Assessing Readiness for Future Maternal Malaria Vaccines: Knowledge, Practices, and Vaccine Attitudes Among Women of Reproductive Age in Malawi

BACKGROUND: Placental malaria (PM) is a serious complication of malaria in pregnancy (MiP). It has major repercussions for mothers' and neonates' health, particularly in sub-Saharan Africa (SSA). As current preventive measures lose efficacy due to drug resistance, malaria vaccines can play a crucial role in malaria control. The main objective of this study was to generate evidence that can guide the design of social and behaviour change interventions to raise awareness of PM and improve vaccine acceptance. METHODS: A facility-based cross-sectional survey was conducted; five dichotomised indicators were constructed; multivariate logistic regression was adjusted for age, education, and districts; and prespecified sensitivity analyses were done. RESULTS: General malaria knowledge and preventive practices were high. Many women (53.4%) reported having had experienced fever during pregnancy. Prevention behaviour was not significantly associated with age or education. Both high knowledge (aOR 0.30, 95% CI 0.16-0.57) and perceived risk awareness (aOR 0.35, 95% CI 0.18-0.68) were lower for Mpemba than for Thyolo. Biomedical healthcare services were less likely utilised by women in Madziabango as compared to Thyolo (aOR 0.47, 95% CI 0.23-0.96). Although 92% acknowledged possible harm, nearly all of them (97%) reported willingness to accept a future maternal malaria vaccine. CONCLUSIONS: There was a high level of maternal malaria vaccine acceptability; however, these findings suggest that local context-specific delivery strategies could be useful for effective future PM vaccine introduction.