Knowledge and attitudes of caregivers of under-five children toward the malaria vaccine in the Tiko Health District, Cameroon: A community-based cross-sectional study

Background

Despite progress in malaria control, it remains a significant public health burden in sub-Saharan Africa, especially among children under five. The introduction of the RTS,S/AS01 (Mosquirix) malaria vaccine offers hope; however, its successful implementation depends largely on caregivers’ knowledge and attitudes. This study assessed the knowledge and attitudes of caregivers of under-five children regarding the malaria vaccine in the Tiko Health District of Cameroon.

Methods

A descriptive cross-sectional survey was conducted from February to April 2025 in four randomly selected health areas within the Tiko Health District. A total of 410 caregivers of children aged 0–5 years were recruited using a multistage sampling technique. Data were collected using a structured, pre-tested questionnaire and analyzed using SPSS version 26. Descriptive statistics summarized sociodemographic characteristics, and knowledge and attitude scores were computed using a scoring system, with a 60% threshold used to define adequate knowledge and positive attitudes.

Results

The mean age of participants was 33.6 years (SD = 8.9), and the majority were female (83.2%). Although 60.7% of caregivers had heard about the malaria vaccine, only 26.6% demonstrated good knowledge, and 25.1% exhibited positive attitudes toward it. Healthcare providers were the most common source of information (35.4%). Misconceptions about vaccine efficacy and purpose were prevalent, and awareness of the vaccine’s approval in Cameroon was limited (41.8%). Positive attitudes were associated with trust in healthcare workers and belief in the vaccine’s importance for child health.

Conclusion

Caregivers in the Tiko Health District exhibited low levels of knowledge and generally negative attitudes toward the malaria vaccine. These findings highlight the need for targeted health education interventions and community engagement strategies to improve vaccine acceptance and uptake in this high-risk population.

What is known on the topic

• Malaria remains a leading cause of morbidity and mortality among children under five in sub-Saharan Africa, despite the availability of preventive tools such as insecticide-treated nets and chemoprevention.

• The RTS,S/AS01 (Mosquirix) malaria vaccine has been approved by the WHO as an additional tool to reduce malaria incidence in young children in endemic areas.

• Successful vaccine uptake depends significantly on caregivers’ knowledge and attitudes, which influence their willingness to seek vaccination for their children.

What this study adds

• This study reveals that although 60.7% of caregivers in the Tiko Health District had heard of the malaria vaccine, only 26.6% demonstrated good knowledge, and just 25.1% had positive attitudes toward it.

• Misconceptions regarding the vaccine’s purpose, effectiveness, and safety were prevalent, and over one-third of caregivers reported receiving no information at all on the vaccine.

• These findings underscore the urgent need for targeted, community-based health education and communication strategies to improve caregivers’ understanding and acceptance of the malaria vaccine in high-risk settings.