Caregivers’ readiness and willingness to accept malaria vaccine for children under five years in Gombe State, Nigeria

Introduction: Malaria remains a leading public health challenge in sub-Saharan Africa, with Nigeria accounting for the highest global burden, particularly among children under five. Despite ongoing prevention efforts, the disease continues to cause significant morbidity and mortality. The introduction of malaria vaccines; RTS, S/AS01 and R21/Matrix-M offers a promising tool to reduce this burden. However, the success of vaccination efforts depends on community acceptance, especially in non-pilot areas like Gombe Local Government Area (LGA) in Gombe State. This study assessed caregiver readiness and willingness to accept the malaria vaccine for children under five in Gombe LGA and explored factors influencing vaccine acceptance. Methods: A mixed-methods cross-sectional study was conducted among 293 caregivers using consecutive sampling from primary healthcare settings. Data were collected using semi-structured questionnaires capturing demographic information, malaria vaccine knowledge, and willingness to vaccinate. In addition, all participants were asked a single open-ended question on strategies to improve trust and vaccine acceptance. Quantitative data were analysed using SPSS version 25, with descriptive statistics summarising caregiver characteristics and logistic regression identifying predictors of vaccine willingness. Qualitative responses were analysed using an inductive thematic approach to provide contextual insights. Results: The majority of caregivers were female (78.8%), married (89.4%), and educated to at least secondary level (73.4%). While awareness of malaria was high (87.7%), only 46.1% had heard of the malaria vaccine, and just 31.4% were aware of its introduction in Nigeria. Nevertheless, 92.5% expressed willingness to vaccinate their children, with 73.0% confident in the vaccine’s protective benefit. Factors significantly associated with willingness included caregiver age and education. Health facilities were the most preferred place for vaccine access (83.3%), with 51.2% of caregivers favouring routine immunisation visits. Meanwhile, healthcare workers were identified as the most trusted source of vaccine information (91.5%). Key motivators for vaccine acceptance included trust in safety and efficacy (73.0%), affordability (10.9%), and health education (9.6%). Caregivers recommended enhancing vaccine uptake through improved community engagement, clear communication, qualified personnel, and government transparency. Conclusion: Despite low awareness of the malaria vaccine, caregiver willingness to vaccinate in Gombe LGA is high. Addressing knowledge gaps through education, building trust in healthcare systems, and ensuring equitable access will be critical for successful vaccine rollout in the region.