Predictors of Malaria Vaccine Hesitancy Among Caregivers in Bumula Subcounty, Bungoma County

Abstract

Abstract Background: Malaria is a disease that threatens health and economy of the world and is number nine among the diseases in contributing to high mortality and disability worldwide. Available WHO-recommended malaria control strategies are becoming less effective due to drug and insecticide resistance and parasite undetectability. In 2019, Mosquirix (RTS, S) vaccine was introduced to complement the existing package towards malaria prevention in children, making malaria a vaccine preventable disease (VPD). Vaccine hesitancy (VH) is a developing pattern in global health. Broad Objective: To determine the predictors of malaria vaccine hesitancy among caregivers in Bumula subcounty, Bungoma County, Kenya. Methodology: The cross-sectional study sampled 419 caregivers and their children eligible for four malaria vaccine doses by December 2022. Caregivers were interviewed face-to-face using a structured customized WHO-SAGE vaccine hesitancy questionnaire. Qualitative data was collected through 4 focus group discussions (FGDs) with 38 community health volunteers (CHVs) and key informant interviews (KIIs) with 10 key informants (KIs). Quantitative data was entered in SPSS version 28.0.1. Chi-square test was used at bivariate level and logistic regression at multivariate level. Significance level was set at 5%. Qualitative data was coded, categorized, summarized, and entered in WHO-SAGE BeSD qualitative data analysis template, where a framework was used to generate results. Findings: Out of 419 caregivers, 86.9% were female while 13.1% were male, mean age was 31.31 years and ranged from 17 to 80 years. Majority (71.8%) were married, and 89.5% Christian. Out of the 419 children, 52.5% were male and mean age was 29.32 months and ranged from 24 and 46 months. The uptake of first dose was 97.6%, which reduced to 96.2% for second dose, 86.6% for the third dose and finally 62.8% for the fourth dose. Vaccine hesitancy was at 37.2%, while vaccine acceptance was 62.8%. There were 13 significant independent variables from the chi-square bivariate analysis; religion (χ2=13.274, df=3, P.=0.004) age of child (χ2=6.739, df=2, P.=0.034), relationship between caregiver and child (χ2=13.287, df=3, P.=0.004), previous decision not to get malaria vaccine for the child (χ2=5.523, df=1, P.=0.019), feeling that information on malaria vaccine was being openly shared (χ2=12.146, df=1, P.=0.00), trust on what the MoH says about malaria vaccine (χ2=7.160, df=1, P.=0.007), source of verification of negative information on malaria vaccine (χ2=15.368, df=3, P.=0.002), knowledge of any group or leaders, or individuals opposed to malaria vaccination (χ2=9.291, df=1, P.=0.002), awareness of people in my community opposed to malaria vaccine due to religion (χ2=8.224, df=1, P.=0.004) trust on malaria vaccine manufacturers to have good intentions for the child and other children in community(χ2=7.168, df=1, P.=0.007), having enough information about malaria vaccine and its safety (χ2=6.344, df=1, P.=0.012), confidence level in the safety of malaria vaccine (χ2=21.119, df=3, P.=0.000), trust in the country to manage risks associated with malaria vaccine side effects (χ2=4.441, df=1, P.=0.035) and trust in the health system to deliver malaria vaccine to your community (χ2=0.185, df=1, P.=0.667). At logistic regression analysis at multivariate level, 4 out of the 13 remained significant; Age of the child (AOR 0.634, 95% CI 0.418-0.962), information about malaria vaccine openly shared (AOR 4.085, 95% CI 1.671-9.987), source of verification of negative information about the malaria vaccine (AOR 1.573, 95% CI 1.120-2.207) and opposition to malaria vaccine linked to religion (AOR 0.581, 95% CI 0.352-0.958). The logistic regression model was statistically significant, χ2 = 37.076, p < .000. The model explained 11.6% (Nagelkerke R2) of the variance in vaccine uptake and correctly classified 65.9% of cases. Conclusions: Uptake of the first and second doses met WHO’s target coverage for vaccines, but uptake of the third and fourth doses do not. Malaria vaccine hesitancy is high, influenced by religion, confidence on the vaccine, open sharing of information and source of verification.