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Dereje N, Fallah MP, Ndembi N, Duga A, Shaweno T, Aragaw M, Abdulaziz M, Ngongo N, Raji T, Kaseya J. A community engagement framework to accelerate the uptake of malaria vaccines in Africa. Nat Med 2024:10.1038/s41591-024-03193-2. [PMID: 39174701 DOI: 10.1038/s41591-024-03193-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Affiliation(s)
- Nebiyu Dereje
- Africa Centres for Disease Control and Prevention, .
| | | | | | | | | | | | | | | | | | - Jean Kaseya
- Africa Centres for Disease Control and Prevention
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Sulaiman SK, Isma'il Tsiga-Ahmed F, Musa MS, Makama BT, Sulaiman AK, Abdulaziz TB. Global prevalence and correlates of mpox vaccine acceptance and uptake: a systematic review and meta-analysis. COMMUNICATIONS MEDICINE 2024; 4:136. [PMID: 38977752 PMCID: PMC11231226 DOI: 10.1038/s43856-024-00564-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/26/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Vaccination has been recommended as one of the most potent ways of controlling the mpox (formerly, monkeypox) outbreak, particularly among high-risk groups. Here, we evaluated the prevalence of mpox vaccine acceptance and uptake globally. METHODS We searched multiple databases for peer-reviewed studies published in English from May 2022 to 25th November 2023 that evaluated mpox vaccine acceptance and/or uptake. We fit a random-effects model meta-analysis to calculate the pooled mpox vaccine acceptance and uptake rates, with their 95% confidence intervals (CI) across population outcomes. We performed subgroup analyses among the six World Health Organization (WHO) regions (Africa [AFR], Region of the Americas [AMR], South-East Asia Region [SEAR], European Region [EUR], Eastern Mediterranean Region [EMR], and the Western Pacific Region [WPR]), as well as among select population subgroups. RESULTS Of the 2531 studies screened, 61 studies, with a cumulative sample size of 263,857 participants from 87 countries were eligible for inclusion. The overall vaccine acceptance and uptake rates were 59.7% and 30.9% globally. Acceptance and uptake rates among the LGBTQI+ community were 73.6% vs 39.8% globally, 60.9% vs. 37.1% in AMR, 80.9% vs. 50.0% in EUR, and 75.2% vs. 33.5% in WPR. Among PLHIV, vaccine acceptance and uptake rates were 66.4% vs. 35.7% globally, 64.0% vs. 33.9% in AMR, 65.1% vs. 27.0% in EUR, and 69.5% vs. 46.6% in WPR. Among healthcare workers, vaccination intention was 51.0% globally. CONCLUSIONS Tailored interventions are needed to bolster confidence in the mpox vaccine, maximize vaccine uptake, and increase vaccine access to close the gaps between acceptance and uptake especially among key populations residing in regions with low rates of acceptance and uptake.
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Affiliation(s)
| | | | - Muhammad Sale Musa
- Department of Medicine, Yobe State University Teaching Hospital, Damaturu, Nigeria
| | | | - Abdulwahab Kabir Sulaiman
- Department of Medicine, Murtala Muhammad Specialist Hospital, Kano, Nigeria
- Kwanar Dawaki COVID-19 Isolation Center, Kano, Nigeria
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Olawade DB, Wada OZ, Ezeagu CN, Aderinto N, Balogun MA, Asaolu FT, David-Olawade AC. Malaria vaccination in Africa: A mini-review of challenges and opportunities. Medicine (Baltimore) 2024; 103:e38565. [PMID: 38875411 PMCID: PMC11175883 DOI: 10.1097/md.0000000000038565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/17/2024] [Accepted: 05/22/2024] [Indexed: 06/16/2024] Open
Abstract
Malaria remains an endemic public health concern in Africa, significantly contributing to morbidity and mortality rates. The inadequacies of traditional prevention measures, like integrated vector management and antimalarial drugs, have spurred efforts to strengthen the development and deployment of malaria vaccines. In addition to existing interventions like insecticide-treated bed nets and artemisinin-based combination therapies, malaria vaccine introduction and implementation in Africa could drastically reduce the disease burden and hasten steps toward malaria elimination. The malaria vaccine rollout is imminent as optimistic results from final clinical trials are anticipated. Thus, determining potential hurdles to malaria vaccine delivery and uptake in malaria-endemic regions of sub-Saharan Africa will enhance decisions and policymakers' preparedness to facilitate efficient and equitable vaccine delivery. A multisectoral approach is recommended to increase funding and resources, active community engagement and participation, and the involvement of healthcare providers.
