Caregivers’ Willingness to Vaccinate Their Children against Childhood Diseases and Human Papillomavirus: A Cross-Sectional Study on Vaccine Hesitancy in Malawi

Abstract

Background: Vaccines are among the most effective and cost-efficient public health interventions for promoting child health. However, uptake is considerably affected by vaccine hesitancy. An example is Malawi, with a decline in second vaccine doses and the highest cervical cancer incidence and mortality rate in Sub-Saharan Africa. Understanding vaccine hesitancy is especially important when new vaccines are introduced. This study explores factors contributing to vaccine hesitancy for routine childhood immunization and the human papillomavirus vaccine in Malawi. Methods: The study used a cross-sectional survey design targeting caregivers of children under five years old and adolescent girls. The sample population was derived using three inclusion criteria: one district with low vaccine uptake (Dowa), one district with high vaccine uptake (Salima), and one district where human papillomavirus vaccine was piloted earlier (Zomba). A convenience sample of one primary and one secondary health facility was selected within each district, and participants were systematically included (n = 600). The measures were based on 5C scale for measuring vaccine hesitancy. Multiple regression analyses were performed to explore vaccination intention predictors. Results: Confidence in vaccine safety was the strongest predictor of routine childhood immunization, followed by constraints due to everyday stress. Caregivers had lower confidence in vaccine safety and efficacy when they believed rumors and misinformation and were unemployed. Confidence was higher for those who had more trust in healthcare workers. Age, gender, religion, education, employment, belief in rumors, and trust in healthcare workers were considered predictors of vaccination intention. A husband’s positive attitude (approval) increased childhood vaccination intention. For human papillomavirus, vaccination intentions were higher for those with lower education, more trust in healthcare workers, lower complacency, and a lower tendency toward calculating the benefits and risks of vaccination. Knowledge of human papillomavirus did not increase vaccination intention, but the need to attain a husband’s approval did. Being a young adult and unemployed increased belief in rumors, while trust in healthcare workers reduced the belief. Conclusions: This study provides good insights into the drivers of vaccine hesitancy across different contexts in Malawi. However, further studies are necessary to understand low risk perception among elderly people and the declining trend in second vaccine doses.

Early Impact of SARS-CoV-2 Pandemic on Immunization Services in Nigeria

“…Therefore, the knowledge gap that created the belief that immunization can prevent all childhood diseases, including malaria or COVID-19, might lead to a lack of confidence in the efficacy of vaccines to prevent VPD and in the healthcare system. The knowledge gap found in this study is similar to that found in Sub-Saharan Africa (SSA), where the population has misconceptions about vaccines [ 21 , 22 , 23 , 24 ]. More work is still needed in SSA to improve the knowledge of VPD and determine the best communication method for vaccination information.…”

Understanding Drivers of Vaccine Hesitancy among Pregnant Women in Nigeria: A Longitudinal Study

“…It is expected that the 5C will predict vaccination intention and behavior as described above. Moreover, we expected the three additional variables (religion, masculinity and rumor/misinformation) to negatively in uence vaccination intention and behavior [31,32]. Also, intention (T1) is expected to predict the mother's vaccination behavior (T2).…”

“…Rumor/misinformation affects the perception and attitude of people, especially as social media continues to dominate the ampli cation of vaccine misinformation, thereby affecting vaccination demand [31,32,42]. It makes the inclusion even more relevant.…”

Examining enablers of vaccine hesitancy toward routine childhood and adolescent vaccination in Malawi

“…The study implementation instruments were interview guides. The guide comprised the following themes and topics, based on validated measures in the same setting [ 26 , 27 , 30 ]: knowledge of immunisation (“What do you know or think about immunisation?”); knowledge of HPV/cervical cancer (“Do you know or have you heard about cervical cancer and/or the HPV vaccine?”); attitude toward childhood RI and the HPV vaccine (“Do you think childhood RI is an important topic for you and/or your community?…How?” and “What do you think about the HPV vaccine and the target group?…Why do you think that way?”); barriers against childhood RI (“Do you know about vaccine hesitancy and what are the reasons for low childhood immunisation demand?…Please describe why”); barriers against HPV vaccine acceptance (“Do you know about hesitation against HPV vaccine?…If so, what are they, among whom are they, and why?”). These measures have been tested across different settings in SSA and has generated high reliability, especially in Malawi.…”