Abstract
<title>Abstract</title> <p>Background RTS, A/S01 is a malaria vaccine that is a major step forward in childhood malaria prevention in sub-Saharan Africa. Maternal awareness, acceptability and willingness to vaccinate, however, are found to be critical to the uptake of vaccines. Methods This study employed a convergent mixed methodology, it involved Quantitative (Cross-sectional survey) and Qualitative (Interviews). Structured questionnaires were used to conduct a survey with 421 mothers of under-five children who were attending immunization clinics. In-depth interviews with eight mothers, five healthcare workers and four community leaders were used to gather qualitative data. Association between the socio-demographic factors and vaccine acceptability were analyzed through chi-square analyses. Thematic analysis was used to identify the key determinants using NVivo software. Results Out of the mothers, 55% were not aware of the vaccine, and the acceptability was moderate to good, with 62% saying they were willing to vaccinate (50% agreed and 12% strongly agreed). 71% were willing to vaccinate if offered. Education (χ² = 256.434, p < 0.001), religion (χ² = 268.140, p < 0.001), employment status (χ² = 118.018, p < 0.001), age (χ² = 98.521, p < 0.001), and income (χ² = 121.610, p < 0.001) were significantly associated with acceptability. Four determinants were determined with thematic analysis: (1) access and convenience, (2) information and social influence, (3) safety and efficacy concerns, and (4) trust in information sources. Conclusions Though there is enthusiasm, there are significant barriers to uptake including low awareness and safety concerns, and socioeconomic inequalities. Implementation strategies should include culturally-tailored communication to reduce awareness gaps, trusted voices in the community and healthcare sectors, minimize financial and logistical barriers, and communicate safety related concerns clearly and factually.</p>