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Affiliation(s)
- David B. Olawade
- Department of Allied and Public Health, School of Health, Sport and Bioscience, University of East London, London, UK
| | - Ojima Z. Wada
- Division of Sustainable Development, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Chiamaka Norah Ezeagu
- Department of Public Health, School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Nicholas Aderinto
- Department of Medicine and Surgery, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
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Kigongo E, Kabunga A, Opollo MS, Tumwesigye R, Musinguzi M, Akello AR, Nabaziwa J, Hardido TG, Puleh SS. Community readiness and acceptance for the implementation of a novel malaria vaccine among at-risk children in sub-saharan Africa: a systematic review protocol. Malar J 2024; 23:182. [PMID: 38858779 PMCID: PMC11165811 DOI: 10.1186/s12936-024-04995-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 05/22/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND The World Health Organization novel malaria vaccine for at-risk children has the potential to greatly reduce the current malaria burden in sub-Saharan Africa. However, most studies have reported contradictory findings regarding community willingness for the vaccine, which could easily undermine the expected benefits of the vaccine. This study aims to ascertain the current state of community readiness and acceptance for the implementation of a novel malaria vaccine (RTS,S/ASO1) among at-risk children in sub-Saharan Africa, based on available evidence. METHODS This study will follow the Preferred Reporting Items for Systematic Reviews and Meta-analyses protocol (PRISMA-P) guidelines. Relevant studies will be comprehensively searched from PubMed, ScienceDirect, Web of Science, Google Scholar, and African journals online, in accordance with the Cochrane search guidelines. Two independent reviewers will screen titles, abstracts and full texts of eligible studies based on some specified eligibility criteria. When it is feasible to conduct a meta-analysis, a random effects model will be employed to estimate the common effect due to anticipated high heterogeneity of the data. The effect measure for readiness or acceptance will be reported as a pooled proportion with corresponding 95% confidence interval. Additionally, odds ratios with 95% confidence interval will be estimated to assess factors associated with readiness. These will be presented on a forest plot. DISSEMINATION PLANS The findings of the study will be peer-reviewed and published in a scientific journal. Conference presentations will also be made to the different stakeholders in the malaria vaccination campaigns. SYSTEMATIC REVIEW REGISTRATION The protocol has been registered with PROSPERO Registration Number: CRD42023480528.
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Affiliation(s)
- Eustes Kigongo
- Faculty of Public Health, Lira University, Lira, Uganda.
| | - Amir Kabunga
- Faculty of Medicine, Lira University, Lira, Uganda
| | | | - Raymond Tumwesigye
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
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Hussein MF, Kyei-Arthur F, Saleeb M, Kyei-Gyamfi S, Abutima T, Sakada IG, Ghazy RM. Hesitancy towards R21/Matrix-M malaria vaccine among Ghanaian parents and attitudes towards immunizing non-eligible children: a cross-sectional survey. Malar J 2024; 23:142. [PMID: 38734664 PMCID: PMC11088762 DOI: 10.1186/s12936-024-04921-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 03/27/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND The newly developed malaria vaccine called "R21/Matrix-M malaria vaccine" showed a high safety and efficacy level, and Ghana is the first country to approve this new vaccine. The present study aimed to evaluate the rate of vaccine hesitancy (VH) towards the newly developed malaria vaccine among parents who currently have children who are not eligible for the vaccine but may be eligible in the near future. Additionally, the study aimed to identify the factors that could potentially influence VH. METHODS A cross-sectional survey using both online-based questionnaires and face-to-face interviews was conducted in Ghana from June to August 2023. The survey specifically targeted parents of ineligible children for vaccination, including those aged less than 5 months or between 3 and 12 years. The Parent Attitudes about Childhood Vaccination (PACV) scale was used to assess parental VH. RESULTS A total of 765 people participated in this study. Their median age was 36.0 years with an interquartile range of 31.0-41.0 years, 67.7% were females, 41.8% completed their tertiary education, 63.3% were married, 81.6% worked in non-healthcare sectors, and 59.7% reported that their monthly income was insufficient. About one-third (34.5%) of the parents were hesitant to give their children the R21/Matrix-M malaria vaccine. The following predictors were associated with VH: working in the healthcare sector (adjusted odds ratio (AOR) = 0.50; 95% confidence interval (CI) 0.30-0.80; p = 0.005), having the other parent working in the healthcare sector (AOR = 0.54; 95% CI 0.30-0.94; p = 0.034), and not taking scheduled routine vaccinations (AOR = 1.90; 95% CI 1.27-2.84; p = 0.002). CONCLUSIONS Addressing VH is crucial for optimizing R21/Matrix-M vaccine coverage in Ghana's malaria control strategy. By tackling VH issues, Ghana can effectively safeguard children's health in malaria-prone areas.
