional study was conducted among 439 caregivers with children aged 0-59 months in Buea urban area. We collected data using a structured questionnaire based on the WHO BeSD tool. We assessed KAP domains using binary categorization: good knowledge (≥50% positive responses to knowledge indicators), positive attitude (≥75% positive responses to attitude indicators), and good practice (≥50% positive responses to practice indicators). Chi-square tests were performed to identify factors associated with each KAP domain.
Results: Among 439 participants, 79.0% demonstrated good knowledge, 82.5% had positive attitudes, and 85.0% showed good vaccination practices. Knowledge was significantly associated with age group (p=0.039), sex (p=0.027), marital status (p<0.001), occupation (p=0.013), primary caregiver role (p<0.001), and housing status (p=0.002). Positive attitudes were associated with age group (p=0.002), marital status (p=0.019), health insurance (p=0.039), primary caregiver role (p=0.042), and number of children (p=0.003). Good practices were linked to marital status (p<0.001), education level (p=0.007), and health insurance (p=0.011).
Conclusion: While most caregivers demonstrated favorable KAP toward vaccination, targeted interventions are needed for specific demographic groups, particularly younger caregivers, males, and those with non-primary caregiver roles to further improve vaccination outcomes.
Keywords
attitudes, Cameroon, childhood vaccination, knowledge, practices
Downloads
References
1. Adedokun, S. T., Uthman, O. A., Adekanmbi, V. T., & Wiysonge, C. S. (2017). Incomplete childhood immunization in Nigeria: a multilevel analysis of individual and contextual factors. BMC public health, 17(1), 236. https://doi.org/10.1186/s12889-017-4137-7 [Google Scholar] [Crossref]
2. Ames, H., Njang, D. M., Glenton, C., Fretheim, A., Kaufman, J., Hill, S., Oku, A., Cliff, J., Cartier, Y., Bosch-Capblanch, X., Rada, G., Muloliwa, A. M., Oyo-Ita, A., Lewin, S. (2017). Stakeholder perceptions of communication about vaccination in two regions of Cameroon: A qualitative case study. PLoS ONE, 12(8), e0183721. https://doi.org/10.1371/journal.pone.0183721 [Google Scholar] [Crossref]
3. Antai D. (2009). Inequitable childhood immunization uptake in Nigeria: a multilevel analysis of individual and contextual determinants. BMC infectious diseases, 9, 181. https://doi.org/10.1186/1471-2334-9-181 [Google Scholar] [Crossref]
4. Ashfield, S. A. (2024). Exploring Parental Vaccine Decision Making: A Mixed Methods Study. Electronic Thesis and Dissertation Repository. 10060. https://ir.lib.uwo.ca/etd/10060/ [Google Scholar] [Crossref]
5. Bbaale E. (2013). Factors influencing childhood immunization in Uganda. Journal of health, population, and nutrition, 31(1), 118–129. https://doi.org/10.3329/jhpn.v31i1.14756 [Google Scholar] [Crossref]
6. Bowen, D. H., Costantino, C., Squared Study Group. (2025). The Vaccine Trust Framework: mixed-method development and validation of a tool to measure and predict vaccine acceptance. The Lancet Global Health, 13(7), e1089-e1098. https://doi.org/10.1016/S2214-109X(25)00245-1 [Google Scholar] [Crossref]
7. Chen, M. F. (2011). Using the Health Belief Model to Understand Caregiver Factors that Affect the Decision by a Caregiver to Vaccinate a Child for Influenza. American Journal of Health Studies, 26(3), 123-130. [Google Scholar] [Crossref]
8. Cohen, J. (1988). Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates. https://doi.org/10.4324/9780203771587 [Google Scholar] [Crossref]
