Caregivers’ practices and factors associated with malaria vaccine uptake among under-five children in the Tiko Health District, Cameroon: A community based cross-sectional study

Abstract

Malaria remains a leading cause of morbidity and mortality among children under five in Cameroon. In 2021, the World Health Organization (WHO) recommended the RTS,S/AS01 malaria vaccine for children in areas with moderate to high transmission. This study assessed caregivers' practices and factors associated with malaria vaccine uptake among under-five children in the Tiko Health District. A community-based cross-sectional study was conducted from March to April 2025, involving 410 caregivers of children aged 0-5 years. Participants were selected through multistage sampling. Data were collected using a structured questionnaire and analyzed with descriptive statistics and logistic regression to identify factors associated with vaccine uptake.. Variables with p < 0.20 in bivariate analysis were included in the multivariable model, and adjusted odds ratios(aOR) with 95% confidence intervals(CI) were reported. Only 32.2%(n = 132) of children had received the malaria vaccine. Of those vaccinated, 72.0% completed the recommended doses, and 82.6% of caregivers maintained vaccination records. Multivariable analysis revealed that children of female caregivers(aOR: 4.16, 95% CI: 1.47-11.75), caregivers in health professions(aOR: 2.87, 95% CI: 1.35-5.69), biological parents(aOR: 11.44, 95% CI: 1.52-86.11), and those with household income of 89USD-179USD(aOR: 2.76, 95% CI: 1.68-4.55) had significantly higher odds of vaccine uptake. Trust in health workers(aOR: 6.12, 95% CI: 2.97-12.61) and information from healthcare providers(aOR: 7.60, 95% CI: 3.82-15.08) were also strong predictors. Conversely, prior malaria infection in children was associated with lower odds of vaccination(aOR: 0.31, 95%CI: 0.18-0.54). Malaria vaccine uptake among under-five children in the Tiko Health District is suboptimal. Caregiver sex, profession, household income, and access to trusted health information significantly influenced uptake. Strengthening caregiver education, improving healthcare access, and enhancing trust in health providers are vital to increase malaria vaccine coverage.