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Affiliation(s)
- Mohamed Fakhry Hussein
- Occupational Health and Industrial Medicine Department, High Institute of Public Health, Alexandria University, Alexandria, 21561, Egypt.
| | - Frank Kyei-Arthur
- Department of Environment and Public Health, the University of Environment and Sustainable Development, Somanya, Ghana
| | - Marina Saleeb
- Biostatistics Department, MARS-GLOBAL, London, WC2H 9JQ, UK
| | - Sylvester Kyei-Gyamfi
- Department of Children, Ministry of Gender, Children and Social Protection, Accra, Ghana
| | - Theophilus Abutima
- Department of Sociology and Anthropology, University for Development Studies, Nyankpala Campus, Nyankpal, Ghana
| | - Ignatius Great Sakada
- Department of Population, Family and Reproductive Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ramy Mohamed Ghazy
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia
- Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, 21561, Egypt
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Osoro CB, Ochodo E, Kwambai TK, Otieno JA, Were L, Sagam CK, Owino EJ, Kariuki S, Ter Kuile FO, Hill J. Policy uptake and implementation of the RTS,S/AS01 malaria vaccine in sub-Saharan African countries: status 2 years following the WHO recommendation. BMJ Glob Health 2024; 9:e014719. [PMID: 38688566 PMCID: PMC11085798 DOI: 10.1136/bmjgh-2023-014719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/31/2024] [Indexed: 05/02/2024] Open
Abstract
In October 2021, the WHO recommended the world's first malaria vaccine-RTS,S/AS01-to prevent malaria in children living in areas with moderate-to-high transmission in sub-Saharan Africa (SSA). A second malaria vaccine, R21/Matrix-M, was recommended for use in October 2023 and added to the WHO list of prequalified vaccines in December 2023. This study analysis assessed the country status of implementation and delivery strategies for RTS,S/AS01 by searching websites for national malaria policies, guidelines and related documents. Direct contact with individuals working in malaria programmes was made to obtain documents not publicly available. 10 countries had documents with information relating to malaria vaccine implementation, 7 referencing RTS,S/AS01 and 3 (Burkina Faso, Kenya and Nigeria) referencing RTS,S/AS01 and R21/Matrix-M. Five other countries reported plans for malaria vaccine roll-out without specifying which vaccine. Ghana, Kenya and Malawi, which piloted RTS,S/AS01, have now integrated the vaccine into routine immunisation services. Cameroon and Burkina Faso are the first countries outside the pilot countries to incorporate the vaccine into national immunisation services. Uganda plans a phased RTS,S/AS01 introduction, while Guinea plans to first pilot RTS,S/AS01 in five districts. The RTS,S/AS01 schedule varied by country, with the first dose administered at 5 or 6 months in all countries but the fourth dose at either 18, 22 or 24 months. SSA countries have shown widespread interest in rolling out the malaria vaccine, the Global Alliance for Vaccines and Immunization having approved financial support for 20 of 30 countries which applied as of March 2024. Limited availability of RTS,S/AS01 means that some approved countries will not receive the required doses. Vaccine availability and equity must be addressed even as R21/Matrix-M becomes available.
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Affiliation(s)
- Caroline Bonareri Osoro
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
- Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Eleanor Ochodo
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
- Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | | | - Jenifer Akoth Otieno
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Lisa Were
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Caleb Kimutai Sagam
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Eddy Johnson Owino
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Simon Kariuki
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Feiko O Ter Kuile
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Jenny Hill
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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Chinawa AT, Ossai EN, Onukwuli VO, Nduagubam OC, Uwaezuoke NA, Okafor CN, Chinawa JM. Willingness to accept malaria vaccines amongst women presenting at outpatient and immunization clinics in Enugu state, Southeast Nigeria. Malar J 2024; 23:117. [PMID: 38664783 PMCID: PMC11044559 DOI: 10.1186/s12936-024-04914-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 03/21/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND There are giant steps taken in the introduction of the novel malaria vaccine poised towards reducing mortality and morbidity associated with malaria. OBJECTIVES This study aimed to determine the knowledge of malaria vaccine and factors militating against willingness to accept the vaccine among mothers presenting in nine hospitals in Enugu metropolis. METHODS This was a cross-sectional study carried out among 491 mothers who presented with their children in nine hospitals in Enugu metropolis, South-East Nigeria. A pre-tested and interviewer-administered questionnaire was used in this study. RESULTS A majority of the respondents, 72.1% were aware of malaria vaccine. A majority of the respondents, 83.1% were willing to receive malaria vaccine. Similarly, a majority of the mothers, 92.9%, were willing to vaccinate baby with the malaria vaccine, while 81.1% were willing to vaccinate self and baby with the malaria vaccine. The subjects who belong to the low socio-economic class were five times less likely to vaccinate self and baby with malaria vaccine when compared with those who were in the high socio-economic class (AOR = 0.2, 95% CI 0.1-0.5). Mothers who had good knowledge of malaria vaccination were 3.3 times more likely to vaccinate self and baby with malaria vaccine when compared with those who had poor knowledge of malaria vaccination (AOR = 3.3, 95% CI 1-6-6.8). CONCLUSION Although the study documented a high vaccine acceptance among the mothers, there exists a poor knowledge of the malaria vaccine among them.
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Affiliation(s)
- Awoere T Chinawa
- Department of Community Medicine, College of Medicine ESUT, Enugu, Nigeria
| | - Edmund N Ossai
- Department of Community Medicine, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria
| | | | - Obinna C Nduagubam
- Department of Paediatrics, College of Medicine, Enugu State University of Technology, Enugu, Nigeria
| | | | - Chinyere N Okafor
- Department of Community Medicine, College of Medicine UNEC, Enugu, Nigeria.
