Knowledge, attitudes and factors associated with the awareness of caregivers of under-five children regarding the malaria vaccine in the Tiko Health District, Cameroon: A community-based cross-sectional study

Despite progress in malaria control, malaria remains a major public health burden in sub-Saharan Africa, particularly among children under five. The introduction of malaria vaccines, including RTS,S/AS01 (Mosquirix) and the recently WHO-recommended R21/Matrix-M, offers renewed hope for reducing malaria morbidity and mortality. The effectiveness of these vaccines, however, depends largely on caregivers' awareness, knowledge, and attitudes. This study assessed caregivers' knowledge and attitudes, and the factors associated with awareness of the malaria vaccine in the Tiko Health District of Cameroon. A community-based cross-sectional study was conducted among 410 caregivers of children aged 0-5 years who were selected using a multistage sampling technique. Data were collected using a structured pre-tested questionnaire. Descriptive statistics summarized participants' characteristics, and knowledge and attitude scores were generated using a structured scoring system with a 60% cut-off defining adequate knowledge and positive attitudes. Logistic regression analysis identified factors independently associated with malaria vaccine awareness with statistical significance set at p < 0.05. The median age of participants was 32 years(IQR:27-40), and most were female(83.2%). Although 60.7% of caregivers had heard of the malaria vaccine, only 26.6% demonstrated adequate knowledge and 25.1% had positive attitudes. Healthcare workers were the primary source of vaccine information(35.4%). Caregivers whose children had a previous malaria episode were less likely to be aware of the vaccine(AOR:0.55; 95% CI:0.28-0.97). Conversely, caregivers who trusted health workers (AOR:3.02; 95% CI:1.83-4.99) and those who routinely attended childhood immunization services (AOR:3.57; 95% CI:2.27-5.60) were more likely to be aware of the vaccine. Caregivers in the Tiko Health District exhibited limited knowledge and generally negative attitudes toward the malaria vaccine. Strengthening health-worker engagement, improving communication during routine immunization services, and addressing gaps in caregivers' understanding may enhance malaria vaccine uptake in the district.