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Abstract
Objective This study aimed to assess mothers’ awareness, perceptions and willingness to accept malaria vaccines for their children under 5 years old in a city in Northcentral Nigeria.
Design The research employed a hospital-based cross-sectional observational study design to gather and analyse relevant data.
Setting The study was conducted at the immunisation clinic of a tertiary health centre in Northcentral Nigeria.
Participants A total of 376 women of reproductive age (15–49 years) participated in the study. All participants resided in the study area and had children aged 0–5 years.
Main outcome measures The study evaluated mothers’ awareness of the malaria vaccine, their perceptions about its use and their willingness to vaccinate their children under 5 years of age.
Results Awareness of the malaria vaccine was low, with only 89 mothers (23.7%) reporting prior knowledge of it. Despite this, an overwhelming 366 participants (97.3%) expressed willingness to vaccinate their children and 352 (93.6%) were willing to pay for the vaccine. Concerns about injection site reactions, fever and pain were common, with 126 mothers (33.6%) preferring an oral vaccine. Positive perception significantly influenced willingness to vaccinate (χ²=5.987, p=0.014). Additionally, age, marital status, educational level and income were significantly associated with willingness to vaccinate (p=0.002, 0.025, 0.015, 0.026, respectively). At the multivariate level, younger maternal age (OR=1.179, p=0.011) and higher income (OR=1.040, p=0.049) emerged as direct predictors of vaccine acceptance.
Conclusions While awareness of malaria vaccines among mothers was limited, there was a strong willingness to vaccinate, influenced by positive perceptions, younger maternal age and higher income. The findings highlight the importance of targeted educational campaigns to improve awareness and acceptance of malaria vaccines. Future studies should explore interventions to enhance vaccine acceptance and address potential barriers to vaccine awareness.
- Health policy
- Cross-Sectional Studies
- Malaria
- Vaccination
- Community Participation
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information. The data that support the findings of this study are available on request from the corresponding author. The data is not publicly available due to privacy or ethical restrictions.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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STRENGTHS AND LIMITATIONS OF THIS STUDY
Thorough analysis of maternal awareness, perceptions and acceptance of malaria vaccines.
A large sample size enhances the reliability of findings within the study population.
Incorporation of both quantitative and qualitative methods provides a well-rounded perspective.
Single-site study design limits the generalisability of findings to broader populations.
Self-reported data may be subject to social desirability bias.
Introduction
Malaria is a significant public health threat in tropical and subtropical regions, caused by Plasmodium parasites, with Plasmodium falciparum being the most dangerous. It often leads to severe and potentially fatal cases, especially in children under age 5 and pregnant women due to their weaker immune systems. The disease spreads primarily through bites from infected female Anopheles mosquitoes, and less commonly through blood transfusions, organ transplants or childbirth. Malaria is endemic in regions like sub-Saharan Africa, South Asia, Southeast Asia and parts of Latin America, with Nigeria bearing a substantial burden of cases and deaths.1–4
Despite efforts to control malaria, it remains widespread in Nigeria. In 2022, globally, there were an estimated 249 million malaria cases, an increase of 5 million cases compared with 2021 with Nigeria accounting for 1.3 million cases out of the 5 million.5 Nigeria accounted for the highest burden globally (27% of all cases) with the Democratic Republic of Congo ranking second at 12% cases. The WHO African region accounted for about 94% of cases of malaria globally (233 million cases).5 Global mortality due to malaria decreased from 631 000 in 2019 to 608 000 in 2022 with Nigeria accounting for the highest proportion of deaths (31%) in 2022.5 Malaria remains a leading cause of hospital visits for children under age 5 and significantly affects school attendance.6 This highlights the importance of effective vaccination and control measures.1 7
Despite global strategies like chemoprophylaxis, environmental management, insecticide-treated nets and biological control, malaria prevention and control face limitations. This leads to high morbidity and mortality, especially among children under age 5 in sub-Saharan Africa. The WHO’s 2023 World Malaria Report shows 29 countries accounted for 95% of malaria cases globally. Four countries—Nigeria (27%), the Democratic Republic of the Congo (12%), Uganda (5%) and Mozambique (4%)—accounted for almost half of all cases globally. The WHO African Region, with an estimated 233 million cases in 2022, accounted for about 94% of cases globally. Between 2000 and 2019, case incidence in the WHO African Region decreased from 370 to 226 per 1000 population at risk, but increased to 232 per 1000 population at risk in 2020, mainly because