Aims: The study measured the level of knowledge and attitudes towards malaria and examined associated factors among caregivers of under-five children. Study Design: The study was community-based, descriptive cross-sectional. Place and Duration of Study: The study was carried out in Buea Health District (BHD) from February to June 2020. Methodology: Data were obtained through face-to-face interviews with the caregivers of under-fives. The above mean scores were used to determine the level of knowledge. The attitude levels were measured by using 3-point Likert scales. Univariate and multivariate logistic regression analyses were performed to identify risk factors associated with knowledge and attitude. SPSS software version 20.0 was used for analysis. Results: Out of the 390 respondents, 69.5% of them had a neutral attitude. Meanwhile, 27.7 % of participants carried a favorable attitude towards malaria and only 2.8 % of them had an unfavorable attitude, Caregivers of under-five children who scored below the mean score were 25.1 % which was considered having poor knowledge and above the mean score was 74.9% which was considered good knowledge. In the multivariable logistic analysis, caregivers with a primary school level of education were 4.1 times (AOR = 4.1, CI = 1.486-11.102) times more likely of receiving a high malaria knowledge score as compared to those with no formal education. Factors associated with caregiver's attitude level towards malaria risk were educational level and marital status which showed significant associations in the univariate analysis Conclusion: Caregivers of under-fives displayed a good knowledge of malaria risk factors. However, in these endemic areas for malaria, caregiver attitude was found to be unenthusiastic and unresponsive, and this poses additional challenges in reaching the malaria elimination goal. Thus, suggesting that educational messages during the campaign should be contextual to reach out to local communities to trigger a positive behavioural change.