AWARENESS AND WILLINGNESS TO ACCEPT MALARIA VACCINE AMONG CARE-GIVERS OF UNDER-5 CHILDREN IN IBADAN NORTH LOCAL GOVERNMENT, NIGERIA

Abstract

Efforts have been directed at the prevention of malaria in pregnant women and young children who carry the greatest burden of disease. Malaria continues to be a leading cause of pain, death and poverty in sub-Saharan Africa. This calls for other plausible effective and acceptable control measures to add to the interventions, this led to the development of malaria vaccines in the last 2-3 decades. Many potential anti-malarial vaccines have been formulated and gone under clinical trials including GlaxoSmithKline Biological malaria vaccine candidate RTS,S, which progressed to a Phase 3 clinical trial. The WHO has indicated that if RTS.S was found effective in the on-going phase 3 clinical trial. it will be recommended for use. Within the context of planning for a vaccine to be used alongside with existing malaria control measures, this study assessed willingness to accept a malaria vaccine if recommended among individuals who influence decisions on childhood vaccination at the community level. This study was a descriptive cross-sectional household survey. A total of 427 consenting caregivers were selected from Ibadan North LGA using cluster sampling technique and were interviewed using a pretested semi structured questionnaire. Information sampled included socio-demographic variables, experiences with previous child vaccination, awareness and willingness to accept malaria vaccine, and information channels to foster acceptability of malaria vaccine. In-depth interview (IOI) was conducted among nine opinion leaders selected purposively from the study communities. Data analysis was done using descriptive statistics, chi square test and logistic regression at p< 0.05 and thematic content analysis was used for the qualitative study. The Ages of the respondents ranged from 18-45 years with a mean age(± standard deviation) of 29.8±5.8 years. Awareness of malaria vaccine was relatively low (20.1%) but willingness to accept a malaria vaccine was high among the respondents (87%) while 13% were not willing. Reasons stated for not willing to accept were, husbands did not want immunization (73.6%), felt it may be expensive (47.2%) and felt it may paralyse children (24.5%). All the participants who were not willing to accept disagreed with the suggestion that religion forbade child immunization. About half (48.7%) of the respondents said if vaccine is not given orally like polio vaccine it will not be accepted while fear of injection (23.1%) was another major concern mentioned. When compared with respondents who attained secondary level and higher education, a significantly high number of respondents with primary education were 2.5 times less likely to accept malaria vaccine (OR: 0.391; 95% CI: 0.179- 0.854). The odds of accepting malaria vaccine were three times lesser among caregivers that mentioned fathers decide for their children vaccine uptake than those who mentioned father did not.(OR: 0.353: 95% CI: 0. 167-0. 748). Influence of community health workers (OR: 0.3 16, 95% Cl: 0.142-0.705) and previous experiences of ever immunize a child were found to predict willingness to accept a malaria vaccine (OR: 0.146; 95% CI: 0.027-0.799). It was also observed from IOI that awareness was low among the participants but willingness to accept was very high. This corroborate with the findings of the survey. Communities were favourably disposed to introduction of a vaccine against malaria, although they have concerns about the characteristics and formation of the vaccine as well as possible adverse events. A well-designed communication strategy implemented prior to introduction of the vaccine would be essential to foster a supportive environment for an eventual adoption as welI as acceptance of malaria vaccine. The communications strategy should target men and women and should involve influential community members as well as provide reassurances about immunization.