Uptake of R21/Matrix-M malaria vaccine and associated factors among children eligible for vaccination in Kole and Kwania districts, Northern Uganda: a cross-sectional study

Abstract

Background The introduction of R21/Matrix-M (R21) vaccine as a malaria control strategy provides an oppor¬tunity to reduce the disease burden. However, there is limited evidence on its uptake and what affects the uptake, information that is important for the successful implementation of the vaccine. We assessed the level of uptake and associated factors among caregivers of children eligible for malaria vaccination in northern Uganda. Methods Between September and October 2025, a cross-sectional survey was conducted among 557 caregiv¬ers of children eligible for malaria vaccination. Data were collected using pretested structured questionnaires in KoboCollect and exported into Stata version 18 for analysis. Child health cards were used to verify vaccine sta¬tus. Uptake was defined as the proportion of caregivers whose eligible children received at least one dose of the vaccine. Factors associated with vaccine uptake were determined using modified Poisson regression, adjusting for village level clustering and reported as adjusted prevalence ratio (aPR) with their 95% confidence intervals. Results Of the 557 caregivers interviewed, 269 reported that their children had received the first dose of the malaria vaccine, putting uptake at 48.3% (95% confidence interval CI: 44.0% − 52.0%). Vaccine uptake was positively associated with exposure to community-based health campaigns (aPR = 1.32, 95% CI: 1.01–1.72); caregivers’ receiving advice from healthcare workers about the vaccine (aPR = 2.61, 95% CI: 1.55–4.40); per¬ceived increased susceptibility of the child to malaria (aPR = 2.26, 95% CI: 1.67–3.04); ease of accessing the vaccine (aPR = 1.47, 95% CI: 1.25–1.73); and trust in government programs (aPR = 1.80, 95% CI: 1.43–2.25). Negative interaction effects were observed between health-worker advice combined with perceived malaria sus¬ceptibility (aPR = 0.44; 95% CI: 0.29–0.66) and long queues combined with poor information (aPR = 0.12; 95% CI: 0.02–0.89). Conclusion The level of R21 malaria vaccine uptake was sub optimal, with less than half of eligible children receiving their first dose. Multiple factors influenced uptake, including those affecting caregiver knowledge and vaccine access. The Ministry of Health should strengthen factors improving uptake including, caregiver educa¬tion on benefits of the vaccine and expanding access through different channels including campaigns