9. Eberhardt, J., Stein, J., Andonegui-Elguera, S., Allen, J. D., Badire, T. J., Bellanger, M., Gollust, S. E. (2023). A qualitative study exploring attitudes and perceptions toward COVID-19 booster vaccination among Black and Hispanic individuals in the United States. BMC Public Health, 23, 419. https://doi.org/10.1186/s12889-023-15292-6 [Google Scholar] [Crossref]
10. Ehreth, J. (2003). The global value of vaccination. Vaccine, 21(7-8), 596–600. https://doi.org/10.1016/s0264-410x(02)00623-0 [Google Scholar] [Crossref]
11. Ellithorpe, M. E., Mathur, P., Nedza, S. M., Dilley, S. E. (2022). Caregivers' COVID-19 vaccination intention for children 5 and under: The role of health beliefs and demographic factors. Vaccine, 40(9), 1334-1341. https://doi.org/10.1016/j.vaccine.2022.01.065 [Google Scholar] [Crossref]
12. Favin, M., Steinglass, R., Fields, R., Banerjee, K., & Sawhney, M. (2012). Why children are not vaccinated: a review of the grey literature. International health, 4(4), 229–238. https://doi.org/10.1016/j.inhe.2012.07.004 [Google Scholar] [Crossref]
13. Freed, G. L., Clark, S. J., Butchart, A. T., Singer, D. C., & Davis, M. M. (2010). Parental vaccine safety concerns in 2009. Pediatrics, 125(4), 654–659. https://doi.org/10.1542/peds.2009-1962 [Google Scholar] [Crossref]
14. Gidado, S., Nguku, P., Biya, O., Waziri, N. E., Mohammed, A., Nsubuga, P., Akpan, H., Oyemakinde, A., Nasidi, A., Suleman, I., Abanida, E., Musa, Y., & Sabitu, K. (2014). Determinants of routine immunization coverage in Bungudu, Zamfara State, Northern Nigeria, May 2010. The Pan African medical journal, 18 Suppl 1(Suppl 1), 9. https://doi.org/10.11694/pamj.supp.2014.18.1.4149 [Google Scholar] [Crossref]
15. Glanz, J. M., Wagner, N. M., Narwaney, K. J., Shoup, J. A., McClure, D. L., McCormick, E. V., Daley, M. F. (2013). A mixed methods study of parental vaccine decision making and parent-provider trust. Academic Pediatrics, 13(5), 481-488. https://doi.org/10.1016/j.acap.2013.05.030 [Google Scholar] [Crossref]
16. Greenaway, E. S., Leon, J., & Baker, D. P. (2012). Understanding the association between maternal education and use of health services in Ghana: exploring the role of health knowledge. Journal of biosocial science, 44(6), 733–747. https://doi.org/10.1017/S0021932012000041 [Google Scholar] [Crossref]
17. Handayani, E. W., Indriyani, R., Lestari, R. P. (2025). Health belief model of parents' COVID-19 vaccination intention for children: A cross-sectional study. Frontiers in Public Health, 13, 1485416. https://doi.org/10.3389/fpubh.2025.1485416 [Google Scholar] [Crossref]
18. Huang, L., Pickle, S., Das, B., Sy, L. S., Glenn, S. C., Dumyati, G., Gerber, J. S., Kharbanda, A. B., Irving, S. A., Naleway, A. L., Weintraub, E. S., Belongia, E. A., Fowlkes, A. L. (2024). A mixed methods analysis of COVID-19 vaccine uptake among 5-11 year olds. Social Science & Medicine, 341, 116484. https://doi.org/10.1016/j.socscimed.2023.116484 [Google Scholar] [Crossref]
19. Jain, M., Tripathi, P., Ogollah, R., Omer, S. B., Fadel, S. A. (2022). Use of community engagement interventions to improve routine child immunisation coverage and vaccination timeliness in low- and middle-income countries: a systematic review. Cochrane Database of Systematic Reviews, 2, CD013378. https://doi.org/10.1002/14651858.CD013378.pub2 [Google Scholar] [Crossref]
20. Kaliyaperumal, K. (2004). Guideline for conducting a knowledge, attitude and practice (KAP) study. AECS Illumination, 4(1), 7–9. [Google Scholar] [Crossref]
21. Kassabekova, L., Nugmanova, Z., Zholdybayeva, E., Kozhakhmetova, G., Imanbaeva, G., Orazova, G., Bayesheva, D., Zhussupov, B. (2025). Barriers to vaccine acceptance and immunization coverage among children in Kazakhstan: a mixed-methods study. Frontiers in Public Health, 13, 1600363. https://doi.org/10.3389/fpubh.2025.1600363 [Google Scholar] [Crossref]