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Chinawa AT, Ossai EN, Onukwuli VO, Nduagubam OC, Uwaezuoke NA, Okafor CN, Chinawa JM. Willingness to accept malaria vaccines amongst women presenting at outpatient and immunization clinics in Enugu state, Southeast Nigeria. Malar J 2024; 23:117. [DOI: https:/doi.org/10.1186/s12936-024-04914-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 03/21/2024] [Indexed: 04/30/2024] Open
Abstract
Abstract
Background
There are giant steps taken in the introduction of the novel malaria vaccine poised towards reducing mortality and morbidity associated with malaria.
Objectives
This study aimed to determine the knowledge of malaria vaccine and factors militating against willingness to accept the vaccine among mothers presenting in nine hospitals in Enugu metropolis.
Methods
This was a cross-sectional study carried out among 491 mothers who presented with their children in nine hospitals in Enugu metropolis, South-East Nigeria. A pre-tested and interviewer-administered questionnaire was used in this study.
Results
A majority of the respondents, 72.1% were aware of malaria vaccine. A majority of the respondents, 83.1% were willing to receive malaria vaccine. Similarly, a majority of the mothers, 92.9%, were willing to vaccinate baby with the malaria vaccine, while 81.1% were willing to vaccinate self and baby with the malaria vaccine. The subjects who belong to the low socio-economic class were five times less likely to vaccinate self and baby with malaria vaccine when compared with those who were in the high socio-economic class (AOR = 0.2, 95% CI 0.1–0.5). Mothers who had good knowledge of malaria vaccination were 3.3 times more likely to vaccinate self and baby with malaria vaccine when compared with those who had poor knowledge of malaria vaccination (AOR = 3.3, 95% CI 1–6–6.8).
Conclusion
Although the study documented a high vaccine acceptance among the mothers, there exists a poor knowledge of the malaria vaccine among them.
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Nyalundja AD, Bugeme PM, Guillaume AS, Ntaboba AB, Hatu’m VU, Tamuzi JL, Ndwandwe D, Iwu-Jaja C, Wiysonge CS, Katoto PDMC. Socio-Demographic Factors Influencing Malaria Vaccine Acceptance for Under-Five Children in a Malaria-Endemic Region: A Community-Based Study in the Democratic Republic of Congo. Vaccines (Basel) 2024; 12:380. [PMID: 38675762 PMCID: PMC11055057 DOI: 10.3390/vaccines12040380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/17/2024] [Accepted: 03/24/2024] [Indexed: 04/28/2024] Open
Abstract
Two novel vaccines against malaria are proposed as a complementary control tool to prevent and reduce Plasmodium falciparum related disease and death in under-five children from moderate to high malaria transmission regions. The Democratic Republic of Congo (DRC) has committed to eradicate malaria by 2030, and significant efforts have been deployed to strengthen control and elimination measures. We aimed to understand factors influencing the malaria vaccine acceptability among the general population in eastern DRC. We conducted a survey among adult Congolese in Bukavu in March 2022. The questionnaire was adapted from the Behavioral and Social Drivers of vaccine uptake (BeSD) framework and was administered online and physically. Multivariate logistic regressions were built, and estimates were represented as adjusted odds ratios (aOR) and corresponding 95% confidence intervals (95%CI). Out of 1612 adults (median age: 39 years, 46.15% female) surveyed, only 7.26% were aware of the malaria vaccine. However, 46.53% expressed willingness to vaccinate themselves, and 52.60% were open to vaccinating their under-five children. Adjusting for confounding factors, non-student/non-healthcare worker professions (aOR = 0.58, 95%CI [0.42-0.78]) and middle-income status (aOR = 1.87, 95%CI [1.25-2.80]) were significantly associated with self-vaccination acceptance. Age played a role in under-five child vaccination acceptability, with 25 to over 64 years showing increased acceptability compared to the 18-24 age group. Additionally, non-student/non-healthcare worker professions (aOR = 1.88, 95%CI [1.37-2.59]), medium education levels (aOR = 2.64, 95%CI [1.29-5.79]), and residing in semi-rural areas (aOR = 1.63, 95%CI [1.27-2.10]) were predictors of under-five child vaccination acceptance. The acceptability of the malaria vaccine for self and for under-five children was suboptimal for effective malaria control in this community in the DRC. Our study constitutes a call for the Expanded Program on Immunization to closely work with various stakeholders to strengthen risk communication for community engagement prior to and during the introduction of this novel and lifesaving tool, malaria vaccination.
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Affiliation(s)
- Arsene Daniel Nyalundja
- Center for Tropical Diseases and Global Health (CTDGH), Catholic University of Bukavu (UCB), Bukavu 285, Democratic Republic of the Congo; (A.D.N.); (P.M.B.)
- Faculty of Medicine, Catholic University of Bukavu (UCB), Bukavu 285, Democratic Republic of the Congo; (A.S.G.); (A.B.N.); (V.U.H.)
| | - Patrick Musole Bugeme
- Center for Tropical Diseases and Global Health (CTDGH), Catholic University of Bukavu (UCB), Bukavu 285, Democratic Republic of the Congo; (A.D.N.); (P.M.B.)