of disruptions to services during the COVID-19 pandemic. In 2022, case incidence declined to 223 per 1000 population at risk. Globally, malaria deaths declined steadily from 864 000 in 2000 to 586 000 000 in 2015 and to 576 000 in 2019. In 2020, malaria deaths increased by 10% compared with 2019, to an estimated 631 000. Estimated deaths declined in 2022 to 608 000 000. The percentage of total malaria deaths in children aged under age 5 decreased from 87% in 2000 to 76% in 2015. Since then, there has been no change. Globally, the malaria mortality rate (ie, deaths per 100 000 population at risk) halved from about 29 in 2000 to 15 in 2015. It then continued to decrease but at a slower rate, falling to 14 in 2019. In 2020, the mortality rate increased again, to 15.2, before decreasing slightly to 14.3 in 2022. About 96% of malaria deaths globally were in 29 countries. Four countries accounted for just over half of all malaria deaths globally in 2022—Nigeria (31%), the Democratic Republic of the Congo (12%), Niger (6%) and the United Republic of Tanzania (4%). Malaria deaths in the WHO African Region decreased from 808 000 in 2000 to 548 000 000 in 2017, before increasing to 604 000 in 2020. Estimated deaths decreased again to 580 000 in 2022. The malaria mortality rate decreased by 60% between 2000 and 2019, from 143 to 57 deaths per 100 000 population at risk, before rising to 61 in 2020 and decreasing again to 56 in 2022.5 The incidence of malaria is highest in Northern and Northeastern Nigeria.8 Data from household surveys show that malaria prevalence in children, accessed via microscopy and rapid diagnostic test, dropped from 27% and 45% in 2015 to 22% and 40% in 2021, respectively.8 While malaria cases decreased in 13 states in Nigeria since 2010, 24 states, 12 of which are from Northern Nigeria, have registered increases in malaria cases.8 9 The emergence of resistance to artemisinin-based combination therapies in Asia and insecticide resistance in regions such as Africa, the Americas, Eastern Mediterranean, South-East Asia and the Western Pacific further complicate malaria control efforts. A large proportion of the population at risk of malaria—particularly in the WHO African region continues to lack access to prevention, diagnosis and treatment. These challenges underscore the urgent need for a more effective preventive measure, highlighting the importance of developing a malaria vaccine.9–11
The WHO Director-General described the malaria vaccine as a major breakthrough for science, child health and malaria control.12 After a pilot programme in Ghana, Kenya and Malawi, the WHO recommended on 6th October 2021, that the RTS, S malaria vaccine be used to prevent P. falciparum malaria in children in regions with moderate to high transmission rates. This vaccine is a crucial addition to existing malaria control measures, especially in endemic countries like Nigeria, and is vital for achieving the pan-African and global goal of ‘Zero malaria’. Although promising innovations in vector control and single-dose cures for malaria have emerged, their impact has not yet fully achieved the goal of ‘Zero malaria’. The introduction of malaria vaccines is promising, but their success depends on public acceptance. A pilot study on malaria vaccine was carried out in Ghana, Malawi and Kenya. The key outcomes of the Malaria Vaccine Pilot Evaluation were reduction in mortality from all causes by 13% in children eligible for the vaccine, reduction in severe malaria hospitalisations by 22%, reaffirmation of the vaccine’s safety and a demonstration that the vaccine was feasible to deliver.7 13–15
While different studies have assessed malaria vaccine awareness and acceptance in parts of Nigeria, including Southwest, South East and Northwest regions, findings reveal varied levels of awareness and willingness to accept the vaccine, influenced by factors such as education, socioeconomic status and concerns about vaccine safety. However, there remains a significant research gap in North-Central Nigeria, with only one identified thesis on malaria vaccine acceptance in the region, limiting region-specific insights needed to tailor effective vaccination campaigns. This study aims to bridge this gap by investigating the awareness, perception and willingness to accept the malaria vaccine among mothers attending the immunisation clinic at a tertiary health centre in Northcentral Nigeria, providing crucial data for targeted public health interventions. Addressing this gap is essential to improving vaccine acceptance, dispelling misconceptions and contributing to malaria elimination efforts in Nigeria.
Methods
Study design, period and setting
A hospital-based cross-sectional observational study was conducted among mothers of children under age 5 at the immunisation clinic of a tertiary health centre in Northcentral, Nigeria, from October to November 2023. The town where the health centre is located has 74 088 women of reproductive age and 66 444 children under age 5, based on the desk report of her local government area, health management information system.16 The immunisation clinic serving women from the study population has a high attendance rate with 479 women per month and an estimated annual total of 5748 child immunisation visits based on the hospital records obtained from the immunisation clinic.
