Awareness, perception and influences on uptake of the RTS,S/AS01 malaria vaccine among caregivers for children under 5 years in South West region, Cameroon.

Background: Malaria remains a major cause of morbidity and mortality among children under five in Cameroon. The recent introduction of the RTS,S/AS01 malaria vaccine provides an important opportunity to reduce the disease burden. However, little is known about caregivers' awareness and perceptions during the early vaccine rollout. This study explored caregivers' understanding, attitudes, and experiences regarding the malaria vaccine in selected urban and rural communities in the South West Region of Cameroon, forming part of a broader mixed-methods project aimed at informing strategies to strengthen vaccine uptake. Methods: An exploratory qualitative design was used, involving two focus group discussions with 20 mothers and caregivers of children aged 11-30 months. Participants were purposively selected to capture diverse perspectives across settings. Discussions examined awareness, perceived benefits, misconceptions, and contextual factors shaping vaccine uptake. Data were audio-recorded, transcribed, translated, and analysed thematically using an inductive deductive coding approach. Results: Findings showed that caregivers in the urban setting had high awareness of the malaria vaccine, though understanding was often limited and sometimes confused with other malaria interventions. Rural caregivers displayed uneven awareness but strong trust in health workers, which positively influenced acceptance. Across both settings, perceived benefits such as reduced severity of malaria episodes enhanced confidence in the vaccine. Barriers included communication gaps, misinformation, gender dynamics, long waiting times, and distance to health facilities. Caregivers recommended strengthening community-based communication through churches, town criers, health talks, outreach sessions, and visual materials. Conclusion: These findings highlight the importance of clear, consistent communication and trust-building as Cameroon expands malaria vaccine implementation. Enhanced community engagement and improved service delivery may support equitable uptake. The insights from this qualitative phase offer a foundation for further research within the wider mixed-methods project.