Acceptability of the RTS, S malaria vaccine and associated factors among caregivers of children under 25 months in Soa Health District, Cameroon: a community-based cross-sectional study
Malaria remains a major cause of morbidity and mortality in sub-Saharan Africa. In Cameroon, malaria accounts for 48% of all hospital admissions, 30% of morbidity, and 67% of childhood mortality per year. Despite the introduction of RTS, S in several African countries, real-world evidence on community acceptability following vaccine rollout remains limited, particularly at the district level. Understanding caregivers’ willingness to vaccinate is critical for optimizing uptake and guiding context-specific implementation strategies. A community-based cross-sectional study was conducted between March and November 2024 in the Soa Health District (HD). A total of 541 caregivers of children under 25 months were recruited using a non-probability convenience sampling method. Data were collected using a structured pre-tested questionnaire and analysed using R software. Modified Poisson regression models with robust variance estimation was used to obtain crude and adjusted prevalence ratio (CPR and APR) with 95% confidence intervals (95% CIs), a statistical significance was set at p-value < 0.05. Among the 541 caregivers, 73.4% expressed willingness to vaccinate their children against malaria. Higher vaccine acceptability was independently associated with residing in Koulou (APR = 1.4; 95% CI: 1.1–2.0), Ngali 2 (APR = 10.6; 95% CI: 1.2–2.2), and Soa (APR = 1.6; 95% CI: 1.1–2.2) compared with Ntsouessong; female sex (APR = 1.2; 95% CI: 1.0–1.3); origine from the North-West, South-West, West, and Littoral regions (APR = 1.2; 95% CI: 1.1–1.4); use street medicine (APR = 1.3; 95% CI: 1.0–1.6) or prescribed medicine (APR = 10.2; 95% CI: 10.0–1.5) rather than traditional medicine for malaria treatment; prior awareness of the malaria vaccine (APR = 1.2; 95% CI: 1.1–1.4). All p < 0.05. Acceptability of the malaria vaccine among caregivers in the Soa HD was relatively high and was significantly influenced by geographic location, sex, region, health-seeking behaviour, and awareness of the vaccine. Targeted health education and culturally sensitive community engagement strategies are essential to improve vaccine acceptability and support the successful scale-up of malaria vaccination programmes in Cameroon and other endemic settings. Not applicable.