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Ashuza Shamamba Guillaume
- Faculty of Medicine, Catholic University of Bukavu (UCB), Bukavu 285, Democratic Republic of the Congo; (A.S.G.); (A.B.N.); (V.U.H.)
| | - Alain Balola Ntaboba
- Faculty of Medicine, Catholic University of Bukavu (UCB), Bukavu 285, Democratic Republic of the Congo; (A.S.G.); (A.B.N.); (V.U.H.)
| | - Victoire Urbain Hatu’m
- Faculty of Medicine, Catholic University of Bukavu (UCB), Bukavu 285, Democratic Republic of the Congo; (A.S.G.); (A.B.N.); (V.U.H.)
| | - Jacques Lukenze Tamuzi
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa;
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town 7501, South Africa; (D.N.); (C.I.-J.); (C.S.W.)
| | - Chinwe Iwu-Jaja
- Cochrane South Africa, South African Medical Research Council, Cape Town 7501, South Africa; (D.N.); (C.I.-J.); (C.S.W.)
| | - Charles S. Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town 7501, South Africa; (D.N.); (C.I.-J.); (C.S.W.)
- Vaccine-Preventable Diseases Program, World Health Organization Regional Office for Africa, Brazzaville P.O. Box 06, Congo
| | - Patrick D. M. C. Katoto
- Center for Tropical Diseases and Global Health (CTDGH), Catholic University of Bukavu (UCB), Bukavu 285, Democratic Republic of the Congo; (A.D.N.); (P.M.B.)
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa;
- Cochrane South Africa, South African Medical Research Council, Cape Town 7501, South Africa; (D.N.); (C.I.-J.); (C.S.W.)
- Centre for General Medicine and Global Health, Department of Medicine, University of Cape Town, Cape Town 7505, South Africa
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Friedman-Klabanoff DJ, Adu-Gyasi D, Asante KP. Malaria prevention in children: an update. Curr Opin Pediatr 2024; 36:164-170. [PMID: 38299986 PMCID: PMC10932812 DOI: 10.1097/mop.0000000000001332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
PURPOSE OF REVIEW Malaria cases and deaths decreased from 2000 to 2015 but remain increased since 2019. Several new developments and strategies could help reverse this trend. The purpose of this review is to discuss new World Health Organization (WHO) guidelines and recent research on malaria prevention in children. RECENT FINDINGS Fifteen countries have now rolled out seasonal malaria chemoprophylaxis (SMC) in children at highest risk for severe malaria, and new WHO recommendations provide more flexibility for SMC implementation in terms of target age groups, geographic region, and number of cycles. Recent studies confirm that malaria burden in school aged children, and their contribution to transmission, is high. New guidelines permit expanded chemoprevention options for these children. Two vaccines have been approved for use in malaria endemic countries, RTS,S/AS01 E and R21/Matrix-M. Additionally, pyrethroid-chlorfenapyr bed nets are being deployed to combat resistant mosquitoes. SUMMARY While challenges remain in malaria control towards elimination, new guidelines and recently approved vaccines offer hope. Monitoring for continued vaccine and chemoprevention effectiveness, and for possible epidemiologic shifts in severe malaria presentation and deaths as additional prevention efforts roll out will be paramount.
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Affiliation(s)
- DeAnna J Friedman-Klabanoff
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Dennis Adu-Gyasi
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
- Centre for Research in Applied Biology, School of Sciences, University of Energy and Natural Resources, Sunyani, Bono Region, Ghana, West Africa
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
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Bongomin F, Megwera FJ, Mundua J, Naluwooza N, Ayesiga F, Nsubuga Y, Madraa G, Kibone W, Okot J. Malaria vaccine acceptance among next of kin of children under 5 years of age in Gulu, northern Uganda in 2023: a community-based study. Ther Adv Infect Dis 2024; 11:20499361241247467. [PMID: 38645298 PMCID: PMC11027599 DOI: 10.1177/20499361241247467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 03/28/2024] [Indexed: 04/23/2024] Open
Abstract
Background Malaria is a leading cause of death among children under 5 years of age in sub-Saharan Africa. The malaria vaccine is an important preventive measure introduced by the World Health Organization to reduce malaria and its associated mortality and morbidity. We aimed to assess the acceptance of the malaria vaccine among next of kin of children under 5 years of age in Gulu City, Northern Uganda. Methods Between October and December 2023, we conducted a cross-sectional study in Pece-Laroo division, Gulu City, Uganda. Socio-demographic, vaccine profile and health system factors were collected. Multivariable logistic regression was performed using STATA 16 to determine factors associated with acceptance of the malaria vaccine among next of kin of children under 5 years. Results A total of 432 participants were enrolled. Of these, the majority were female (72.5%, n = 313) with most aged 30 years and above (51.2%, n = 221). Overall, 430 (99.5%) participants had good knowledge about malaria. The majority (91.4%, n = 395) had good acceptance of the malaria vaccine. Factors independently associated with acceptance of the malaria vaccine were knowing a child who died of malaria [adjusted prevalence ratio (aPR): 1.07, 95% confidence interval (CI): 1.01-1.13, p = 0.022] and preferring the injection route for a malaria vaccine (aPR: 1.1, 95% CI: 1.06-1.22, p < 0.001). All 395 participants with good knowledge of malaria had good acceptance of the malaria vaccine (p = 0.007). Conclusion There was a high acceptance of the malaria vaccine in Laroo-Pece division, Gulu, Uganda. However, there is a need for further health education to achieve universal acceptability of the malaria vaccine in preparation for the malaria vaccine implementation program in Uganda.
