R21/MATRIX malaria vaccine: awareness, perception, acceptability, and willingness to pay among caregivers of under-five children in endemic communities in Lagos, Nigeria

BACKGROUND: Malaria remains a leading cause of morbidity and mortality, particularly among children under five years of age in sub-Saharan Africa. Nigeria has the highest burden of malaria cases worldwide, accounting for 26% of all cases. The introduction of the R21/Matrix malaria vaccine is promising for reducing the malaria burden. However, vaccine awareness, perceptions, and willingness to pay among caregivers are key to ensuring successful rollout. This study assessed caregivers' awareness, perceptions, acceptability, and willingness to pay for the R21/MATRIX malaria vaccine in endemic communities in Lagos, Nigeria. METHODS: A community-based cross-sectional survey was conducted among 372 caregivers of children under five years of age. A multistage sampling technique was employed to select respondents from five malaria-endemic communities in Lagos. Data were collected via a semi-structured, interviewer-administered questionnaire. Descriptive statistics were computed, and binary logistic regression was used to identify predictors of vaccine awareness, perception, and willingness to pay. RESULTS: Awareness of the R21/MATRIX vaccine was low (9.7%), with the internet as the primary source of information. Positive perceptions of the vaccine were high, with 98.1% of caregivers believing it to be safe and effective. Acceptability was also high, as 76.6% of the caregivers indicated that they would "definitely" vaccinate their child. Willingness to pay was reported by 71.2% of the respondents, with 51.9% willing to pay between ₦1,001-₦5,000 per dose. The factors significantly associated with awareness included gender, marital status, and relationship with the child (p < 0.05). Higher household income and guardianship status increased the likelihood of willingness to pay (p < 0.05). CONCLUSIONS: Despite the low awareness of the R21/MATRIX malaria vaccine, caregivers demonstrated a strong positive perception, high acceptability, and moderate willingness to pay. Targeted community awareness campaigns focused on the benefits and safety of the vaccine are essential to improve knowledge of the vaccine in endemic communities.