Determinants of Malaria Vaccine Acceptance Among Caregivers of Under 5 Children in Kisumu East Sub-County, Kisumu, Kenya
Abstract
Malaria remains a major public health challenge in Kenya, particularly among children under five years, despite the introduction of the malaria vaccine as part of routine immunization. Caregiver acceptance is critical to achieving high vaccine uptake and maximizing the vaccine's public health impact. This study examined the determinants of malaria vaccine acceptance among caregivers of children under five years in Kisumu East Sub-County, Kenya, focusing on socio-demographic, health system, and knowledge and perception factors. An analytic cross-sectional mixed-methods study was conducted among 387 caregivers selected through systematic random sampling from public health facilities. Quantitative data were collected using structured questionnaires and analyzed using descriptive statistics, chi-square tests, and multivariable logistic regression, while qualitative data from Focus Group Discussions (FGDs) and Key Informant Interviews (KIIs) were analyzed thematically. Malaria vaccine acceptance was high, with 86.6% of caregivers reporting that their children had received the vaccine. In multivariable analysis, male caregivers were significantly less likely to accept the vaccine than female caregivers (AOR = 0.066, p < 0.001). Health system barriers reduced vaccine acceptance (AOR = 0.107, p = 0.003), whereas receiving vaccine information from community leaders (AOR = 55.989, p = 0.030) and awareness of vaccine side effects (AOR = 12.97, p = 0.011) significantly increased acceptance. Age and education were not significant predictors in the adjusted model. Qualitative findings highlighted trust in healthcare providers, community engagement, and service accessibility as key facilitators, while long waiting times and occasional vaccine stock-outs hindered uptake. Strengthening male involvement, improving service delivery, and leveraging community leadership structures could further enhance malaria vaccine acceptance and uptake.