KNOWLEDGE, PERCEPTION AND ACCEPTANCE OF MALARIA VACCINE AMONG CAREGIVERS OF UNDER-FIVE CHILDREN IN BENIN CITY, EDO STATE

Background: Malaria remains a leading cause of morbidity and mortality among under-five children in Nigeria. The introduction of malaria vaccines (RTS,S/AS01 and R21/Matrix-M) offers a promising complementary intervention. However, vaccine acceptance is critically dependent on caregivers' knowledge and perceptions—factors that remain poorly characterized in Benin City, Edo State. Objective: To assess the knowledge, perception, acceptance, and factors influencing acceptance of malaria vaccines among caregivers of under-five children in Benin City, Edo State, Nigeria. Methods: A community-based descriptive cross-sectional study was conducted from May 2024 to May 2026 among 426 caregivers of under-five children selected through a multi- stage sampling technique in Ekosodin community, Ovia North-East Local Government Area, Benin City. Data were collected using a pretested, structured, interviewer-administered questionnaire. Knowledge was assessed using a 12-point scoring system (categorized as good: ≥50%), perception using a 10-item Likert scale (positive: >60%), and acceptance as willingness to vaccinate. Data were analyzed using IBM SPSS version 27.0; bivariate and multivariate logistic regression analyses were performed with statistical significance set at p<0.05. Results: The mean age of respondents was 35.2±10.4 years; the majority were female (68.1%), married (67.1%), and had secondary education (43.7%). While awareness of malaria was universal (99.8%), only 44.1% had heard of the malaria vaccine, and overall good knowledge of the vaccine was poor (20.2%). Positive perception toward the malaria vaccine was high (84.7%). Willingness to accept the vaccine was 73.5%, although actual uptake remained low (11.5%). Fear of adverse reactions (82.3%) was the predominant reason for refusal. Significant predictors of good vaccine knowledge included tertiary education (AOR=4.84; 95% CI: 2.67–8.77; p=0.001) and ever-married status (AOR=2.40; 95% CI: 1.09–5.26; p=0.030). Positive perception was strongly associated with Christian religious affiliation (AOR=7.37; 95% CI: 3.10–17.54; p<0.001). The strongest independent predictor of willingness to accept the malaria vaccine was positive perception (AOR=7.39; 95% CI: 3.87–14.12; p<0.001), followed by good knowledge of the vaccine (AOR=2.87; 95% CI: 1.24–6.63; p=0.014). Increasing age was associated with reduced willingness (AOR=0.97; 95% CI: 0.95–1.00; p=0.046). Conclusion: Despite favorable perception and high willingness to accept malaria vaccines among caregivers in Benin City, significant gaps exist in knowledge and awareness. Perception emerged as the strongest driver of acceptance, while educational status and marital status influenced knowledge. These findings underscore the urgent need for targeted health education interventions, particularly leveraging healthcare professionals as trusted information sources, to bridge the knowledge-practice gap and optimize malaria vaccine uptake in this setting. Keywords: Malaria vaccine, knowledge, perception, acceptance, caregivers, under-five children, Benin City, Nigeria.