Health Literacy and Socioeconomic Determinants of Attitudes and Willingness to Accept Malaria Vaccines Among Caregivers of Under-Five Children in Plateau State, Nigeria

Background: Health literacy plays a critical role in shaping health behaviors and informed decision-making, particularly in the context of newly introduced vaccines. In malaria-endemic countries such as Nigeria, caregivers’ ability to access, understand, and apply vaccine-related information can significantly influence acceptance and uptake. This study assessed the role of health literacy and socioeconomic factors in shaping attitudes and willingness to accept malaria vaccines among caregivers of under-five children in Plateau State, Nigeria. Methods: A community-based cross-sectional study was conducted among 408 caregivers selected using multistage sampling. Data were collected using a structured interviewer-administered questionnaire assessing vaccine-related knowledge, attitudes, exposure to health education, and willingness to accept malaria vaccines. Descriptive statistics, chi-square tests, and multivariate logistic regression were performed, with statistical significance set at p  < 0.05. Results: Caregivers demonstrated overwhelmingly positive attitudes toward malaria vaccines, with 94.9% exhibiting favourable perceptions. However, important gaps in vaccine-specific health literacy were identified. While most respondents recognized the potential benefits of malaria vaccination, concerns regarding vaccine safety, effectiveness, and religious considerations persisted. Overall, 85.3% of caregivers expressed willingness to accept malaria vaccines. Education level, occupation, family structure, and religion were significantly associated with attitudes, while occupation independently predicted willingness to vaccinate. Caregivers exposed to health education were more likely to demonstrate positive attitudes and willingness, underscoring the role of health literacy in shaping vaccine-related decision-making. Conclusion: Although attitudes toward malaria vaccines were largely favorable, gaps in vaccine-specific health literacy and socioeconomic disparities influenced willingness to vaccinate. Strengthening health communication, improving community-based health education, and addressing socioeconomic barriers are essential to enhance malaria vaccine acceptance and equitable uptake. Improving health literacy related to malaria vaccination will contribute to achieving Sustainable Development Goal 3 (Good Health and Well-being) by supporting informed health decisions and reducing health inequities.