Kigongo Eustes, Puleh Sean Steven, Kabunga Amir, Akech Stella Immaculate, Ocen Francis, Opollo Marc Sam, Ebong Moses
Department of Health Planning, Policy and Management, Faculty of Public Health, Lira University, Lira, Uganda.
Department of Epidemiology and Biostatistics, Faculty of Public Health, Lira University, Lira, Uganda.
Malar J. 2025 Aug 12;24(1):259. doi: 10.1186/s12936-025-05384-9.
Malaria remains a leading cause of morbidity and mortality in sub-Saharan Africa, particularly among children under five. The introduction of the malaria vaccine presents an opportunity to reduce malaria-related deaths. However, the success of vaccination campaigns depends on community acceptance and willingness to vaccinate. This study aimed to assess the pooled acceptance and willingness to adopt the malaria vaccine in sub-Saharan Africa, with a focus on variations across regions and the impact of the COVID-19 pandemic.
A systematic review and meta-analysis were conducted following PRISMA guidelines. A comprehensive search of databases, including PubMed, ScienceDirect, Google Scholar, and African Journals Online, was performed. Studies reporting on malaria vaccine acceptance and willingness among caregivers of children under five in sub-Saharan Africa were included. Data were extracted and analysed using STATA, with heterogeneity assessed through the I statistic. Subgroup analyses were performed based on region and pre- and post-COVID periods. Publication bias was assessed using Egger's test.
A total of 1611 records were identified, and 34 studies met inclusion criteria after screening. Of these, 25 studies with a combined sample of 25,867 participants were included in the meta-analysis. The pooled acceptance rate for the malaria vaccine among caregivers of children under five in sub-Saharan Africa was 82% (95% CI: 73%-90%), while the pooled willingness rate was 80% (95% CI: 70%-90%). Subgroup analyses showed no statistically significant differences in acceptance or willingness by COVID-19 period or region, though the lowest acceptance (53%) was reported in the DRC. High heterogeneity was observed (I > 99%), and publication bias was indicated in the willingness outcome (Egger's test, P = 0.002).
The findings indicate high levels of acceptance and willingness among caregivers to vaccinate children under five against malaria in sub-Saharan Africa, suggesting strong community readiness for vaccine rollout. However, the observed heterogeneity and potential publication bias highlight the need for context-specific strategies and further high-quality studies to support implementation and uptake across diverse regions. Systematic review registration The protocol has been registered with PROSPERO registration number: CRD42023480528.
疟疾仍然是撒哈拉以南非洲地区发病和死亡的主要原因，尤其是在五岁以下儿童中。疟疾疫苗的引入为减少疟疾相关死亡提供了契机。然而，疫苗接种运动的成功取决于社区的接受程度和接种意愿。本研究旨在评估撒哈拉以南非洲地区对疟疾疫苗的综合接受程度和接种意愿，重点关注不同地区的差异以及新冠疫情的影响。
按照PRISMA指南进行系统综述和荟萃分析。对包括PubMed、ScienceDirect、谷歌学术和非洲在线期刊在内的数据库进行全面检索。纳入报告撒哈拉以南非洲地区五岁以下儿童看护者对疟疾疫苗的接受程度和接种意愿的研究。使用STATA提取和分析数据，通过I统计量评估异质性。根据地区以及新冠疫情前后时期进行亚组分析。使用Egger检验评估发表偏倚。
共识别出1611条记录，筛选后有34项研究符合纳入标准。其中，25项研究（合并样本量为25867名参与者）被纳入荟萃分析。撒哈拉以南非洲地区五岁以下儿童看护者对疟疾疫苗的综合接受率为82%（95%置信区间：73%-90%），而综合接种意愿率为80%（95%置信区间：70%-90%）。亚组分析显示，无论在新冠疫情时期还是不同地区，接受程度或接种意愿均无统计学显著差异，不过刚果民主共和国报告的接受程度最低（53%）。观察到高度异质性（I>99%），并且在接种意愿结果中显示存在发表偏倚（Egger检验，P=0.002）。
研究结果表明，撒哈拉以南非洲地区的看护者对五岁以下儿童接种疟疾疫苗的接受程度和接种意愿较高，这表明社区对疫苗推广有很强的准备程度。然而，观察到的异质性和潜在的发表偏倚凸显了需要制定因地制宜的策略以及开展进一步高质量研究，以支持在不同地区的实施和推广。系统综述注册 该方案已在PROSPERO注册，注册号：CRD42023480528。
