Patterns and factors associated with mothers’ willingness to vaccinate their children against malaria in Uganda: evidence from a nationally representative survey

Uganda is one of the high burden malaria endemic countries in sub-Saharan Africa (SSA), with women and children under-five disproportionately affected. The objective of this study was to investigate mothers’ willingness to vaccinate their children against malaria in Uganda. A cross-sectional study was conducted for 5281 mothers aged 15–49 years using the 2024–25 Uganda Malaria Indicator Survey (MIS) data. Mothers’ willingness to vaccinate their children against malaria were examined using percentages, the chi-square test, and a multivariable binary logistic regression model. All estimates account for the complex survey design through sampling weights, clustering and stratification. The multivariable model was fitted on 4951 women with complete data on all covariates. Statistical significance was determined at p < 0.05. A weighted prevalence of 92.7% (95% CI 91.6–93.6%) of mothers who reported willingness to vaccinate their children against malaria. Mothers from Busoga, Bukedi, Teso, Lango, Karamoja, West Nile, Bunyoro, Toro and Ankole regions had higher odds of willingness to vaccinate their children against malaria than mothers from the Kampala region, although several regional estimates were imprecise. Rural dwellers have 1.88 times higher odds of positive mothers’ willingness to vaccinate their children against malaria, when compared with their urban counterparts (aOR = 1.88; 95% CI 1.38–2.56). Mothers with primary education (aOR = 1.58; 95% CI 1.01–2.48) and with secondary education (aOR = 2.15; 95% CI 1.26–3.66) had higher odds of willingness than mothers with no formal education, whereas mothers educated beyond secondary level did not differ from mothers with no formal education (aOR = 0.81; 95% CI 0.45–1.45) and recorded the lowest unadjusted prevalence of willingness of any educational group (81.9%; 95% CI 76.0–86.6). Mothers who have heard/seen malaria messages within six months prior to the survey, have higher odds of positive mothers’ willingness to vaccinate their children against malaria, when compared with mothers who did not hear/see malaria messages within six months prior to the survey (aOR = 1.73; 95% CI 1.26–2.36). Mothers who visited health facility for antenatal care (ANC) during the index pregnancy, have higher odds of positive mothers’ willingness to vaccinate their children against malaria, when compared with mothers who did not have ANC visit (aOR = 1.41; 95% CI 1.05–1.90). Mothers who have heard of malaria vaccine (awareness) have 1.69 times higher odds of willingness to vaccinate their children against malaria, when compared with those who have never heard of malaria vaccine. Willingness to allow a child to receive a malaria vaccine was high among mothers in Uganda shortly before the national introduction of the vaccine. Willingness varied by region, place of residence and level of education, and was higher among mothers who had recently encountered malaria messages, who had attended antenatal care and who had heard of the malaria vaccine. These cross-sectional associations identify groups in which stated willingness was comparatively lower and may help target communication and delivery strategies. They do not establish that any of these factors causes willingness, and stated willingness should not be read as a forecast of vaccine uptake.