Abstract
<title>Abstract</title> <p> <bold>Background:</bold> Childhood immunization is a critical public health strategy for reducing vaccine-preventable diseases and associated mortality in Nigeria. Despite efforts to improve vaccination coverage, significant barriers persist, hindering the achievement of universal immunization. This study aims to comprehensively review the knowledge, practices, and factors influencing caregivers' roles in childhood immunization in Nigeria. <bold>Method</bold> : A systematic review was conducted in accordance with the PRISMA guidelines. Literature searches were performed on PubMed, EMBASE, and African Journals Online using keywords such as "childhood immunization," "childhood vaccination," "obstacles," "challenges," and "barriers." Studies published from January 2014 to June 2024 were included if they explored factors influencing childhood immunization in Nigeria, employed qualitative, quantitative, or mixed-methods designs, and were in English. Non-peer-reviewed articles, reviews, letters, and studies not addressing vaccination knowledge, attitudes, and practices were excluded. Duplicates were removed, and titles and abstracts were screened for relevance. Full texts of eligible studies were critically appraised using the Joanna Briggs Institute (JBI) tool. Data were extracted focusing on study aims, participant demographics, methodologies, and findings related to vaccination behaviors. A narrative synthesis was employed to identify common themes and patterns across studies, ensuring methodological rigor through triangulation and the development of a conceptual framework. <bold>Results</bold> : Following screening and eligibility assessment, 21 articles met the inclusion criteria and were included in the review. The included studies encompassed a range of cross-sectional and qualitative research, with a combined total of 29,321 participants. The review identified five major themes as barriers influencing childhood immunization in Nigeria: knowledge and awareness gaps, limited access and availability of healthcare services, prevalent attitudes and beliefs towards vaccination, challenges within the healthcare system, and sociodemographic factors affecting caregivers. <bold>Conclusion</bold> : In our review, several critical barriers influencing childhood immunization in Nigeria were identified. Addressing these barriers required a multifaceted approach involving improved health literacy, enhanced healthcare infrastructure, culturally competent care, and targeted interventions to increase access and reduce disparities. Strengthening communication strategies and leveraging mobile technology for reminders could have significantly enhanced vaccination coverage. Policymakers and healthcare providers needed to prioritize these strategies to achieve higher immunization rates and improve child health outcomes in Nigeria. The protocol for this systematic review was registered with PROSPERO under registration number CRD42024558533 </p>