Purpose <p>Acute otitis media is one of the common diseases of childhood with prevalence ranging from 9.4 to 20% among children aged 5–15 years and remains to be the most important cause of hearing loss in children. Determining the experiences of caregivers on the risk factors for acute otitis media remains to be a substantial priority if substantial reduction in the disease prevalence has to occur.</p> Methods <p>This was a hospital based descriptive cross-sectional study that was conducted at a regional referral hospital in Kilimanjaro Region from June to October 2022. Study participants were recruited using convenient sampling and data was collected using pre-tested semi-structured questionnaires. Data was analyzed using Statistical Package for Social Sciences version 23. Correlation between socio-demographic parameters and knowledge, attitude and practices were established using Chi-square tests.</p> Results <p>More than 90% of the study participants (90.4%) never heard about acute otitis media and also 97.1% of the caretakers who have ever heard of acute otitis media had good attitude. There was a significant association between knowledge on risk factors for acute otitis media and some socio-demographic characteristics such as educational level and employment status.</p> Conclusion <p>Socio-demographic factors such as level of education and employment status as well as poor knowledge, attitude and unhealthy practices regarding risk factors for acute otitis media contribute to the high prevalence of acute otitis media in Northern Tanzania. Health education regarding risk factors for acute otitis media and provision of accessible health care to under-five children is essential to reduce the burden of this disease among paediatric patients.</p>