Awareness, acceptability and determinants of the new malaria vaccine among caregivers of under-five children in Asaba, Nigeria: a multi-centre cross-sectional study

BACKGROUND: Malaria infection continues to cause significant morbidity and mortality in Nigeria despite the integration of the R21/Matrix-M malaria vaccine into the National Programme on immunization. Understanding how caregivers of young children perceive this new vaccine is important for successful implementation. AIM: To assess the awareness, acceptability and factors affecting uptake of the new R21/Matrix-M malaria vaccine among caregivers of under-fives in Asaba, Southern Nigeria. MATERIALS AND METHODS: A cross-sectional study was conducted between January and June 2025, among 358 consenting caregivers of under-5 children who presented at the children's outpatient and immunization clinic in three health facilities in Asaba, Delta State, Nigeria. The study utilized pretested semi-structured, self-administered questionnaires containing information on vaccine awareness, hesitancy and adverse reactions. Data was analyzed using SPSS 26, with a p-value < 0.05 considered significant. RESULTS: Only 36.3% of respondents were aware of the vaccine. However, most (85.8%) were willing to vaccinate their children. Reasons for reluctance to accept the vaccine were fear of adverse reactions (45.1%), lack of interest (19.6%), and spousal disagreement (13.7%). There was a statistically significant association between the type of health facility and knowledge of malaria vaccines (p = 0.038). Occupation (p = 0.018) and gender of caregivers (p = 0.006) were significant factors, female caregivers and civil servants were more willing to accept malaria vaccination for their wards. CONCLUSION: Despite a strong willingness among caregivers to vaccinate their children, awareness of the malaria vaccine was inadequate. Targeted awareness campaigns, especially addressing safety concerns and spousal engagement, are urgently needed to translate high willingness into actual uptake.