Awareness and acceptance of the malaria vaccine among caregivers attending primary health care centres in Sudan: a mixed-methods study

Abstract Background Despite significant progress in malaria control, the disease remains a major cause of morbidity and mortality, particularly among children under five in sub-Saharan Africa. Sudan, with substantial malaria burden, faces challenges in integrating new interventions, such as malaria vaccines, into national immunization programmes. This study aimed to assess Sudanese caregivers' awareness and acceptance of the malaria vaccine and to identify factors influencing their willingness to vaccinate their children. Methods A descriptive, cross-sectional mixed-methods study was conducted from November 2024 to January 2025 in two public primary healthcare centres in Sudan. A total of 159 caregivers participated through consecutive sampling. Quantitative data on sociodemographic factors, malaria experience, vaccine awareness, and acceptance were collected via structured questionnaires and analysed using descriptive and inferential statistics. Qualitative responses were gathered on reasons behind vaccine hesitancy and analysed thematically. Results Caregiver acceptance of the malaria vaccine was high (86.2%) despite limited prior awareness (11.3%). Acceptance was significantly associated with perceived malaria severity (p < 0.001), caregivers' own vaccination history (p = 0.034), and children's complete immunization (p = 0.047). Qualitatively, vaccine safety concerns predominated, alongside scepticism toward healthcare systems and a perceived lack of vaccine necessity. Trusted health information primarily came from healthcare providers (66%). Conclusion Sudanese caregivers demonstrate strong willingness to vaccinate their children against malaria, driven largely by perceived disease threat and trust in routine immunization services. Effective vaccine introduction should prioritize targeted communication to address safety concerns and integrate the malaria vaccine within existing immunization frameworks to sustain high uptake.