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Affiliation(s)
- Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, P.O. Box 166, Gulu, Uganda
- Department of Internal Medicine, Gulu Regional Referral Hospital, Gulu, Uganda
| | - Fiona Jollyne Megwera
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Jerry Mundua
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Nabirah Naluwooza
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Frank Ayesiga
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Yakobo Nsubuga
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Grace Madraa
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Winnie Kibone
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Jerom Okot
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
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12
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Sulaiman SK, Musa MS, Tsiga-Ahmed FI, Sulaiman AK, Bako AT. A systematic review and meta-analysis of the global prevalence and determinants of COVID-19 vaccine acceptance and uptake in people living with HIV. Nat Hum Behav 2024; 8:100-114. [PMID: 37904021 PMCID: PMC10810755 DOI: 10.1038/s41562-023-01733-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 09/26/2023] [Indexed: 11/01/2023]
Abstract
People living with HIV (PLHIV) are at higher risk of poor outcomes of SARS-CoV-2 infection. Here we report the pooled prevalence of COVID-19 vaccine acceptance/uptake and determinants among this vulnerable population of PLHIV based on a systematic review and meta-analysis of studies published by 25 August 2023. Among the 54 included studies (N = 167,485 participants), 53 (N = 166,455) provided data on vaccine acceptance rate, while 27 (N = 150,926) provided uptake data. The global prevalences of COVID-19 vaccine acceptance and uptake were 67.0% and 56.6%, respectively. Acceptance and uptake rates were 86.6% and 90.1% for the European Region, 74.9% and 71.6% for the Region of the Americas, 62.3% and 78.9% for the South-East Asian Region, 64.6% and 19.3% for the Eastern Mediterranean Region, 58.0% and 35.5% for the African Region, and 57.4% and 44.0% for the Western Pacific Region. The acceptance rate increased from 65.9% in 2020 to 71.0% in 2022, and the uptake rate increased from 55.9% in 2021 to 58.1% in 2022. Men, PLHIV aged ≥40 years and those who had recently received the influenza vaccine were more likely to accept and receive the COVID-19 vaccine. Factors associated with lower uptake included Black race, other races (Latinx/Hispanic/mixed race), low education level and being unemployed. Vaccine-related factors associated with higher acceptance included belief in vaccine effectiveness, vaccine trust, perceived high susceptibility to SARS-CoV-2 infection and fear of potential COVID-19 effect in PLHIV. Sustained efforts and targeted interventions are needed to reduce regional disparities in COVID-19 vaccine uptake among PLHIV.
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Affiliation(s)
| | - Muhammad Sale Musa
- Department of Medicine, Yobe State University Teaching Hospital, Damaturu, Nigeria
| | | | - Abdulwahab Kabir Sulaiman
- Department of Medicine, Murtala Muhammad Specialist Hospital, Kano, Nigeria
- Kwanar Dawaki COVID-19 Isolation Center, Kano, Nigeria
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Price J, Gurley N, Gyapong M, Ansah EK, Awusabo-Asare K, Gyasi SF, Nkhoma P, Nyondo-Mipando AL, Okello G, Webster J, Desmond N, Hill J, Gordon WS. Acceptance of and Adherence to a Four-Dose RTS,S/AS01 Schedule: Findings from a Longitudinal Qualitative Evaluation Study for the Malaria Vaccine Implementation Programme. Vaccines (Basel) 2023; 11:1801. [PMID: 38140205 PMCID: PMC10747521 DOI: 10.3390/vaccines11121801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/19/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND The WHO recommended the use of the RTS,S/AS01 malaria vaccine (RTS,S) based on a pilot evaluation in routine use in Ghana, Kenya, and Malawi. A longitudinal qualitative study was conducted to examine facilitators and barriers to uptake of a 4-dose RTS,S schedule. METHODS A cohort of 198 caregivers of RTS,S-eligible children from communities where RTS,S was provided through the pilot were interviewed three times over a ≈22-month, 4-dose schedule. The interviews examined caregiver perceptions and behaviors. Children's vaccination history was obtained to determine dose uptake. RESULTS 162 caregivers remained at round 3 (R3); vaccination history was available for 152/162 children. Despite early rumors/fears, the uptake of initial doses was high, driven by vaccine trust. Fears dissipated by R2, replaced with an enthusiasm for RTS,S as caregivers perceived its safety and less frequent and severe malaria. By R3, 98/152 children had received four doses; 34 three doses; 9 one or two doses; and 11 zero doses. The health system and information barriers were important across all under-dose cases. Fears about AEFIs/safety were important in zero-, one-, and two-dose cases. Competing life/livelihood demands and complacency were found in three-dose cases. Regardless of the doses received, caregivers had positive attitudes towards RTS,S by R3. CONCLUSIONS Findings from our study will help countries newly introducing the vaccine to anticipate and preempt reasons for delayed acceptance and missed RTS,S doses.
