Knowledge without Conviction: Education, Information Pathways, and Paradoxical Attitudes toward Malaria Vaccination among Pregnant Women and Mothers in a High-burden Setting
Stephen Olaide Aremu *
Global Health and Infectious Diseases Control Institute, Nasarawa State University, Keffi, Nasarawa State, Nigeria.
Dada Ayomide Christopher
Global Health and Infectious Diseases Control Institute, Nasarawa State University, Keffi, Nasarawa State, Nigeria.
Victor Emmanuel
Global Health and Infectious Diseases Control Institute, Nasarawa State University, Keffi, Nasarawa State, Nigeria.
Aisha Temitope Kasali
Global Health and Infectious Diseases Control Institute, Nasarawa State University, Keffi, Nasarawa State, Nigeria.
Damilola Esther Aremu
Global Health and Infectious Diseases Control Institute, Nasarawa State University, Keffi, Nasarawa State, Nigeria.
Hannah Ojonogecha Ocheni
Global Health and Infectious Diseases Control Institute, Nasarawa State University, Keffi, Nasarawa State, Nigeria.
John Nuhu
Global Health and Infectious Diseases Control Institute, Nasarawa State University, Keffi, Nasarawa State, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Background: Malaria vaccines complement established control measures, but their population-level impact depends on caregiver acceptance.
Aims: This study examined how education, awareness, information sources, risk perception, and beliefs about effectiveness were related to maternal knowledge and willingness to accept malaria vaccination.
Methods: A cross-sectional survey of 530 mothers assessed knowledge of malaria vaccination, awareness of the RTS, S vaccine, perceptions of safety, beliefs regarding effectiveness, and willingness to vaccinate. Associations were examined using chi-square tests, one-way analysis of variance, Pearson correlation, and multivariable regression analyses.
Results: Overall, 72.8% of mothers demonstrated knowledge of malaria vaccination (mean knowledge score = 0.73 ± 0.45). Knowledge was significantly associated with educational level (χ² = 9.15, df = 3, p = 0.027), although the effect size was weak (Φ = 0.13). Notably, 28.7% of mothers with tertiary education lacked knowledge. Awareness of the RTS, S vaccine did not significantly predict knowledge (OR = 1.18, p = 0.457; Nagelkerke R² = 0.002). Information sources explained 12.7% of the variance in knowledge (F = 7.54, p < 0.001), with television (β = 0.22, p = 0.015), friends (β = 0.26, p = 0.003), family (β = 0.16, p = 0.001), and posters (β = 0.12, p = 0.027) emerging as significant predictors. Despite a relatively high perception of vaccine safety (73.0%), only 21.7% of mothers expressed willingness to receive the vaccine. Awareness of malaria-related mortality was paradoxically associated with lower willingness (χ² = 10.13, p = 0.001). Belief in vaccine effectiveness was negatively correlated with willingness (r = −0.11, p = 0.013).
Conclusions: High maternal knowledge of malaria vaccination did not translate into acceptance. Informal and media-based information channels exerted greater influence than formal health systems, while risk awareness may have unintentionally increased resistance. Addressing cognitive–attitudinal disconnects is essential for scaling up malaria vaccination.
Keywords: Malaria vaccination, maternal knowledge, vaccine acceptance, vaccine hesitancy, information pathways, pregnant women