22. Kumar, D., Aggarwal, A., & Gomber, S. (2010). Immunization status of children admitted to a tertiary-care hospital of north India: reasons for partial immunization or non-immunization. Journal of health, population, and nutrition, 28(3), 300–304. https://doi.org/10.3329/jhpn.v28i3.5560 [Google Scholar] [Crossref]
23. Larson, H. J., Jarrett, C., Eckersberger, E., Smith, D. M., & Paterson, P. (2014). Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: a systematic review of published literature, 2007-2012. Vaccine, 32(19), 2150–2159. https://doi.org/10.1016/j.vaccine.2014.01.081 [Google Scholar] [Crossref]
24. Launiala, A. (2009). How much can a KAP survey tell us about people's knowledge, attitudes and practices? Some observations from medical anthropology research on malaria in pregnancy in Malawi. Anthropology Matters, 11(1), 1–13. https://doi.org/10.22582/am.v11i1.31 [Google Scholar] [Crossref]
25. Li, L., Zhang, W., Barello, S., Karekla, M., Raducu, R., Diculescu, E. C., Jie, H., Arnberg, F. K., Cipolletta, S., Pravettoni, G. (2021). Vaccine hesitancy and behavior change theory-based social media interventions: a systematic review. BMC Public Health, 21, 2242. https://doi.org/10.1186/s12889-021-12268-w [Google Scholar] [Crossref]
26. MacDonald, N. E., & SAGE Working Group on Vaccine Hesitancy (2015). Vaccine hesitancy: Definition, scope and determinants. Vaccine, 33(34), 4161–4164. https://doi.org/10.1016/j.vaccine.2015.04.036 [Google Scholar] [Crossref]
27. Machingaidze, S., Wiysonge, C. S., & Hussey, G. D. (2013). Strengthening the expanded programme on immunization in Africa: looking beyond 2015. PLoS medicine, 10(3), e1001405. https://doi.org/10.1371/journal.pmed.1001405 [Google Scholar] [Crossref]
28. Orr, C. A., Boulton, M. L. (2022). Using Health Behavior Theory to Address COVID-19 Vaccine Hesitancy. American Journal of Health Behavior, 46(6), 704-719. https://doi.org/10.5993/AJHB.46.6.11 [Google Scholar] [Crossref]
29. Republic of Cameroon. General population and housing census. Yaoundé: National Institute of Statistics; 2010. [Google Scholar] [Crossref]
30. Restrepo-Méndez, M. C., Barros, A. J., Wong, K. L., Johnson, H. L., Pariyo, G., França, G. V., Wehrmeister, F. C., & Victora, C. G. (2016). Inequalities in full immunization coverage: trends in low- and middle-income countries. Bulletin of the World Health Organization, 94(11), 794–805B. https://doi.org/10.2471/BLT.15.162172 [Google Scholar] [Crossref]
31. Shrivastwa, N., Gillespie, B. W., Kolenic, G. E., Lepkowski, J. M., & Boulton, M. L. (2015). Predictors of vaccination in India for children aged 12-36 months. Vaccine, 33 Suppl 4, D99–D105. https://doi.org/10.1016/j.vaccine.2015.09.034 [Google Scholar] [Crossref]
32. Singh, K., Bloom, S., & Brodish, P. (2015). Gender equality as a means to improve maternal and child health in Africa. Health care for women international, 36(1), 57–69. https://doi.org/10.1080/07399332.2013.824971 [Google Scholar] [Crossref]
33. Skirrow, H., Barnett, J., Bell, S., Mounier-Jack, S., Kampmann, B., Yarwood, J., Bailie, C., Redsell, S., Saliba, V., Mandal, S., Ramsay, M. E., Peckham, C. S. (2024). 'Why did nobody ask us?': A mixed-methods co-produced study exploring UK parents' perspectives on childhood vaccination. Vaccine, 42(20), 126059. https://doi.org/10.1016/j.vaccine.2024.126059 [Google Scholar] [Crossref]
34. Story, W. T., Burgard, S. A., Lori, J. R., Taleb, F., Ali, N. A., & Hoque, D. M. (2012). Husbands' involvement in delivery care utilization in rural Bangladesh: A qualitative study. BMC pregnancy and childbirth, 12, 28. https://doi.org/10.1186/1471-2393-12-28 [Google Scholar] [Crossref]
