Caregivers awareness, knowledge, attitudes, and perceptions towards malaria vaccine in Kole and Kwania Districts, Northern Uganda

BACKGROUND: The R21 malaria vaccine has recently been rolled out in Uganda and other endemic settings across sub-Saharan Africa. Its implementation, faces many potential challenges. We assessed caregivers' awareness, knowledge, attitude, and perceptions towards the vaccine in northern Uganda. METHODS: A sequential explanatory mixed methods study was conducted in Kole and Kwania districts, Northern Uganda. Quantitative data were collected through a structured survey of 574 randomly selected caregivers of age-eligible children. Qualitative data were gathered through follow-up focus group discussions with caregivers. Descriptive statistics and exploratory factor analysis were used to assess knowledge and latent dimensions of attitudes and perceptions. Qualitative data were transcribed verbatim, anonymized, organized within ATLAS.ti version 25, and analysed using deductive thematic analysis. RESULTS: Among the 574 caregivers 90.1%, (95% CI 87.3-92.4) were aware of malaria vaccine. However, only 13.9% (95% CI 11.2-17.0) demonstrated factual knowledge regarding key aspects of malaria vaccine including; number of doses required (16.4%), dosing intervals (21.0%), and age eligibility (34.2%). Overall, 57.4% of the caregivers expressed positive attitudes and 57.5% reported positive perceptions towards the vaccine. Common factor analysis (CFA) revealed two key dimensions of vaccine attitudes: caregiver confidence (54.9%) and safety concerns (49.7%). Regarding perceptions, three factors emerged: vaccine confidence (56.5%), trust in delivery (54.9%), and safety concerns. While most caregivers stated confidence and trust, nearly half reported lingering concerns. Qualitative data reinforced these results and revealed five central themes: caregivers' knowledge and awareness of the malaria vaccine; enduring community misconceptions; mixed attitudes reflecting trust, and fear; and perceptions related to vaccine's safety, effectiveness, and value for child-health. CONCLUSION: Although, factual knowledge was limited, caregivers reported high awareness of malaria vaccine, alongside positive attitudes and perceptions tempered by safety concerns. The Ministry of Health needs to implement regular, nationwide community education campaigns anchored in locally tailored communication strategies.