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Affiliation(s)
| | - Nikki Gurley
- King County Department of Community and Human Services, 401 5th Ave #500, Seattle, WA 98104, USA;
| | - Margaret Gyapong
- Institute of Health Research, University of Health and Allied Sciences, PMB 31, Ho, Volta Region, Ghana;
| | - Evelyn Korkor Ansah
- Center for Malaria Research, University of Health and Allied Sciences, PMB 31, Ho, Volta Region, Ghana;
| | - Kofi Awusabo-Asare
- Department of Population and Health, University of Cape Coast, New Administration Block, Cape Coast, Ghana;
| | - Samuel Fosu Gyasi
- Center for Research in Applied Biology, School of Sciences, University of Energy and Natural Resources, P.O. Box 214, Sunyani, Ghana;
| | - Pearson Nkhoma
- Goldsmiths, University of London, 8 Lewisham Way, New Cross, London SE14 6NW, UK;
| | - Alinane Linda Nyondo-Mipando
- Department of Health Systems and Policy, Kamuzu University of Health Sciences, Private Bag 360, Blantyre 3, Malawi;
| | - George Okello
- Kenya Medical Research Institute, Centre for Geographic Medicine, Kisumu P.O. Box 1578, Kenya;
| | - Jayne Webster
- London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK;
| | - Nicola Desmond
- Department of International Public Health, Liverpool School of Tropical Medicine, University of Liverpool, Pembroke Pl, Liverpool L3 5QA, UK;
| | - Jenny Hill
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Pl, Liverpool L3 5QA, UK;
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Röbl K, Fischer HT, Delamou A, Mbawah AK, Geurts B, Feddern L, Baldé H, Kaba I, Pozo-Martin F, Weishaar H, Menelik-Obbarius S, Burger G, Diaconu V, Dörre A, El Bcheraoui C. Caregiver acceptance of malaria vaccination for children under 5 years of age and associated factors: cross-sectional household survey, Guinea and Sierra Leone, 2022. Malar J 2023; 22:355. [PMID: 37986067 PMCID: PMC10662512 DOI: 10.1186/s12936-023-04783-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/04/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Malaria is a leading cause of death and reduced life span in Guinea and Sierra Leone, where plans for rolling out the malaria vaccine for children are being made. There is little evidence about caregiver acceptance rates to guide roll-out policies. To inform future vaccine implementation planning, this analysis aimed to assess potential malaria vaccine acceptance by caregivers and identify factors associated with acceptance in Guinea and Sierra Leone. METHODS A cross-sectional household survey using lot quality assurance sampling was conducted in three regions per country between May 2022 and August 2022. The first survey respondent in each household provided sociodemographic information. A household member responsible for childcare shared their likelihood of accepting a malaria vaccine for their children under 5 years and details about children's health. The prevalence of caregiver vaccine acceptance was calculated and associated factors were explored using multivariable logistic regression modelling calculating adjusted odds ratios (aOR) with 95% confidence intervals (CI). RESULTS Caregivers in 76% of 702 sampled households in Guinea and 81% of 575 households in Sierra Leone were accepting of a potential vaccine for their children. In both countries, acceptance was lower in remote areas than in urban areas (Guinea: aOR 0.22 [95%CI 0.09-0.50], Sierra Leone: 0.17 [0.06-0.47]). In Guinea, acceptance was lower among caregivers living in the richest households compared to the poorest households (0.10 [0.04-0.24]), among those whose children were tested for malaria when febrile (0.54 [0.34-0.85]) and in households adopting more preventative measures against malaria (0.39 [0.25-0.62]). Better knowledge of the cause of malaria infection was associated with increased acceptance (3.46 [1.01-11.87]). In Sierra Leone, vaccine acceptance was higher among caregivers living in households where the first respondent had higher levels of education as compared to lower levels (2.32 [1.05-5.11]). CONCLUSION In both countries, malaria vaccine acceptance seems promising for future vaccine roll-out programmes. Policy makers might consider regional differences, sociodemographic factors, and levels of knowledge about malaria for optimization of implementation strategies. Raising awareness about the benefits of comprehensive malaria control efforts, including vaccination and other preventive measures, requires attention in upcoming campaigns.