35. Taddese HB, Deressa W, Ali A, et al. Utilization of antenatal care and associated factors among women in rural communities of Sidama zone, southern Ethiopia. BMC Pregnancy Childbirth. 2018;18(1):467. [Google Scholar] [Crossref]
36. Tadesse, H., Deribew, A., & Woldie, M. (2009). Predictors of defaulting from completion of child immunization in south Ethiopia, May 2008: a case control study. BMC public health, 9, 150. https://doi.org/10.1186/1471-2458-9-150 [Google Scholar] [Crossref]
37. Thorpe, S., VanderEnde, K., Peters, C., Bardin, L., & Yount, K. M. (2016). The Influence of Women's Empowerment on Child Immunization Coverage in Low, Lower-Middle, and Upper-Middle Income Countries: A Systematic Review of the Literature. Maternal and child health journal, 20(1), 172–186. https://doi.org/10.1007/s10995-015-1817-8 [Google Scholar] [Crossref]
38. Wado, Y. D., Afework, M. F., & Hindin, M. J. (2014). Childhood vaccination in rural southwestern Ethiopia: the nexus with demographic factors and women's autonomy. The Pan African medical journal, 17 Suppl 1(Suppl 1), 9. https://doi.org/10.11694/pamj.supp.2014.17.1.3135 [Google Scholar] [Crossref]
39. Wendt A, Stephenson R, Young M, et al. Individual and facility-level determinants of infant and young child feeding practices in Ethiopia. PLoS One. 2015;10(9):e0137016. [Google Scholar] [Crossref]
40. Wiysonge, C. S., Uthman, O. A., Ndumbe, P. M., & Hussey, G. D. (2012). Individual and contextual factors associated with low childhood immunisation coverage in sub-Saharan Africa: a multilevel analysis. PloS one, 7(5), e37905. https://doi.org/10.1371/journal.pone.0037905 [Google Scholar] [Crossref]
41. World Health Organization, (2014). Report of the SAGE working group on vaccine hesitancy. https://cdn.who.int/media/docs/default-source/immunization/sage/2014/october/sage-working-group-revised-report-vaccine-hesitancy.pdf?sfvrsn=240a7c1c_4 [Google Scholar] [Crossref]
42. World Health Organization, (2016). Guide to introducing HPV vaccine into national immunization programmes. https://www.who.int/publications/i/item/9789241549769 [Google Scholar] [Crossref]
43. World Health Organization, (2022). Behavioural and social drivers of vaccination: tools and practical guidance for achieving high uptake. https://www.who.int/publications/i/item/9789240049680 [Google Scholar] [Crossref]
44. World Health Organization, (2025). Immunization coverage. https://www.who.int/news-room/fact-sheets/detail/immunization-coverage [Google Scholar] [Crossref]
45. World Health Organization. (2022). Cameroon steps up vaccination efforts with support from WHO, UNICEF, WB and other partners. Available from: https://www.who.int/news/item/11-12-2022-cameroon-steps-up-vaccination-efforts [Google Scholar] [Crossref]
46. Xie, Y. J., Liu, E. Q., Anson, J., Ma, C., Wang, B., Lai, J. C. Y., Wang, Q., Tao, L., He, X., Duan, S., Sun, M., Wang, H., Zhao, H., Zhang, H., Deng, L., Yang, H., Zhang, Q., Gao, Z., Wong, S. Y. S., Zhang, D. (2024). Community engagement to improve childhood immunization in the WHO Western Pacific Region: a scoping review. BMC Public Health, 24, 1127. https://doi.org/10.1186/s12889-024-18539-6 [Google Scholar] [Crossref]
Metrics
Views & Downloads
Similar Articles
- Tribal Child Nutrition and Health in District of Sundargarh: A Public Health Review of ICDS Intervention
- Knowledge, Attitudes and Practices Towards Prostate Cancer Screening Amongst Men Aged 40-60 Years in The Buea Health District: A Cross-Sectional Study
- Compliance with JCI Protocols: A Focus on Employee Safety
- Influence and Involvement of Teachers in Menstrual Hygiene Management of Female Secondary School Students in Kogi State, Nigeria
- A Critical Evaluation of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana in Bihar