Caregivers’ willingness and factors influencing uptake of the malaria vaccine among under-five children at Masaka Regional Referral Hospital, Uganda
4 affiliations
- 1Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
- 2Department of Data, Makerere University John Hopkins University, Kampala, Uganda
- 3Maternal and Child health Department, Masaka Regional Referral Hospital, Masaka, Uganda
- 4Uganda National Expanded Program on Immunization, Ministry of Health, Kampala, Uganda
Abstract
Uganda ranks third with the highest malaria cases globally, highlighting limitations in existing prevention efforts. Malaria vaccination is a key promising strategy to reduce both morbidity and severity among children under 5 (U5) years. In April 2025, Uganda introduced a four-dose R21 malaria vaccine for U5s. We assessed willingness to vaccinate with the malaria vaccine and associated factors among caregivers of U5s to support vaccine rollout in the targeted population. In March 2025, we conducted a cross-sectional study at the Maternal and Child Health unit of Masaka Regional Referral Hospital among 292 caretakers. We generated caretaker attendance lists daily to serve as sampling frames and developed a sampling interval. We used systematic sampling to obtain the total sample size. We administered a questionnaire assessing caregivers’ willingness to vaccinate, and identified associated factors using modified Poisson regression. We interviewed 292 caretakers, 250(86%) were female and 249(85%) indicated willingness to vaccinate their children. Prior experience with adverse events following immunization (AEFIs) (adjusted prevalence ratio [aPR]=0.2,95%Confidence Interval [CI]0.05-0.5), having other relatives than biological parents as main decision makers (aPR 0.2, 95%CI0.04-0.9) and having tertiary education (aPR 0.14, 95%CI0.04-0.6) were associated with reduced willingness to vaccinate, while receipt of malaria Intermittent Preventive Treatment in pregnancy (IPTp) (aPR 6.2, 95%CI1.6-23) and trust in vaccine safety (aPR 13, 95%CI4.0-43) were associated with increased willingness to vaccinate. Majority of the caretakers were not aware of the malaria vaccine butwere willing to vaccinate their children when oriented. AEFI history, household decision-making roles, and education level were associated with reduced willingness, while having received malaria IPTp and trust in vaccine safety were associated with increased willingness to vaccinate. We recommended providing malaria vaccine information through antenatal care, preparing health workers to address the AEFI history and vaccine-safety concerns and prioritizing safety-focused messaging over general awareness messaging.
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BibTeX
@article{namusisi2026caregivers,
title = {{Caregivers’ willingness and factors influencing uptake of the malaria vaccine among under-five children at Masaka Regional Referral Hospital, Uganda}},
author = {Annet Mary Namusisi and Richard Migisha and Dominic Kizza and Benon Kwesiga and Lilian Bulage and Valeria Tusuubira and Lucy Maria Nakayiza and Sophia Tageya and Fred Nsubuga and Rita Atugonza and Michael Baganizi and Alex Riolexus Ario},
journal = {PLOS Global Public Health},
year = {2026},
month = oct,
doi = {10.1371/journal.pgph.0005764},
url = {https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0005764},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Caregivers’ willingness and factors influencing uptake of the malaria vaccine among under-five children at Masaka Regional Referral Hospital, Uganda
AU - Annet Mary Namusisi
AU - Richard Migisha
AU - Dominic Kizza
AU - Benon Kwesiga
AU - Lilian Bulage
AU - Valeria Tusuubira
AU - Lucy Maria Nakayiza
AU - Sophia Tageya
AU - Fred Nsubuga
AU - Rita Atugonza
AU - Michael Baganizi
AU - Alex Riolexus Ario
PY - 2026
DA - 2026/10/06
JO - PLOS Global Public Health
DO - 10.1371/journal.pgph.0005764
UR - https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0005764
AB - Uganda ranks third with the highest malaria cases globally, highlighting limitations in existing prevention efforts. Malaria vaccination is a key promising strategy to reduce both morbidity and severity among children under 5 (U5) years. In April 2025, Uganda introduced a four-dose R21 malaria vaccine for U5s. We assessed willingness to vaccinate with the malaria vaccine and associated factors among caregivers of U5s to support vaccine rollout in the targeted population. In March 2025, we conducted a cross-sectional study at the Maternal and Child Health unit of Masaka Regional Referral Hospital among 292 caretakers. We generated caretaker attendance lists daily to serve as sampling frames and developed a sampling interval. We used systematic sampling to obtain the total sample size. We administered a questionnaire assessing caregivers’ willingness to vaccinate, and identified associated factors using modified Poisson regression. We interviewed 292 caretakers, 250(86%) were female and 249(85%) indicated willingness to vaccinate their children. Prior experience with adverse events following immunization (AEFIs) (adjusted prevalence ratio [aPR]=0.2,95%Confidence Interval [CI]0.05-0.5), having other relatives than biological parents as main decision makers (aPR 0.2, 95%CI0.04-0.9) and having tertiary education (aPR 0.14, 95%CI0.04-0.6) were associated with reduced willingness to vaccinate, while receipt of malaria Intermittent Preventive Treatment in pregnancy (IPTp) (aPR 6.2, 95%CI1.6-23) and trust in vaccine safety (aPR 13, 95%CI4.0-43) were associated with increased willingness to vaccinate. Majority of the caretakers were not aware of the malaria vaccine butwere willing to vaccinate their children when oriented. AEFI history, household decision-making roles, and education level were associated with reduced willingness, while having received malaria IPTp and trust in vaccine safety were associated with increased willingness to vaccinate. We recommended providing malaria vaccine information through antenatal care, preparing health workers to address the AEFI history and vaccine-safety concerns and prioritizing safety-focused messaging over general awareness messaging.
SN - 2767-3375
ER -