Perceived safety and efficacy of the malaria vaccine, RTS,S/AS01 among vaccinated children in the South West Region of Cameroon: Mixed Study Approach

Background Malaria remains a leading cause of morbidity and mortality among children under five in Cameroon. In 2024, the RTS,S/AS01 malaria vaccine was introduced into the Expanded Programme on Immunization (EPI), yet evidence on community perceptions, uptake, and real-world effectiveness remains limited. This study assessed caregivers’ and healthcare workers’ perceptions of the vaccine’s safety and efficacy, and examined factors influencing uptake among children in three high-burden districts of the South West Region (SWR) of Cameroon. Methods A mixed-methods study was conducted using a cross-sectional survey of caregivers of vaccinated children and qualitative interviews with mothers and healthcare workers. Quantitative data captured awareness, perceived safety, reported side effects, and vaccine effectiveness. Qualitative data also explored perceptions, communication gaps, cultural influences, and health-system challenges. Descriptive and inferential statistics, including logistic regression, were used for quantitative analysis, while thematic analysis guided qualitative interpretation. Results Among 418 surveyed caregivers, complete vaccine uptake was 62% (258) which is below the WHO recommended target. Lack of knowledge (33%, 109), fear of side effects (22%, 75), and low trust in the health system (14%, 47) were major barriers to full adherence. Perceived safety was generally high (55%, 195), with no serious adverse events reported. Children who completed all vaccine doses were significantly less likely to develop malaria (OR = 0.52; p = 0.037) and had markedly lower odds of severe malaria than those partially vaccinated (OR = 14.5; p < 0.01). Qualitative findings confirmed safety and effectiveness, but limited awareness, misconceptions, stock-outs, and the need for improved community sensitization. Conclusion The RTS,S/AS01 vaccine is perceived as safe and effective, but uptake is hindered by knowledge gaps, communication challenges, and supply constraints in the study area. Therefore, strengthening community awareness, improving health-worker training, and ensuring consistent vaccine availability are essential.