Malaria vaccine awareness, perceptions, willingness to vaccinate, and willingness to pay among caregivers of children admitted with malaria in eastern Uganda: a cross-sectional study

The WHO recommends RTS,S/AS01 and R21/Matrix-M for children in malaria-endemic areas, and Uganda introduced R21/Matrix-M in April 2025. A child’s malaria admission may provide an opportunity for caregiver vaccine counselling, but few studies have examined awareness and willingness in this setting. We aimed to describe malaria vaccine awareness, perceptions, willingness to vaccinate and willingness to pay among caregivers of children admitted with malaria in eastern Uganda before rollout. From October 2024 to February 2025, we conducted a descriptive hospital-based cross-sectional survey among caregivers of children under 5 years admitted with clinician-documented malaria to Tororo General Hospital, eastern Uganda. We measured prior awareness before providing standardised vaccine information, then assessed perceptions on five-point agreement scales and willingness on five-category scales. We summarised counts, percentages and Wilson 95% confidence intervals (CIs). Exploratory subgroup comparisons used Fisher's exact tests with Holm adjustment. All analyses were performed in R version 4.6.0. The median age of the 166 caregivers was 28 years (interquartile range: 24–34) and 143/166 (86.1%) were female. Before the interview, 125/166 (75.3%, 95% CI 68.2–81.2) had heard of a malaria vaccine and health professionals were the most frequently reported information source (109/125, 87.2%). After receiving standardised information, 154/166 (92.8%) agreed or strongly agreed that the vaccine may prevent malaria and 150/166 (90.4%) that it may be safe. For child vaccination, 139/166 (83.7%) were very willing and 23/166 (13.9%) were somewhat willing, giving an overall willingness of 97.6% (95% CI 94.0–99.1). Only 64/166 (38.6%, 95% CI 31.5–46.1) were very or somewhat willing to pay, while 80/166 (48.2%) were not willing at all. Among 62 reporting an amount, the median was UGX 5,000 (US$1.36). In exploratory comparisons, caregivers reporting a prior household malaria-related death were more often willing to vaccinate (129/129 [100.0%] versus 33/37 [89.2%]; P = 0.009) but less often willing to pay (34/129 [26.4%] versus 30/37 [81.1%]; P < 0.001). Prior awareness of the malaria vaccine was common and stated willingness to vaccinate was high in this single-hospital pre-rollout sample of caregivers, whereas willingness to pay was lower. Implementation studies should assess whether stated willingness translates into uptake, and whether costs affect access.