{
  "abstract": "Introduction Malaria remains a leading cause of under-5 mortality in Nigeria, with Abia State exemplifying hyperendemic transmission. The 2024 introduction of the R21/Matrix-M and RTS,S/AS01 vaccines offers promise, but evidence on caregiver awareness and acceptance in the non-pilot South-East region to inform equitable rollout is scarce.Methods We conducted a mixed-methods study from June to August 2025 among 618 caregivers of under-5 children engaged with the routine immunisation programme in Abia State. Quantitative cross-sectional surveys assessed awareness (knowledge of malaria vaccines) and acceptance (willingness on Likert scales), and inferential analysis was carried out using logistic regression. Qualitative in-depth interviews (n=28) and focus group discussions (n=6, 50 participants) explored perceptions using thematic analysis. Triangulation was applied to integrate the findings.Results Awareness overall was low (38.2%; 95% CI 34.5% to 42.0%) but highest among urban educated caregivers (52.3%). However, acceptance was high (88.7%), driven by child protection (67.4%) and provider trust (59.8%). Barriers included fears of side effects (51.4%) and misinformation (18.7%). Significantly, education (adjusted OR (AOR)=3.28) and urban residence (AOR=1.78) predicted awareness, and income (AOR=2.05) and awareness status (AOR=6.92) influenced acceptance. Qualitative themes corroborated quantitative findings: ‘fragmented information’ explained rural gaps and ‘maternal instinct’ amplified willingness to accept.Conclusion Based on our findings, caregivers demonstrated strong acceptance of malaria vaccines despite critically low awareness, a disparity fuelled by information gaps and socio-demographic inequities such as low education and rural residence that threaten vaccine rollout and malaria elimination goals. Consequently, this pioneering mixed-methods study recommends that specific channels that leverage primary healthcare centre providers and community leaders for information dissemination should be used, given the high levels of trust, to ensure malaria vaccine uptake and accelerate progress in reducing under-5 deaths.",
  "authors": [
    {
      "affiliations": [
        "Department of Medical Microbiology, Gregory University, Uturu, Nigeria"
      ],
      "name": "Eziyi Iche Kalu"
    },
    {
      "affiliations": [
        "Department of Community Medicine, Federal University of Technology Owerri, Owerri, Nigeria"
      ],
      "name": "Ugo Uwadiako Enebeli"
    },
    {
      "affiliations": [
        "Department of Community Medicine, University of Nigeria - Enugu Campus, Enugu, Nigeria"
      ],
      "name": "Benjamin S Chudi Uzochukwu"
    },
    {
      "affiliations": [
        "Department of Science and Technology, Lancaster University - Ghana Campus, Accra, Ghana"
      ],
      "name": "Ebelechukwu Lawence Enebeli"
    },
    {
      "affiliations": [
        "Department of Biochemistry, Michael Okpara University of Agriculture, Umudike, Nigeria"
      ],
      "name": "Faith Adamma Kalu"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Federal Medical Centre Umuahia, Umuahia, Nigeria"
      ],
      "name": "Perfection Chinyere Igwe"
    },
    {
      "affiliations": [
        "Department of Community Medicine, University of Calabar, Calabar, Nigeria"
      ],
      "name": "Justin Junior Kalu"
    },
    {
      "affiliations": [
        "Department of Pharmacy, Igbinedion University Okada, Benin City, Nigeria"
      ],
      "name": "Beauty Olamma Kalu"
    },
    {
      "affiliations": [
        "Department of Public Health, Federal University of Technology Owerri, Owerri, Nigeria"
      ],
      "name": "Agwu Nkwa Amadi"
    },
    {
      "affiliations": [
        "Center for Artificial Intelligence Accountability in Health, Abuja, Nigeria"
      ],
      "name": "Yakubu Joel Cherima"
    },
    {
      "affiliations": [
        "Center for Artificial Intelligence Accountability in Health, Abuja, Nigeria"
      ],
      "name": "Uchenna Stephen Nwokenna"
    },
    {
      "affiliations": [
        "Center for Artificial Intelligence Accountability in Health, Abuja, Nigeria"
      ],
      "name": "Rejoice Kaka Hassan"
    }
  ],
  "title": "Awareness and acceptance of malaria vaccines by caregivers of under-5 children in Abia State, Nigeria: a mixed methods study",
  "uid": "3cbbf985-994d-5862-8925-a4991301c1c4"
}