Determinants of malaria vaccine willingness among caregivers of children under five years in Akoko, Southwestern Nigeria.

Background: Malaria remains a significant public health challenge in Nigeria, especially among children under five years. The recent introduction of WHO-recommended malaria vaccines offers renewed hope for reducing malaria-related morbidity and mortality, but caregivers' willingness to vaccinate their children depends on their awareness, perceptions and practices. Guided by the Health Belief Model (HBM), this study investigated caregivers' willingness to vaccinate their children against malaria and the factors associated with this willingness in the Akoko area of Ondo State, Nigeria. Materials and Methods: A community-based cross-sectional study was conducted among 498 caregivers of children aged 0-59 months across eight rural and semi-urban communities in Akoko, selected using a multi-stage sampling technique. Data were collected using a structured, pre-tested questionnaire alongside malaria testing using rapid diagnostic test (RDT) kits, and analysed with Microsoft Excel and R software using descriptive and inferential statistics, including multivariable logistic regression. Results: The mean age (± SD) of caregivers was 34.5±11.0 years, and most were female (87.1%). Most caregivers reported appropriate malaria preventive practices, particularly mosquito net ownership, use of insecticide-treated nets, and environmental sanitation; preventive practice was significantly associated with caregiver education (p < 0.05). Malaria prevalence among under-five children was 10.1% and varied significantly with age (p = 0.008). Awareness of the malaria vaccine was high (77.9%), predominantly sourced from the health system, and willingness to vaccinate was high (87.9%). The mean overall HBM score was 48.3±13.9 (out of 60). Willingness to vaccinate was significantly associated with religion, trust in vaccine information and HBM category (p = 0.014, p = 0.002, p < 0.001, respectively). In multivariable analysis, caregivers who did not trust the information they received (AOR = 0.16; 95% CI: 0.05-0.53; p = 0.002) and those whose previous vaccination experiences influenced their decision (AOR = 0.24; 95% CI: 0.09-0.71; p = 0.009) had lower odds of willingness to vaccinate, while a higher HBM score was associated with higher odds of willingness (AOR = 1.04; 95% CI: 1.00-1.08; p = 0.030). Conclusions: Malaria preventive practices and health beliefs were generally favourable in this population, and this may have contributed to the relatively low malaria prevalence observed. Trust in health information and positive health beliefs were the factors most strongly associated with caregivers' willingness to vaccinate their children. Strengthening healthcare-worker engagement, improving vaccine communication, and addressing caregivers' informational gaps are recommended to support effective and equitable malaria vaccine uptake.