Prevalence, determinants, and reasons for malaria vaccine hesitancy among caregivers of under-five children in Nigeria: Results from a nationwide cross-sectional survey

• Published in: Vaccine Vol. 41; no. 8; pp. 1503 - 1512
• Main Authors: Kabir Sulaiman, Sahabi, Isma'il Tsiga-Ahmed, Fatimah, Sale Musa, Muhammad, Kabir Sulaiman, Abdulwahab, Muhammad Dayyab, Farouq, AB Khan, Moien, Idris Ahmad, Saidu, Abasi-okot Akpan, Udoyen, Ibrahim Usman, UmmuKulthum, Tjjani Bako, Abdulaziz
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 17.02.2023; Elsevier Limited
• Subjects: Acceptance/Hesitancy/Refusal; Adult; Age; Caregivers; Caregivers of under-five children; Child; Children; Children & youth; Cross-Sectional Studies; Family size; Female; Fertility; Geopolitics; Health services; Humans; Immunization; Information sources; Literature reviews; Malaria; Malaria - prevention & control; Malaria Vaccines; Male; Medical personnel; Nigeria - epidemiology; Population; Prevalence; Questionnaires; Regression models; Religious groups; RTS,S malaria vaccine; Sample size; Skepticism; Social networks; Sociodemographics; Statistical analysis; Surveys; Vaccination; Vaccination Hesitancy; Vaccines; Vector-borne diseases; Nigeria; Ghana; Africa; RTS,S malaria vaccine; Immunization; Malaria; Acceptance/Hesitancy/Refusal; Caregivers of under-five children
• ISSN: 0264-410X; 1873-2518
• DOI: 10.1016/j.vaccine.2023.01.060

•The present study is the first to examine hesitancy toward accepting a malaria vaccine by caregivers within the community.•Close to one-third of the caregivers in this survey were hesitant to accept a malaria vaccine for their under-five children.•Receiving information about the malaria vaccine initially from healthcare workers was associated with lower odds of hesitancy.•Having a high monthly income (> NGN100, 000), and having a family size >10 was associated with higher odds of hesitancy.•Major reasons for hesitancy included fear of vaccine adverse effects and availability of other malaria preventive measures. Malaria contributes to an enormous global burden of disease and mortality, especially in children. Approximately one in every four global cases and deaths from malaria occurs in Nigeria. This study aims to evaluate the prevalence and correlates of community hesitancy to the malaria vaccine, including the reasons for the hesitancy, following the approval of the RTS,S malaria vaccine by the World Health Organization (WHO). This was a nationwide cross-sectional online survey of Nigerian adults conducted from 20th October to 30th November 2021. Participants who replied ‘no' or ‘maybe’ to a question assessing their willingness to accept the RTS,S malaria vaccine were considered “hesitant”. We fit a multivariate logistic regression model to report the adjusted odds ratio (aOR) and 95 % confidence interval (CI) for the factors associated with vaccine hesitancy. Among 3377 total respondents (1961 [57.86 %] males; mean age [SD]: 30[9.1]), 1010 (29.91 %) were hesitant. Receiving information about the RTS,S malaria vaccine initially from healthcare workers (vs. the internet) (aOR:0.55; 95 % CI:0.35–0.87) was significantly associated with lower odds of hesitancy. Conversely, earning a high income of over NGN100, 000 (vs. < NGN 30,000) per month (aOR: 2.10, 95 % CI: 1.36–3.24), belonging to other religious groups (vs. Islam) (aOR:3.25, 95 % CI:1.18–8.98), and having a family size of more than ten (vs. < 5) (aOR:1.84; 95 % CI:1.08–3.13) were significantly associated with a higher odds of hesitancy. The main reasons for vaccine hesitancy included fear of vaccine adverse effects (34.95 %), availability of other malaria preventive measures (33.96 %) and not seeing the positive effect of the vaccine in others first (32.97 %). The findings of this survey provide a valuable blueprint for the development of targeted interventions to facilitate caregiver acceptance of the RTS,S vaccine.