Factors Associated with Mother’s Adoption of the Malaria Vaccine in the Allada-Toffo-Zè Health Zone in Benin, 2025

Background: Vaccine hesitancy in communities is recognized as one of the major threats to public health and remains a significant challenge in the control of vaccine-preventable infectious diseases. In 2024, Benin introduced the malaria vaccine (MV) on a pilot basis in three health zones, including the Allada-Toffo-Zè (ATZ) Health Zone, due to the high malaria endemicity reported in these areas by the national health information system. Objective: To investigate the factors associated with the uptake of the malaria vaccine among mothers of children aged 6 to 18 months in the ATZ Health Zone, Benin, in 2025. Methods: This was a descriptive and analytical cross-sectional study conducted from December 1, 2024, to June 28, 2025. The survey included 604 mothers of children, recruited through a three-stage cluster probability sampling method. Data analysis was performed using R software, version 4.3.3. Results: Mothers were predominantly aged 26 to 35 years (47.4% among the 572 mothers with recorded age; median age: 26 years, IQR: 22 - 30), and the median age of selected children was 12 months (IQR: 9 - 18 months), ranging from 6 to 18 months, with 57.0% aged 12 to 18 months and a female predominance of 50.7%. At the time of the survey, 72.6% of mothers had had their children vaccinated with the MV, being up to date for their age with respect to the MV vaccination schedule. The main factors associated with MV uptake were the intention to vaccinate the child (aOR = 6.69; 95% CI: [2.18 - 20.54]; p = 0.002), a favorable perception of MV effectiveness (aOR = 9.46; [2.92 - 30.62]; p = 0.001), strong community endorsement of the MV (aOR = 2.62; 95% CI: [1.37 - 5.00]; p = 0.006), and a favorable opinion from parents or close friends (aOR = 3.84; 95% CI: [1.63 - 9.04]; p = 0.004). Conclusion: These findings highlight the need to strengthen healthcare workers’ interpersonal communication skills regarding the malaria vaccine, particularly the content of key messages; revise communication strategies on the malaria vaccination schedule to better align with existing community practices; and improve the accessibility and quality of vaccination services.