KNOWLEDGE OF CHILDHOOD AND ADULT IMMUNISATION AMONG CAREGIVERS OF CHILDREN UNDER FIVE IN RURAL AND URBAN COMMUNITIES OF THE EASTERN REGION, GHANA: A COMPARATIVE CROSS-SECTIONAL STUDY

Caregivers' knowledge of the immunisation schedule shapes whether children are presented for each dose and whether adults seek recommended vaccines, yet rural–urban differences in this knowledge have not been examined across childhood and adult vaccination within one design in Ghana. This study assessed and compared knowledge of immunisation among caregivers of children under five years in rural and urban communities of the Eastern Region. A comparative cross-sectional survey enrolled 1,400 caregivers, 700 in each arm, by multistage sampling of two rural and two urban districts. Knowledge was measured with 14 binary items (score 0–14). Arms were compared using Welch's t test, Cohen's d, chi-square and trend tests, a proportional-odds model and item-level risk differences, with false-discovery-rate and design-effect corrections. Mean knowledge was 6.78 (SD 2.59) in rural and 7.87 (SD 2.41) in urban respondents, a difference of 1.09 points (95% CI 0.83–1.35; d = 0.44). Poor knowledge was recorded for 61.0% of rural and 43.4% of urban respondents, and urban residence was associated with higher odds of a better knowledge category (proportional-odds OR 2.02; 95% CI 1.65–2.49). Urban respondents answered all 14 items correctly more often, by 4.9 to 11.3 percentage points; 13 differences were significant, all of which survived false-discovery-rate correction and 10 of which survived design-effect correction. The largest gaps concerned adult and maternal vaccination, and the weakest knowledge in both arms concerned operational facts: that routine vaccines are free (38.1% rural, 44.1% urban), that a mild illness does not preclude vaccination, and where and when a child should be vaccinated. Within each arm, knowledge level was not associated with willingness to vaccinate or with receipt of the third pentavalent dose, and stratification by knowledge left the rural–urban gap in willingness unchanged (OR 3.01 before and after). Knowledge of immunisation was modest in both settings and consistently lower in rural communities. Health education should prioritise operational information on cost, timing, eligibility and place of vaccination, particularly in rural communities, alongside measures that address access and confidence.