Factors Influencing Maternal Knowledge and Attitudes Toward Childhood Vaccination in Mosul City, Iraq

Abstract

Background: Childhood vaccination remains one of the most effective strategies for preventing infectious diseases and reducing child morbidity and mortality worldwide. Maternal knowledge and attitudes play a critical role in vaccine acceptance and adherence to immunization schedules. However, misconceptions and access-related barriers continue to challenge immunization efforts, particularly in fragile healthcare settings such as Iraq. Aim: This study aimed to assess mothers’ knowledge and attitudes toward childhood vaccination in Mosul City, with a focus on misconceptions, reasons for non-compliance, and socio-demographic determinants. Methods: A cross-sectional study was conducted between January 15 and April 20, 2025, in six primary health care centers in Mosul. A total of 400 mothers of children aged ≤5 years were recruited using convenience sampling. Data was collected through face-to-face administration of a structured, validated questionnaire covering socio-demographic characteristics, knowledge, and attitudes. The instrument demonstrated good internal consistency (Cronbach’s α = 0.80). Data was analyzed using descriptive statistics, Chi-square tests, and binary logistic regression to identify independent predictors. Statistical significance was set at p < 0.05. Results: Overall, 62.8% of mothers demonstrated good knowledge, and 72.5% expressed positive attitudes toward childhood vaccination. While most participants recognized vaccines as safe and effective, 42.0% incorrectly considered mild illness a contraindication, and 18.5% reported fear of serious side effects. Non-compliance (28.0%) was primarily associated with vaccine unavailability (33.9%) and concerns about side effects (26.8%). Logistic regression analysis identified maternal education and employment status as significant independent predictors of both knowledge and attitudes (p < 0.05). Conclusion: Mothers in Mosul demonstrated generally adequate knowledge and positive attitudes toward childhood vaccination; however, important misconceptions and access-related barriers persist. These findings highlight the need for targeted, evidence-based public health strategies addressing knowledge gaps and system-level challenges. Further interventional research is recommended to evaluate approaches aimed at improving vaccination adherence.