Peer-reviewed article
Awareness and acceptance of malaria vaccines by caregivers of under-5 children in Abia State, Nigeria: a mixed methods study.
Kalu EI, Enebeli UU, Uzochukwu BSC, Enebeli EL, Kalu FA et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined awareness and acceptance of malaria vaccines among caregivers of children under 5 in Abia State, Nigeria, using surveys and interviews with 618 caregivers. While overall awareness of malaria vaccines was low at 38.2%, acceptance was high at 88.7%, driven by caregivers' desire to protect their children and trust in health providers. Education, urban residence, and income significantly influenced both awareness and acceptance, revealing socio-demographic inequities that threaten equitable vaccine rollout.
Key points
- Awareness of malaria vaccines was low overall (38.2%) but higher among urban educated caregivers (52.3%)
- Acceptance was high (88.7%) despite low awareness, primarily motivated by child protection (67.4%) and provider trust (59.8%)
- Key barriers to acceptance included fears of side effects (51.4%) and misinformation (18.7%)
- Education (AOR=3.28) and urban residence (AOR=1.78) significantly predicted awareness
- Income (AOR=2.05) and awareness status (AOR=6.92) significantly influenced acceptance
Limitations
The study was conducted during a specific three-month period (June-August 2025) in one state, so findings may not generalise to other regions or time periods. The cross-sectional design cannot establish causality or track changes in awareness and acceptance over time.
Abstract
Introduction Malaria remains a leading cause of under-5 mortality in Nigeria, with Abia State exemplifying hyperendemic transmission. The 2024 introduction of the R21/Matrix-M and RTS,S/AS01 vaccines offers promise, but evidence on caregiver awareness and acceptance in the non-pilot South-East region to inform equitable rollout is scarce. Methods We conducted a mixed-methods study from June to August 2025 among 618 caregivers of under-5 children engaged with the routine immunisation programme in Abia State. Quantitative cross-sectional surveys assessed awareness (knowledge of malaria vaccines) and acceptance (willingness on Likert scales), and inferential analysis was carried out using logistic regression. Qualitative in-depth interviews (n=28) and focus group discussions (n=6, 50 participants) explored perceptions using thematic analysis. Triangulation was applied to integrate the findings. Results Awareness overall was low (38.2%; 95% CI 34.5% to 42.0%) but highest among urban educated caregivers (52.3%). However, acceptance was high (88.7%), driven by child protection (67.4%) and provider trust (59.8%). Barriers included fears of side effects (51.4%) and misinformation (18.7%). Significantly, education (adjusted OR (AOR)=3.28) and urban residence (AOR=1.78) predicted awareness, and income (AOR=2.05) and awareness status (AOR=6.92) influenced acceptance. Qualitative themes corroborated quantitative findings: 'fragmented information' explained rural gaps and 'maternal instinct' amplified willingness to accept. Conclusion Based on our findings, caregivers demonstrated strong acceptance of malaria vaccines despite critically low awareness, a disparity fuelled by information gaps and socio-demographic inequities such as low education and rural residence that threaten vaccine rollout and malaria elimination goals. Consequently, this pioneering mixed-methods study recommends that specific channels that leverage primary healthcare centre providers and community leaders for information dissemination should be used, given the high levels of trust, to ensure malaria vaccine uptake and accelerate progress in reducing under-5 deaths.
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 and RTS,S/AS01 malaria vaccines with information dissemination through routine immunisation programme
- Population
- 618 caregivers of under-5 children engaged with routine immunisation programme in Abia State, Nigeria; qualitative subset of 78 participants (28 in-depth interviews, 50 in focus groups)
Key finding
Overall awareness was low at 38.2% (95% CI 34.5% to 42.0%) but acceptance was high at 88.7%