Caregivers’ awareness, attitudes, uptake, and willingness toward the RTS,S/AS01 malaria vaccine, Oti Region, Ghana 2023

Introduction: Malaria remains a major public health challenge, particularly among children under five years of age. The World Health Organization’s approval of the RTS, S/AS01 malaria vaccine for pilot implementation in Ghana, Kenya, and Malawi on May 1, 2019, marked a significant milestone in malaria prevention. This study assessed caregivers’ awareness, attitudes, vaccine uptake, adverse events following immunization (AEFI), and willingness to accept the RTS, S vaccine in the Oti Region of Ghana. Methods: A community-based cross-sectional study was conducted in 2023 across five sub-districts. Using a multistage sampling technique, 39 communities and 367 caregivers of children aged 6–59 months were selected. Data were collected using a semi-structured questionnaire administered via Google Forms (Google LLC, Mountain View, CA, USA), and RTS, S vaccination status was verified using Child Welfare Clinic cards. Descriptive statistics and multivariable logistic regression analyses were performed, with adjusted odds ratios (AORs) and 95% confidence intervals (CIs) reported. Results: Of the 367 caregivers, 342 (93.2%) were female, with a median age of 25 years (IQR: 9). Awareness of malaria vaccination was high (323/367; 87.5%), and 309/367 (84.2%; 95% CI: 80.2–87.6) demonstrated a positive attitude toward the vaccine. RTS, S uptake declined progressively from 96.5% for dose 1 to 50.4% for dose 4. Age-appropriate full vaccination was achieved by 238/367 (64.9%) children. Positive caregiver attitude (AOR = 2.74; 95% CI: 1.47–5.12) and higher educational attainment were independently associated with full vaccination, whereas older child age and prior AEFI (aOR=0.41 95%CI:0.25–0.67) were associated with lower completion. Overall, 161/367 (43.9%) caregivers reported AEFI, the majority of which were non-serious. Conclusion: Although awareness, positive attitudes, and willingness to accept the RTS, S vaccine were high, completion of later doses remained suboptimal. Strengthening caregiver engagement, addressing concerns related to AEFI, reinforcing Evidence for Action (E4A) strategies, and enhancing follow-up systems are essential to improve full vaccination coverage and maximise the public health impact of the malaria vaccine.