Barriers and Enablers to the Uptake of Malaria Vaccines among Caregivers of Eligible Children in Sub-Saharan Africa: A Scoping Review

Background: Malaria remains a major public health challenge in sub-Saharan Africa and continues to disproportionately affect children under five years of age despite ongoing control efforts. The introduction of the RTS,S/AS01 and R21/Matrix-M malaria vaccines represents a major advancement in malaria prevention. However, successful implementation depends not only on vaccine availability and effectiveness but also on caregiver acceptance and uptake. Evidence regarding barriers and facilitators influencing malaria vaccine uptake among caregivers across sub-Saharan Africa remains fragmented. Therefore, this scoping review mapped and synthesized existing evidence on barriers and enablers influencing malaria vaccine uptake among caregivers of eligible children in sub-Saharan Africa and identified areas requiring future policy and research attention.Methods: A scoping review was conducted following the Joanna Briggs Institute (JBI) methodology and reported according to PRISMA-ScR guidelines. Literature searches were undertaken across PubMed/MEDLINE, Scopus, Embase, Web of Science, and CINAHL, supplemented by grey literature from WHO, UNICEF, PATH, Africa CDC, and GAVI repositories. Eligible studies published in English between January 2015 and May 2025 included quantitative, qualitative, mixed-methods, and selected grey literature studies focusing on caregivers of children eligible for malaria vaccination in sub-Saharan Africa. Data were synthesized using descriptive and thematic analyses and mapped to the COM-B Model, Health Belief Model (HBM), and WHO SAGE Vaccine Hesitancy Matrix.Results: A total of 386 records were identified, of which 35 studies met the inclusion criteria following screening and eligibility assessment. Studies were conducted across 13 countries in sub-Saharan Africa, with Ghana and Nigeria contributing the largest proportion. Most studies reported high caregiver acceptance of malaria vaccines, with acceptance rates ranging from 59% to 97.7% in 85.7% of included studies. Major barriers to vaccine uptake included socio-cultural factors (religious beliefs, misconceptions, spousal influence), informational barriers (limited awareness and misinformation), economic constraints (transport and affordability concerns), health-system limitations (poor access, stock-outs, long waiting times), perceived vaccine risks, and logistical challenges. Key enablers included trust in healthcare workers, awareness of vaccine benefits, positive previous vaccination experiences, free vaccine provision, strong health-system support, community endorsement, and perceived vaccine effectiveness. Behavioural framework mapping demonstrated that caregiver capability, opportunity, and motivation strongly influenced vaccine uptake decisions.Conclusion: Malaria vaccine uptake among caregivers in sub-Saharan Africa is shaped by interconnected socio-cultural, economic, informational, and health-system determinants. Although caregiver acceptance is generally high, sustaining uptake requires context-specific strategies that strengthen risk communication, improve access to vaccination services, build trust in health systems, and engage communities. Addressing these barriers while reinforcing existing enablers will be essential to maximize the public health impact of malaria vaccination programmes.