Peer-reviewed article
Caregivers’ willingness and factors influencing uptake of the malaria vaccine among under-five children at Masaka Regional Referral Hospital, Uganda
Annet Mary Namusisi, Richard Migisha, Dominic Kizza, Benon Kwesiga, Lilian Bulage et al. ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5-5This cross-sectional study surveyed 292 caregivers of children under five at the Maternal and Child Health unit of Masaka Regional Referral Hospital in Uganda in March 2025. It looked at willingness to vaccinate children with the newly introduced four-dose R21 malaria vaccine. About 85% of caregivers said they were willing to vaccinate, even though most had not heard of the vaccine before. Past adverse events after immunisation, relatives other than the parents making decisions, and tertiary education were linked to lower willingness. Receiving malaria preventive treatment in pregnancy and trusting vaccine safety were linked to higher willingness.
Key points
- 249 of 292 caregivers (85%) were willing to vaccinate their children; 250 (86%) of respondents were female.
- Most caregivers were not aware of the malaria vaccine but were willing to vaccinate when oriented.
- Prior adverse events following immunisation (aPR 0.2), relatives other than biological parents as main decision makers (aPR 0.2) and tertiary education (aPR 0.14) were associated with reduced willingness.
- Receipt of malaria IPTp in pregnancy (aPR 6.2) and trust in vaccine safety (aPR 13) were associated with increased willingness.
- Authors recommend giving vaccine information through antenatal care, preparing health workers to address adverse-event history and safety concerns, and prioritising safety-focused messaging.
Limitations
The study is a single-site cross-sectional survey in one hospital, so it cannot show cause and effect or represent caregivers across Uganda. It measures stated willingness, not actual vaccine uptake, and the wide confidence intervals show imprecise estimates for some factors.
Abstract
Uganda ranks third with the highest malaria cases globally, highlighting limitations in existing prevention efforts. Malaria vaccination is a key promising strategy to reduce both morbidity and severity among children under 5 (U5) years. In April 2025, Uganda introduced a four-dose R21 malaria vaccine for U5s. We assessed willingness to vaccinate with the malaria vaccine and associated factors among caregivers of U5s to support vaccine rollout in the targeted population. In March 2025, we conducted a cross-sectional study at the Maternal and Child Health unit of Masaka Regional Referral Hospital among 292 caretakers. We generated caretaker attendance lists daily to serve as sampling frames and developed a sampling interval. We used systematic sampling to obtain the total sample size. We administered a questionnaire assessing caregivers’ willingness to vaccinate, and identified associated factors using modified Poisson regression. We interviewed 292 caretakers, 250(86%) were female and 249(85%) indicated willingness to vaccinate their children. Prior experience with adverse events following immunization (AEFIs) (adjusted prevalence ratio [aPR]=0.2,95%Confidence Interval [CI]0.05-0.5), having other relatives than biological parents as main decision makers (aPR 0.2, 95%CI0.04-0.9) and having tertiary education (aPR 0.14, 95%CI0.04-0.6) were associated with reduced willingness to vaccinate, while receipt of malaria Intermittent Preventive Treatment in pregnancy (IPTp) (aPR 6.2, 95%CI1.6-23) and trust in vaccine safety (aPR 13, 95%CI4.0-43) were associated with increased willingness to vaccinate. Majority of the caretakers were not aware of the malaria vaccine butwere willing to vaccinate their children when oriented. AEFI history, household decision-making roles, and education level were associated with reduced willingness, while having received malaria IPTp and trust in vaccine safety were associated with increased willingness to vaccinate. We recommended providing malaria vaccine information through antenatal care, preparing health workers to address the AEFI history and vaccine-safety concerns and prioritizing safety-focused messaging over general awareness messaging.