Impact of caregivers’ perceptions of malaria on their hesitancy toward childhood malaria vaccination

BackgroundThere is a prevalent perception of low personal risk of malaria in Ghana. This perception and other beliefs about the disease held by caregivers may influence hesitancy toward childhood malaria vaccination. Understanding these dynamics is crucial to the national scale-up of the malaria vaccines. This study investigates this relationship to inform strategies for enhancing vaccination coverage.MethodsThis cross-sectional household study was conducted in six regions across Ghana. Data were collected from 2590 adults. Malaria vaccine hesitancy was measured by adapting the seven-item Oxford COVID-19 vaccine hesitancy scale, deriving composite scores and dichotomizing at the median. For malaria perception, eight items of the Brief Illness Perception Questionnaire (B-IPQ) were adapted. Exploratory factor analysis derived two factors: malaria threat/emotional burden, and perceived control/understanding. Sociodemographic and behavioural factors were included. Chi-square test, boxplots, and modified Poisson regression determined associations.ResultsThe prevalence of malaria vaccine hesitancy was 44.8%. Greater perceived control and understanding was associated with increased hesitancy (aPR = 1.15; 95% CI: 1.09–1.21; p < 0.001). Other factors associated with vaccine hesitancy were caregivers' region of residence, marital status, ethnicity, housing structure, relationship with household head, employment status, having existing health conditions, and alcohol intake.ConclusionPerceived control and understanding of malaria increase hesitancy, illustrating how familiarity with malaria weakens preventive behaviour. Public health communication should prioritize locally resonant, language-appropriate messages that clarify the complementary role of malaria control measures.