Work

A scoping review and conceptual framework mapping the determinants of malaria vaccine acceptance among adults in Africa

Year: 2026

Type: article

Abstract: Background Malaria remains a severe public health crisis in Africa, causing 94% of global cases and 95% of deaths in 2023. While the rollout of the RTS, S/AS01 and R21/Matrix-M vaccines marks a historic shift, long-term public health success relies on adult acceptance particularly among parents, caregivers, and healthcare workers amid rising vaccine hesitancy. This scoping review systematically identified and classified the determinants of malaria vaccine acceptance and hesitancy among adults in Africa using the Health Belief Model (HBM) and the World Health Organization Strategic Advisory Group of Experts (WHO SAGE) Vaccine Hesitancy Matrix, presenting the operationalized proposed conceptual framework to guide future rollout strategies. Methods Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist, six electronic databases (PubMed, Scopus, Web of Science, AJOL, CINAHL, and PsycINFO) and grey literature sources were searched for literature published from January 2019 to July 2025. Studies exploring adult perceptions, barriers, and facilitators toward malaria vaccination in Africa were screened. Deductive thematic content analysis was applied to map findings across HBM constructs and WHO SAGE domains. Results Out of 3000 retrieved records, 30 studies met the strict inclusion criteria, comprising 25 peer-reviewed articles and 5 grey literature reports across 13 African countries. High baseline vaccine willingness rates (> 80%) were primarily driven by trust in healthcare providers (26.7% of studies), high perceived malaria severity (23.3%), and community engagement workshops (16.7%). Conversely, critical barriers to uptake included deep-seated misinformation and infertility rumors (16.7%), fear of vaccine side effects (23.3%), complex multi-dose schedules (23.3%), and logistical or cold-chain constraints (16.7%). These determinants were successfully synthesized into three key operational domains: Contextual, Individual/Group, and Vaccine-Specific Influences. Conclusion Addressing structural and psychological barriers requires evidence-informed, culturally sensitive interventions. National Ministries of Health should prioritize community-led health education, integrate trusted religious and local figures to counteract misinformation, and reinforce cold-chain infrastructure to ensure equitable delivery.

Source: Discover Public Health

DOI: 10.1186/s12982-026-02946-3

Authors: Clinton Kwemu Njakoi, Carine Njwengba Owajege, Frankline Sevidzem Wirsiy

Institutions: University of Bamenda, Cameroon Baptist Convention Health Services, Brunel University of London, Africa Centres for Disease Control and Prevention, University of Nebraska Medical Center

Language: English

Topic: Vaccine Coverage and Hesitancy

Subfield: Health

Field: Social Sciences

Domain: Social Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W7221437643