Study population and source
The study included all women aged 15–49 living in the area where the target population was located who attended the immunisation clinic of a tertiary health facility in Northcentral Nigeria from October to November 2023. Participants were mothers of children under age 5 attending the clinic during this period. Those who were seriously ill and unable to respond were excluded from the study.
Sample size estimation
The sample size was determined using the single population proportion formula,17 18 assuming a 95% CI, a 5% margin of error and a 61.4% positive perception of the malaria vaccine, based on a study by Chukwuocha et al 19 in Southeastern Nigeria. This calculation initially resulted in 364 participants. Adjusting for the clinic’s smaller population of less than 10 000, the sample size was adjusted to 342 based on Cochran’s formula for adjusting sample size if the population is less than 10 000. Including a 10% non-response rate, the final sample size was set at 376.
The sample frame was the attendance register of the immunisation clinic of the study location while the sampling interval (K) was 3.
Sampling procedure
A systematic random sampling technique was used to select eligible participants from mothers who attended the immunisation clinic over a 6-week period. Data collection was conducted on clinic days (Mondays, Wednesdays and Thursdays) averaging 21 respondents per day and 63 respondents per week. Each third mother on the attendance register on each clinic day was randomised (K=3).
Data collection
A pretested, semistructured, interviewer-administered questionnaire was used for this study, previously validated in several studies.20–22 It had four sections: sociodemographic data, awareness of the malaria vaccine, perceptions of the vaccine and willingness to accept it. Perception was measured using eight Likert scale items, with scores of 4 or less indicating poor perception and 5 or more indicating good perception. Willingness to accept the malaria vaccine was assessed by asking if respondents would vaccinate their child when the vaccine is available, with ‘yes’ scored as 1 and ‘no’ as 0. Awareness was evaluated by asking if they had heard of the vaccine, with ‘yes’ scored as 1 and ‘no’ as 0. The study also explored sources of awareness and barriers to vaccine acceptance. Research assistants ensured all questions were answered.
Data analysis
Data analysis was conducted using IBM SPSS V.27, describing categorical variables with frequencies and percentages. χ2 tests and multivariate binary logistic regression were used, with significance set at p<0.05. Prevalence rates for awareness, perception and willingness to accept the malaria vaccine were calculated. The main outcome variable, willingness to vaccinate children under age 5, was cross-tabulated with sociodemographic characteristics. Variables with p≤0.05 in binary logistic analysis were included in the multivariate model, with results presented as adjusted ORs and 95% CIs.
Patient and public involvement
The patients and the public were first involved at the point of collection of data where the study was introduced with the aims and objectives of the study explained to them and their written consent obtained.
The research questions were developed based on the challenges faced in the implementation of new vaccines in the past.
Patients and the public were not involved in the design of the research, choice of outcome measures, recruitment to the study and choosing the methods and agreeing plan for dissemination of the study results to participants and linked communities.
Results
Sociodemographic characteristics of respondents
Respondents ranged in age from 15 to 49 years, with a mean age of 28.9±5.2 years (table 1). The largest age group was 25–35 years (69.1%), while the smallest was 45–49 years (1%). Most respondents (97.3%) were married. Over half (54%) had tertiary education, while only 0.8% had no formal education. The majorities were involved in business and trading (49.2%) or worked as artisans (16%). Additionally, 60.6% earned less than ₦30 000 (US$18) monthly, indicating a low socioeconomic status.
Sociodemographic characteristics of mothers of under age 5 children in Northcentral, Nigeria 2023 (n=376)
Awareness of the malaria vaccine
Of the 376 participants, 89 (23.7%) had heard about the malaria vaccine (table 2). The main sources of information were friends (47.1%), healthcare workers (19.1%) and antenatal clinics (15.2%). Other sources included social media (8.7%), relatives (5.9%), news/advertisements (2.9%) and radio (1.1%).
Awareness and sources of information on malaria vaccine among mothers of under age 5 children in Northcentral, Nigeria 2023 (n=376)
Perception of the malaria vaccine
Almost two-fifths of the respondents, 217 (57.7%), had a positive perception of the malaria vaccine, while 159 (42.3%) of them had a negative perception of the vaccine.
