Abstract / Summary
Background: Sierra Leone has one of the highest malaria burdens in the world and children under 5 years of age are the most vulnerable. The malaria vaccine RTS,S/AS01 is a promising vaccine, but its use is still very low (around 50% of eligible children nationally). Knowledge of the willingness of caregivers and related factors is crucial for enhancing vaccine uptake. Objective: To evaluate the uptake of malaria vaccination among caregivers of under fives children attending two major government hospitals in Freetown and to determine factors influencing uptake of malaria vaccine. Method: A cross sectional study was carried out from January to July 2025 at Princess Christian Maternity Hospital (PCMH) and Connaught Hospital. The immunization registers were used to select 201 caregiver-child records through systematic random sampling. Structured questionnaires were employed to gather data on the socio-demographic characteristics, awareness, trust, and perceived effectiveness. Chi-square tests and logistic regression (SPSS v25) were used to identify predictors of vaccine acceptance. Results: Vaccine uptake was only 21.9% (44/201). The most common primary barriers were concerns about side effects (58.0%) and lack of awareness (29.3%). Significant predictors of acceptance were: awareness (χ²=17.82, p<0.001; OR=5.63, 95%CI: 2.36-13.45), perceived effectiveness (OR=3.12, 95%CI: 1.74-5.59, p<0.001), trust in healthcare workers (OR=2.89, 95%CI: 1.65-5.08, p<0.001), tertiary education (OR=2.34, 95%CI: 1.31-4.17, p=0.005), and urban residence (OR=2.12, 95%CI: 1.15-3.91, p=0.015). Conclusion: The acceptance of malaria vaccines among caregivers in Freetown is very low. The main obstacles are fear of side effects and lack of awareness. There is an urgent need for targeted health education with trusted health care providers to improve vaccine uptake and reduce child mortality due to malaria in Sierra Leone. This study explores the attitudes of caregivers towards the introduction of a malaria vaccine in under-fives in Sierra Leone, with a particular focus on vaccine acceptance.