Acceptance of Malaria Vaccine and its Determinants among Caregivers of Children under 5 Years at Mulago National Referral Hospital-a Mixed Methods Study.

Abstract

Background: Malaria remains a major public health challenge in Uganda. Although the malaria vaccine offers a promising additional control measure, its successful uptake depends on caregiver acceptance. There’s a critical gap in understanding caregivers’ willingness to accept the vaccine which poses a challenge in effective vaccine implementation. Objective: To investigate the acceptance, knowledge, and perceptions of the malaria vaccine among caregivers of children under the age of five attending Mulago National Referral Hospital. Methodology: This was a convergent parallel mixed methods cross- sectional study. The quantitative component involved a cross-sectional survey of 385 caregivers of children under five attending the Paediatrics Outpatient Clinic at Mulago National Referral Hospital, selected through systematic sampling. An interviewer administered questionnaire was used to collect data on willingness to accept the malaria vaccine, knowledge and perceptions. The qualitative component comprised in-depth interviews with 24 caregivers, selected purposively. Qualitative data was analysed using thematic content analysis. Results: Vaccine acceptance was high at 86.5% though this fell markedly when a hypothetical fee was introduced. Good vaccine knowledge was the strongest independent predictor of acceptance (aOR 2.658, 95% CI: 1.005-7.033, p=0.049). Health worker contact (aOR 2.984, 95%CI: 1.146-7.775, p=0.025) was the primary independent predictor of knowledge. Caregivers perceived the malaria vaccine as beneficial for immunity and cost reduction but expressed safety concerns and unrealistic expectations. Despite high acceptance driven by high malaria burden and trust in government programs, hesitancy persisted due to fear of side effects and negative experiences from COVID 19 spill over within a contested social environment. Conclusions: Malaria vaccine acceptance was near universal but conditional on free delivery and vulnerable to safety misinformation and cross-vaccine distrust. Knowledge was the most critical modifiable determinant of acceptance and health workers were its most powerful driver. Structured health worker counselling and preservation of cost-free vaccine delivery even in an urban setting are essential to translating high acceptance intent into complete, schedule adherent vaccine uptake.