Objectives <p>Childhood immunization remains one of the most effective public health interventions, yet coverage gaps persist in northern Nigeria. This study assessed parental knowledge, attitudes, and sociocultural factors influencing childhood immunization uptake in Azare, Katagum Local Government Area, Bauchi State.</p> Study design <p>A cross-sectional descriptive survey was conducted among parents of children eligible for routine immunization.</p> Methods <p>Data were collected from 91 parents attending selected primary healthcare facilities using a pretested, researcher-developed questionnaire. Internal consistency reliability was acceptable (Cronbach’s alpha = 0.78). Descriptive statistics summarized responses, while chi-square tests examined associations between parental characteristics and immunization uptake. A multivariable logistic regression model was additionally applied to adjust for potential confounders.</p> Results <p>Most respondents (66%) had formal education, while 23% had informal education and 8% had no education. Parental knowledge of immunization was strongly associated with service utilization (χ² = 80.92, <i>p</i> &lt; 0.001). Religion significantly influenced immunization uptake (χ² = 44.66, <i>p</i> &lt; 0.001). Fear of vaccine side effects was also a significant determinant (χ² = 90.04, <i>p</i> &lt; 0.001). After adjustment, parental education and immunization knowledge remained independent predictors of full immunization.</p> Conclusion <p>Parental education, religious beliefs, and perceptions of vaccine safety substantially influence childhood immunization uptake in Azare. Strengthening culturally sensitive health education, engaging religious leaders, and improving women’s educational and economic opportunities may enhance immunization coverage and reduce preventable childhood morbidity and mortality.</p>