Uptake and determinants of malaria vaccination among under-five children in the Tiko Health District: a community based cross-sectional study

Background Malaria remains a major public health challenge in Cameroon, with children under five years of age being the most vulnerable group. In 2021, the World Health Organization (WHO) recommended the use of the RTS,S/AS01 malaria vaccine in areas of moderate to high malaria transmission. This study assessed caregiver practices and determinants influencing malaria vaccine uptake among under-five children in the Tiko Health District. Methods A community-based cross-sectional study was conducted from the 1st of March 2025 to the 11th of April 2025 among 410 caregivers of children aged 0–5 years, selected using multistage sampling. Data were collected using a structured questionnaire covering sociodemographic characteristics, vaccine-related practices, and factors influencing uptake. Descriptive statistics were computed, and logistic regression analyses were used to determine factors independently associated with malaria vaccine uptake. Results Only 32.2% (n = 132) of children had received the malaria vaccine. Among those vaccinated, 72.0% completed all recommended doses, and 82.6% of caregivers reported keeping vaccination records. However, only 24.1% of all respondents demonstrated good overall practices toward the vaccine. Factors associated with uptake of malaria vaccine were, female caregivers (aOR: 4.16, 95% CI: 1.47–11.75), caregivers in health professions (aOR: 2.87, 95% CI: 1.35–5.69), biological parents (aOR: 11.44, 95% CI: 1.52–86.11), and those with monthly income of XAF 51,000–100,000 (aOR: 2.76, 95% CI: 1.68–4.55) had significantly higher odds of vaccination. Trust in health workers (aOR: 6.12, 95% CI: 2.97–12.61) and information from healthcare providers (aOR: 7.60, 95% CI: 3.82–15.08) were also strong predictors and children who had previously suffered from malaria were less likely to be vaccinated (aOR: 0.31, 95% CI: 0.18–0.54). Conclusion Malaria vaccine uptake in the Tiko Health District remains low, and caregiver practices are generally poor. Factors such as caregiver sex, profession, household income, and access to information and healthcare services significantly influenced uptake. Strengthening caregiver education, improving access to health services, and building trust in healthcare providers are essential for increasing malaria vaccine coverage.