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Affiliation(s)
- Klara Röbl
- Department of Infectious Disease Epidemiology, Robert Koch-Institute, Seestraße 10, 13353, Berlin, Germany
- Postgraduate Training for Applied Epidemiology (PAE), Robert Koch-Institute, Seestraße 10, 13353, Berlin, Germany
- ECDC Fellowship Programme, Field Epidemiology Path (EPIET), European Centre for Disease Prevention and Control (ECDC), Gustav III:S Boulevard 40, 16973, Solna, Sweden
| | - Hanna-Tina Fischer
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Alexandre Delamou
- Centre d'Excellence Africain pour la Prévention et le Contrôle des Maladies Transmissibles (CEA-PCMT), Université Gamal Abdel Nasser de Conakry (UGANC), Dixinn, PoBox 1017, Conakry, Guinea
- Faculté des sciences techniques de la santé (FSTS), Université Gamal Abdel Nasser de Conakry (UGANC), Conakry, Guinea
| | - Abdul Karim Mbawah
- College of Medicine and Allied Health Sciences (COMAHS), University of Sierra Leone, Connaught Hospital, Freetown, Sierra Leone
| | - Brogan Geurts
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany
| | - Lukas Feddern
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany
| | - Habibata Baldé
- Centre d'Excellence Africain pour la Prévention et le Contrôle des Maladies Transmissibles (CEA-PCMT), Université Gamal Abdel Nasser de Conakry (UGANC), Dixinn, PoBox 1017, Conakry, Guinea
- Faculté des sciences techniques de la santé (FSTS), Université Gamal Abdel Nasser de Conakry (UGANC), Conakry, Guinea
| | - Ibrahima Kaba
- Centre d'Excellence Africain pour la Prévention et le Contrôle des Maladies Transmissibles (CEA-PCMT), Université Gamal Abdel Nasser de Conakry (UGANC), Dixinn, PoBox 1017, Conakry, Guinea
- Faculté des sciences techniques de la santé (FSTS), Université Gamal Abdel Nasser de Conakry (UGANC), Conakry, Guinea
| | - Francisco Pozo-Martin
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany
| | - Heide Weishaar
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany
| | - Sara Menelik-Obbarius
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany
| | - Gerrit Burger
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany
| | - Viorela Diaconu
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany
| | - Achim Dörre
- Department of Infectious Disease Epidemiology, Robert Koch-Institute, Seestraße 10, 13353, Berlin, Germany
| | - Charbel El Bcheraoui
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany.
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Kabir Sulaiman S, Isma'il Tsiga-Ahmed F, Sale Musa M, Kabir Sulaiman A, Muhammad Dayyab F, Ab Khan M, Idris Ahmad S, Abasi-Okot Akpan U, Ibrahim Usman U, Tjjani Bako A. Prevalence, determinants, and reasons for malaria vaccine hesitancy among caregivers of under-five children in Nigeria: Results from a nationwide cross-sectional survey. Vaccine 2023; 41:1503-1512. [PMID: 36725434 DOI: 10.1016/j.vaccine.2023.01.060] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 01/18/2023] [Accepted: 01/24/2023] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Malaria contributes to an enormous global burden of disease and mortality, especially in children. Approximately one in every four global cases and deaths from malaria occurs in Nigeria. This study aims to evaluate the prevalence and correlates of community hesitancy to the malaria vaccine, including the reasons for the hesitancy, following the approval of the RTS,S malaria vaccine by the World Health Organization (WHO). METHODS This was a nationwide cross-sectional online survey of Nigerian adults conducted from 20th October to 30th November 2021. Participants who replied 'no' or 'maybe' to a question assessing their willingness to accept the RTS,S malaria vaccine were considered "hesitant". We fit a multivariate logistic regression model to report the adjusted odds ratio (aOR) and 95 % confidence interval (CI) for the factors associated with vaccine hesitancy. FINDINGS Among 3377 total respondents (1961 [57.86 %] males; mean age [SD]: 30[9.1]), 1010 (29.91 %) were hesitant. Receiving information about the RTS,S malaria vaccine initially from healthcare workers (vs. the internet) (aOR:0.55; 95 % CI:0.35-0.87) was significantly associated with lower odds of hesitancy. Conversely, earning a high income of over NGN100, 000 (vs. < NGN 30,000) per month (aOR: 2.10, 95 % CI: 1.36-3.24), belonging to other religious groups (vs. Islam) (aOR:3.25, 95 % CI:1.18-8.98), and having a family size of more than ten (vs. < 5) (aOR:1.84; 95 % CI:1.08-3.13) were significantly associated with a higher odds of hesitancy. The main reasons for vaccine hesitancy included fear of vaccine adverse effects (34.95 %), availability of other malaria preventive measures (33.96 %) and not seeing the positive effect of the vaccine in others first (32.97 %). CONCLUSION The findings of this survey provide a valuable blueprint for the development of targeted interventions to facilitate caregiver acceptance of the RTS,S vaccine.
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Affiliation(s)
| | | | - Muhammad Sale Musa
- Department of Medicine, Yobe State University Teaching Hospital, Damaturu, Nigeria
| | | | | | - Moien Ab Khan
- Health and Wellness Research Group, Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates; Primary Care, NHS North West London, London TW3 3EB, United Kingdom
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