Willingness to accept malaria vaccine
The majority of respondents, 366 (97.7%), indicated that they would vaccinate their children against malaria once the vaccine becomes available. Additionally, 352 respondents (93.6%) were willing to pay for the vaccine. Among the few unwilling mothers (figure 1), reasons for refusal included fear of side effects (44.4%), religious beliefs (22.2%), potential high cost (11.1%) and concerns about discomfort causing the baby to cry (11.1%).
Reason for unwillingness to receive the malaria vaccine by respondents (n=10). 
Cost; 
fear of side effects; 
Religious beliefs; 
makes baby to cry.
Perceived fears about the malaria vaccine
A significant portion of respondents (176 or 46.8%) had fears about the malaria vaccine. Additionally, 126 respondents (33.6%) preferred the vaccine to be administered orally to minimise discomfort and avoid issues like swelling, abscesses or paralysis. The main concerns among those with fears (table 3) included swelling at the injection site (34.1%), fever (24.8%), pain (14.1%) and rash (12.4%). Other concerns included infertility in male children (3.5%), fear of the unknown (2.9%), death (2.3%) and doubts about vaccine effectiveness (2.3%), allergies (1.8%) and the belief that the vaccine could cause disease (1.8%).
Perceived fears, preferred route and fear about malaria vaccine among mothers of under age 5 children in Northcentral, Nigeria 2023 (n=376)
Relationship between awareness, perception and willingness to accept the malaria vaccine for children
Assessing the relationship between awareness and perception of the malaria vaccine with mothers’ willingness to vaccinate their children (table 4) revealed that awareness alone did not predict vaccine uptake (χ²=1.062, p=0.302). However, a positive perception of the vaccine was significantly associated with the willingness to vaccinate (χ²=5.987, p=0.014).
Relationship between awareness, perception and willingness to accept the malaria vaccine for children among mothers in Northcentral, Nigeria 2023
Factors influencing willingness to accept the malaria vaccine for children
A bivariable logistic regression analysis of sociodemographic and health-related characteristics, along with perceptions about the malaria vaccine, revealed significant associations with willingness to vaccinate (tables 5 and 6). Younger mothers (15–34 years) were 1.2 times more likely to vaccinate their children compared with older mothers (35–49 years) (OR 1.179; 95% CI 1.039 to 1.338; p=0.011). Mothers with a positive perception of the vaccine were 7.4 times more likely to vaccinate their children compared with those with a poor perception (OR 7.400; 95% CI 1.358 to 40.327; p=0.021). Additionally, those with an average monthly income over ₦30 000 (US$18) were 1.04 times more likely to vaccinate their children compared with those earning less (OR=1.040; 95% CI 1.164 to 1.731; p=0.049).
Association between sociodemographic characteristics and willingness to accept malaria vaccine
Binary logistic regression for predictors of willingness to accept malaria vaccine
Discussion
This study conducted at a tertiary hospital in Northcentral Nigeria, explores mothers’ awareness, perceptions and willingness to accept the malaria vaccine for their children. The majority of respondents were aged 25–35 years, predominantly engaged in business and trading, and earning below the minimum wage. These socioeconomic characteristics provide context for their attitudes towards the malaria vaccine. Awareness of the malaria vaccine was notably low, with only 23.7% of respondents aware of its existence. This is consistent with findings by Nnaji et al 23 in rural Nigeria and Adedini et al 24 in Lagos, where vaccine awareness levels were similarly low at 25%, despite urban settings typically having better access to health information. Similarly, Okeibunor et al 25 in Tanzania reported that only 20% of participants were aware of the vaccine, with most learning about it through informal channels such as community leaders and friends, rather than formal healthcare systems. Other studies have also documented low levels of malaria vaccine awareness, including Amin et al 26 (25%) in Bangladesh and Asmare27 (18%) in Southwest Ethiopia. However, some studies reported higher awareness levels, such as Ajayi and Emeto.28 (40.3%) in Northern Nigeria, Musa et al 29 (56%) in Kaduna, Northwest Nigeria and Chinawa et al 30 (72.1%) in Southeastern Nigeria. These findings highlight the urgent need for targeted educational campaigns in malaria-endemic regions to enhance vaccine awareness.
