Socio-Demographic Factors Influencing Malaria Vaccine Acceptance for Under-Five Children in a Malaria-Endemic Region: A Community-Based Study in the Democratic Republic of Congo

Arsene Daniel Nyalundja; Patrick Musole Bugeme; Ashuza Shamamba Guillaume; Alain Balola Ntaboba; Victoire Urbain Hatu'm; Jacques Lukenze Tamuzi; Duduzile Ndwandwe; Chinwe Iwu-Jaja; Charles S Wiysonge; Patrick D M C Katoto

doi:10.3390/vaccines12040380

Socio-Demographic Factors Influencing Malaria Vaccine Acceptance for Under-Five Children in a Malaria-Endemic Region: A Community-Based Study in the Democratic Republic of Congo

Vaccines (Basel). 2024 Apr 2;12(4):380. doi: 10.3390/vaccines12040380.

Authors

Affiliations

¹ Center for Tropical Diseases and Global Health (CTDGH), Catholic University of Bukavu (UCB), Bukavu 285, Democratic Republic of the Congo.
² Faculty of Medicine, Catholic University of Bukavu (UCB), Bukavu 285, Democratic Republic of the Congo.
³ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
⁴ Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa.
⁵ Cochrane South Africa, South African Medical Research Council, Cape Town 7501, South Africa.
⁶ Vaccine-Preventable Diseases Program, World Health Organization Regional Office for Africa, Brazzaville P.O. Box 06, Congo.
⁷ Centre for General Medicine and Global Health, Department of Medicine, University of Cape Town, Cape Town 7505, South Africa.

Abstract

Two novel vaccines against malaria are proposed as a complementary control tool to prevent and reduce Plasmodium falciparum related disease and death in under-five children from moderate to high malaria transmission regions. The Democratic Republic of Congo (DRC) has committed to eradicate malaria by 2030, and significant efforts have been deployed to strengthen control and elimination measures. We aimed to understand factors influencing the malaria vaccine acceptability among the general population in eastern DRC. We conducted a survey among adult Congolese in Bukavu in March 2022. The questionnaire was adapted from the Behavioral and Social Drivers of vaccine uptake (BeSD) framework and was administered online and physically. Multivariate logistic regressions were built, and estimates were represented as adjusted odds ratios (aOR) and corresponding 95% confidence intervals (95%CI). Out of 1612 adults (median age: 39 years, 46.15% female) surveyed, only 7.26% were aware of the malaria vaccine. However, 46.53% expressed willingness to vaccinate themselves, and 52.60% were open to vaccinating their under-five children. Adjusting for confounding factors, non-student/non-healthcare worker professions (aOR = 0.58, 95%CI [0.42-0.78]) and middle-income status (aOR = 1.87, 95%CI [1.25-2.80]) were significantly associated with self-vaccination acceptance. Age played a role in under-five child vaccination acceptability, with 25 to over 64 years showing increased acceptability compared to the 18-24 age group. Additionally, non-student/non-healthcare worker professions (aOR = 1.88, 95%CI [1.37-2.59]), medium education levels (aOR = 2.64, 95%CI [1.29-5.79]), and residing in semi-rural areas (aOR = 1.63, 95%CI [1.27-2.10]) were predictors of under-five child vaccination acceptance. The acceptability of the malaria vaccine for self and for under-five children was suboptimal for effective malaria control in this community in the DRC. Our study constitutes a call for the Expanded Program on Immunization to closely work with various stakeholders to strengthen risk communication for community engagement prior to and during the introduction of this novel and lifesaving tool, malaria vaccination.

Keywords: BeDS; Bukavu; immunization; plasmodium falciparum; prevention and control.

Grants and funding

This work was supported by internal funding from the Center for Tropical Diseases and Global Health (CTDGH) at the Catholic University of Bukavu (UCB), awarded on 1 February 2022.