Peer-reviewed article
Suboptimal uptake of the malaria vaccine in Sudan: what's behind the blinds?
Malik EM, El-Hassan HM, Ali MAA, Alsoni KAA, Alnair NMA et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined why only 36.7% of eligible children under five in Sudan received the new R21/Matrix-M malaria vaccine in 2024. Although mothers had positive attitudes toward vaccination generally, most were unaware of the malaria vaccine, underestimated malaria as a health threat, and lacked knowledge about the vaccine schedule. Supply chain problems and geographic access also limited uptake. The researchers concluded that low vaccine uptake was caused mainly by insufficient health education and health system barriers rather than vaccine hesitancy.
Key points
- Only 36.7% (94 of 256) eligible children received the malaria vaccine in Gedarif and Blue Nile States
- 57.7% of mothers were aware of the malaria vaccine, but only 36.7% knew the number of doses required and 25.7% knew the recommended starting age
- 53.1% of mothers did not perceive malaria as a significant health problem
- Vaccine stockouts and geographic access barriers were identified as additional constraints to uptake
- General attitudes toward vaccination were positive, indicating that vaccine hesitancy was not the primary barrier
Limitations
The study was limited to two states in Sudan and did not test interventions to improve uptake. It cannot determine whether the findings apply to other regions or whether any specific communication or supply strategies would effectively increase vaccine uptake.
Abstract
Background Malaria is a public health problem in Sudan, with more than 89% of cases caused by Plasmodium falciparum. In 2024 Sudan introduced R21/Matrix-M malaria vaccine in two states through routine immunization system. This study aimed to determine and identify the factors affecting the utilization of the vaccine. Methods A cross-sectional mixed -methods study was conducted in Gedarif and Blue Nile States of Sudan. Quantitative data were collected through pre-tested, pre-coded, structured questionnaire from samples of mothers or caregivers of children under the age of five. Additionally, Focus Group Discussions (FGDs) with school teachers and in-depth interviews with key Informants (KIIs) were conducted. Quantitative data were analyzed using SPSS, where univariate and multivariate analyses were performed. Qualitative thematic analysis was undertaken to identify barriers and drivers for each target group's behavior related to the malaria vaccine. Results A total of 416 mothers or caregivers (with a 99.0% response rate) who had children under the age of five were interviewed. The median age was 27.0 years. Of 256 children eligible for the malaria vaccine, only 36.7%, 95% CI 31.1-42.8% or 94 received it, with no difference between states or residence. Attitudes towards vaccination were generally positive. Perceptions of malaria and awareness of the vaccine were low: 53.1% of mothers perceive malaria as not a significant health problem; 57.7% were aware of the malaria vaccine; 36.7% knew the number of required doses; 25.7% knew the recommended starting dose age. FGDs and KIIs highlighted vaccine stockouts and geographic access as additional barriers, indicating the importance of sustaining supply chains. Conclusions and recommendations The suboptimal uptake of the malaria vaccine was not attributed to vaccine hesitancy or behavioral and social determinants, but rather to limited educational efforts and a lack of focus on the malaria vaccine as a new intervention. Reviewing the communication strategy and addressing health system barriers might help achieve the vaccine targets set by the Ministry of Health. Furthermore, assessing vaccine acceptability and identifying the enabling and inhibiting factors for vaccination before introducing the malaria vaccine in addition to engagement of higher authorities will lead to better vaccine uptake. Further research to test the effectiveness of culturally tailored communication interventions and the use of reminders or small incentives to raise the uptake is highly needed.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Introduction of R21/Matrix-M malaria vaccine through routine immunization system in Gedarif and Blue Nile States
- Population
- Children under five years old in Gedarif and Blue Nile States, Sudan; mothers or caregivers of eligible children
Key finding
Vaccine uptake was only 36.7% among 256 eligible children
EM et al. · Europe PMC · 14 Mar 2026