The main sources of information about the malaria vaccine in this study were friends, healthcare workers and antenatal clinics, mirroring results from other studies. For instance, Olowokure et al 31 in Ghana highlighted the pivotal role of healthcare workers and antenatal clinics in disseminating vaccine information, with friends and family serving as secondary sources. This suggests that public health campaigns should extend beyond conventional media and health facilities. Community influencers and social structures could be integrated into outreach efforts to improve vaccine awareness. The trust placed in healthcare workers for vaccine recommendations was also emphasised by Dubé et al 32 in Kenya, where parents were more likely to accept vaccines when endorsed by trusted providers. Training healthcare workers to provide accurate information and addressing misinformation spread through informal sources are crucial steps. Comprehensive community education programmes, as demonstrated by Onyejekwe et al 33 in Nigeria, have proven effective in enhancing vaccine knowledge and awareness.
Despite low awareness, 97.7% of respondents in this study expressed willingness to vaccinate their children against malaria, consistent with findings from other malaria-endemic regions. Dubé et al 32 reported similar acceptance levels in Kenya, where the disease’s significant burden motivated parental support for vaccination. In Ghana, Olowokure et al 31 reported strong parental support for malaria vaccines, a trend similarly observed in other studies. For instance, Ajayi and Emeto28 found a high acceptance rate of 91.9% in Northern Nigeria, while Chinawa et al 30 reported an even higher acceptance rate of 92.9% in Southeastern Nigeria. Furthermore, 93.6% of respondents in this study expressed willingness to pay for the vaccine, underscoring its perceived health benefits. This finding aligns with Adedini et al,24 who observed that parents prioritised their children’s health despite facing economic challenges, highlighting a widespread willingness to embrace effective malaria prevention strategies even in low-income settings. In contrast, Asmare27 reported a lower level of willingness to accept the malaria vaccine (32.3%) in Southwest Ethiopia, which was significantly influenced by individuals' previous experiences with vaccination.
Vaccine refusal in this study was attributed to fear of side effects, religious beliefs and concerns about cost and discomfort. Similar barriers were identified by Onyejekwe et al 33 and Taddese et al 34 in Nigeria and Ethiopia, respectively, where fear of adverse effects was a significant factor. Addressing these concerns through transparent communication about vaccine safety is essential. Okeibunor et al 25 emphasised the importance of healthcare providers in building trust and reassuring parents about vaccine safety. Religious beliefs also influenced refusal, highlighting the need for culturally sensitive promotion strategies. Engaging religious leaders, as demonstrated by Oduwole et al 35 in Nigeria, effectively addressed misconceptions and improved vaccine acceptance. Cost concerns further reflect the socioeconomic challenges faced by families in malaria-endemic regions. Subsidising vaccines or integrating them into free immunisation programmes, as successfully implemented in several African countries, can alleviate this barrier.
Fear of injection site reactions, fever and pain was a notable concern among respondents, with 33.6% preferring a non-injectable vaccine. This preference aligns with findings from other studies. Oduwole et al 35 noted that less invasive vaccine delivery methods, such as oral vaccines, improved acceptance in Kenya and Tanzania. The success of the oral polio vaccine campaign, as highlighted by Grassly et al,36 supports the potential for an oral malaria vaccine to increase uptake. Educational campaigns addressing fears of injectable vaccines and providing evidence-based information about vaccine safety can mitigate these concerns. Goldstein et al 37 demonstrated that tailored educational interventions effectively reduced vaccine hesitancy. Trusted healthcare providers play a crucial role in these efforts, as shown by Opel et al,38 where open, non-judgemental conversations led to higher acceptance rates. Community leaders and influencers can amplify these campaigns, as Kaufmann39 reported improved vaccine acceptance in Nigeria’s polio eradication campaigns through the involvement of traditional and religious leaders. Enhancing surveillance and reporting systems for adverse events following immunisation is also vital. Transparent reporting and prompt management of adverse events can build public trust, as emphasised by the WHO’s Global Vaccine Safety Initiative.
While awareness did not directly predict vaccine acceptance in this study, a positive perception of the malaria vaccine significantly influenced willingness to vaccinate. This underscores the importance of shaping perceptions, not just spreading information. Okeibunor et al 25 similarly found that high awareness of vaccination campaigns did not guarantee uptake, which depended more on perceived benefits and safety. This finding aligns with the Health Belief Model, which suggests that individuals engage in health-related behaviours when the benefits outweigh the barriers. Brewer40 also identified positive beliefs about vaccine efficacy and safety as key predictors of vaccination rates. Educational campaigns should focus on addressing common fears and misconceptions to foster a positive perception of the malaria vaccine. Karafillakis and Larson41 found that targeted communication addressing vaccine safety concerns significantly improved acceptance. Engaging trusted community figures and using storytelling can enhance these efforts. For instance, Jegede42 demonstrated that involving religious and traditional leaders in vaccination campaigns in Nigeria increased uptake. Personal testimonials from parents with positive vaccination experiences, as highlighted by Betsch et al,43 can also effectively shift perceptions. Integrating educational efforts into routine healthcare visits, such as antenatal and child welfare clinics, provides additional opportunities for engagement.
