Knowledge, awareness and willingness to accept malaria vaccine among women presenting at immunization centres in Calabar, Nigeria

Despite the introduction of the malaria vaccine, hesitancy remains a challenge in Nigeria. Maternal acceptance is central to vaccination program success, hence understanding mothers’ knowledge, attitudes, and concerns is essential. This study assessed knowledge, awareness, and willingness to accept the malaria vaccine among women attending immunization centres at tertiary and secondary health institutions in Calabar, Nigeria. A hospital-based cross-sectional study was conducted from September 2024 to June 2025 among 730 women aged 15–49 years. Data were collected using a pretested, semi-structured, interviewer-administered questionnaire. The main outcome was willingness to receive malaria vaccination for both mother and child. Variables with p ≤ 0.2 in bivariate analysis were included in a logistic regression model, with statistical significance set at p ≤ 0.05. Most respondents (83.6%) were aware of the malaria vaccine, and 74.5% demonstrated good knowledge. However, 25.5% had poor knowledge. Overall, 59.2% expressed willingness to vaccinate themselves and their children. Single women (AOR = 0.45; 95% CI 0.2–0.9) and those with primary (AOR = 0.17; 95% CI 0.0-0.8) or no education (AOR = 0.13; 95% CI 0.0-0.8) were significantly less willing to accept vaccination. Respondents who had not treated malaria in the previous three months (AOR = 0.67; 95% CI 0.4–0.9) and those with poor knowledge (AOR = 0.17; 95% CI 0.1–0.2) were also less willing. Recent malaria treatment was significantly associated with presence of stagnant water, infrequent grass clearing, and non-use of insecticide-treated nets. The study highlights the need for strengthened health education to improve vaccine knowledge, alongside promoting environmental sanitation, ITN use, and integrating vaccine education into malaria prevention programs.