Assessment of malaria vaccine acceptance and willingness among caregivers of children under two years in Sudan: a cross-sectional study

In Sudan, malaria remains a major public health concern, particularly among children under five years of age who represent the most vulnerable group. The ongoing conflict between the Sudanese Armed Forces (SAF) and the Rapid Support Forces (RSF) has further complicated malaria control efforts. The WHO-recommended R21/Matrix-M malaria vaccine represents an important addition to preventive strategies targeting high-risk children. This study aimed to evaluate the knowledge, perceptions, and willingness of Sudanese caregivers regarding malaria vaccination for children under two years of age. A cross-sectional online survey was administered and distributed through social media platforms to Sudanese caregivers. Descriptive statistics were used to present the data. Inferential statistics including binary logistic regression were computed to investigate the possible factors associated with malaria knowledge and malaria vaccine knowledge. A total of 231 responses were received. While malaria awareness was universal (100%), only one-third of caregivers demonstrated good malaria knowledge (33.8%). Over half of the participants were aware of the malaria vaccine (52.4%); however, high vaccine-related knowledge was notably low (5.6%). Despite this, willingness to vaccinate was high (86.6%). Multivariable analysis showed that malaria knowledge was significantly associated with high monthly income (AOR = 2.168; 95% CI 1.010–4.650; P = 0.04). Regarding vaccine knowledge, significant associations were found with non-medical occupation (AOR = 0.481; 95% CI 0.232–0.995; P = 0.049) and moderate income (AOR = 0.469; 95% CI 0.228–0.966; P = 0.04). Vaccine uptake remained limited, with only 11.3% of children currently vaccinated. Caregivers demonstrated high willingness, notable fears and poor knowledge. Strengthening focused health education and improving access to reliable vaccine information particularly for caregivers inside Sudan and those with low income are critical to address knowledge gaps, reducing fear, and supporting successful uptake of the R21/Matrix-M malaria vaccine.