Knowledge, attitudes and practices associated with malaria vaccine acceptance among primary caregivers of children under two years in Lurambi Sub-County, Kakamega County, Kenya

Abstract

Malaria remains a major public health threat and a leading cause of mortality among children under five years globally. Despite the launch of the malaria vaccine in Kenya, high malaria transmission persists alongside declining completion rates of the four-dose vaccine schedule, highlighting the need to understand factors influencing vaccine acceptance. This study assessed the knowledge, attitudes and practices associated with malaria vaccine acceptance among primary caregivers of children under two years in Lurambi Sub County. Guided by the Health Belief Model, a community based cross-sectional mixed methods study design was employed. The target population comprised primary caregivers of children under two years and key informants. Quantitative data were collected from 417 primary caregivers using structured questionnaires while qualitative data were obtained via focus group discussions and 15 key informant interviews. The sample size was calculated using the Cochran formula and multistage sampling was used to select the study participants. Quantitative data were analyzed using descriptive statistics, chi-square tests and binary logistic regression while qualitative data were analyzed thematically. The findings revealed high awareness of the malaria vaccine (97%) and generally positive attitudes from caregivers (73%). However, 51% were classified as knowledgeable and only 13% correctly identified the recommended age for vaccination. Additionally, 95% had attempted to vaccinate their children and 96% had received at least one dose. Despite this, only 40% had completed the full four dose schedule, indicating substantial dropout. Vaccine stock outs, long waiting times and distance to health facilities were identified as major barriers to vaccine uptake. Both knowledge level (χ2=12.13, p<0.01) and caregivers’ attitudes (χ2=10.87, p<0.01) were significantly associated with vaccine acceptance. Caregivers with high knowledge were more than twice as likely to accept the vaccine (OR=2.11, p<0.01), while those with negative attitudes were significantly less likely to accept it (OR=0.49, p<0.01). Therefore, although awareness and willingness to vaccinate are high in Lurambi Sub County, incomplete knowledge, and high dropout rates and health system challenges limit full vaccine uptake. Strengthening vaccine supply chains, improving service delivery efficiency, reducing access barriers and enhancing community based health education are essential to improve malaria vaccine acceptance and completion.