The study identified several factors influencing vaccine acceptance, including positive perception, maternal age and income. Younger caregivers and those with higher incomes were more likely to accept the vaccine, consistent with findings by Adedini et al 24 and Musa et al.29 These studies highlight the role of socioeconomic factors in shaping health behaviours. Positive perceptions of vaccine safety and efficacy were key predictors of uptake, as shown by Betsch et al.43 Tailored educational interventions are necessary to build trust and address concerns. Jarrett et al 44 demonstrated the effectiveness of tailored communication strategies in improving vaccine uptake. Public health campaigns should provide clear, evidence-based information about vaccine safety and efficacy while addressing specific concerns and misconceptions.
Understanding maternal age and income can help target interventions more effectively. Younger caregivers may be more receptive to digital and social media platforms, which can be leveraged to disseminate positive messages about the malaria vaccine. Merten et al 45 found social media to be an effective tool for health communication among younger demographics. Financial barriers can be addressed by offering vaccines at subsidised rates or integrating them into free immunisation programmes. Bednarczyk and Birkhead46 showed that reducing financial barriers increased vaccine uptake among low-income populations. Maternal education also plays a significant role in vaccine acceptance. Educated mothers are more likely to understand the benefits of vaccination and actively seek it for their children. Abdulraheem et al 47 found a positive correlation between maternal education levels and vaccination rates. Educational campaigns targeting less educated mothers, providing them with necessary information and support, can help bridge this gap.
This study highlights critical gaps in awareness and significant willingness to accept the malaria vaccine among mothers in the study population in Northcentral Nigeria. Addressing barriers such as fear of side effects, religious beliefs and cost concerns through targeted educational campaigns and community engagement can enhance vaccine uptake. Leveraging trusted healthcare providers, community influencers, and innovative communication strategies can foster positive perceptions and improve acceptance. Socioeconomic factors such as income and maternal education should inform public health policies to ensure equitable access to malaria vaccines. By addressing these challenges, public health initiatives can effectively reduce the burden of malaria and improve child health outcomes in endemic regions.
Conclusions
The study found a low awareness of the malaria vaccine among the study population. However, there was a positive perception towards the vaccine. There was a high level of willingness to accept the malaria vaccine. Factors affecting willingness include age, socioeconomic status and positive perception.
The study highlights the need to increase vaccine awareness strategies within communities and also address the fears associated with vaccination in general. These strategies will help improve acceptance of the malaria vaccine and are crucial for reducing malaria’s burden. Future research should assess the effectiveness of these interventions and explore additional factors affecting vaccine acceptance.
Recommendation
Policy-makers, Federal Ministry of Health, malaria implementation partners should develop educational campaigns using effective methods and ensure availability of malaria vaccines.
Health workers should include malaria vaccine education as part of their health education sessions.
Health facilities should liaise with communities to conduct malaria vaccine awareness and sensitisation campaigns to sensitise people on the malaria vaccine.
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information. The data that support the findings of this study are available on request from the corresponding author. The data is not publicly available due to privacy or ethical restrictions.
Ethics statements
Patient consent for publication
Ethics approval
This study involves human participants and ethical approval was obtained from the Health Research Ethics Committee (FMCB/HCS/HREC/APPR/VOL.2/45/23) of the study location. Participants were informed about the study’s aims, and their written consent was obtained, with information provided clearly to mothers. Confidentiality and anonymity were maintained using a numbering system instead of names. Participants gave informed consent to participate in the study before taking part.
Acknowledgments
We thank the management and staff of the study location for their support during the study. We also appreciate the mothers who participated and our research assistants for their efforts in data collection.
Footnotes
X @OludareAlagbe
Contributors All authors were involved in generating the idea about the research, planning and implementation of the research. All author contributed to the interpretation of the data and draft revisions. All authors were involved in draft revision and approved the final version submitted. All author agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. OOA is responsible for the overall content as guarantor.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.
Provenance and peer review Not commissioned; externally peer reviewed.