Predictors of malaria vaccine acceptability among healthcare providers in conflict-affected Sudan: a cross-sectional analysis

Abstract

BACKGROUND: In October 2024, Sudan introduced the malaria vaccine, beginning in Al-Qadarif and Blue Nile states amidst an ongoing armed conflict. Vaccine acceptance among healthcare providers (HCPs) is critical for a successful national rollout. This study assessed malaria vaccine knowledge, acceptability, concerns, and their independent predictors among HCPs in these conflict-affected regions. METHODS: A descriptive cross-sectional study was conducted from January to February 2025 et al.-Qadarif and Al-Damazin teaching hospitals. An online questionnaire was administered to 342 HCPs. Multivariable linear regression was employed to identify factors associated with continuous knowledge scores. Subsequently, a multivariable logistic regression model was utilized to determine the independent predictors of high vaccine acceptability, incorporating the knowledge score as a continuous independent variable. RESULTS: Among the 342 respondents, general vaccine acceptability was promising, yet specific operational knowledge remained limited. Significant overall concern about the vaccine was prevalent (64.0%), primarily regarding adverse effects (57.0%), cold-chain handling conditions in Sudan (56.4%), and vaccine effectiveness (42.7%). Social media (48.5%) and peers (45.0%) were the most common information sources. Multivariable linear regression indicated that older age (p = 0.004)and hospital of work (p < 0.001) significantly predicted higher knowledge. In the multivariable logistic regression, the continuous knowledge score emerged as the only statistically significant independent predictor in this model of high vaccine acceptability (adjusted odds ratio: 1.15, 95% confidence interval: 1.01-1.32, p = 0.033), with no significant influence from demographic variables. CONCLUSIONS: Despite a generally favorable attitude toward the malaria vaccine, Sudanese HCPs exhibit critical knowledge gaps and valid systemic concerns. Our findings suggest a sequential pathway wherein accumulated clinical experience (older age) enhances technical knowledge, which in turn acts as the primary independent driver of vaccine acceptability. Consequently, health authorities must pivot from generalized promotional campaigns to targeted, technical educational interventions. Leveraging secure digital professional networks is urgently needed to bridge these knowledge gaps, optimize provider confidence, and ensure a successful vaccine rollout in this fragile setting. Trial registration Not applicable.