Awareness, Acceptability, and Willingness to Pay for the R21/Matrix-M Malaria Vaccine: A Cross-Sectional Study Among Pregnant Women and Nursing Mothers Living in Enugu State, Nigeria

OBJECTIVES: The R21/Matrix-M vaccine was recommended for use in malaria prevention, having shown a significant reduction in the incidence of malaria in children aged 3 to 36 months. However, there is limited evidence on its awareness, acceptance, and affordability which are relevant factors to its successful rollout. This study assessed the awareness, acceptability, and willingness to pay (WTP) for the R21/Matrix-M malaria vaccine among pregnant women and nursing mothers in Enugu State, Nigeria.

METHODS: This was a prospective cross-sectional study that was carried out in 3 selected centers in Enugu and included pregnant and nursing mothers. The study instrument was a validated 30-item questionnaire with four domains that included: sociodemographic details, awareness, acceptability, and WTP questions. The WTP was assessed using the contingent valuation method. Descriptive statistics were used to summarize the characteristics of the study variables. A logistic regression model was used to determine the predictors of WTP for the vaccine with significance level set at p ≤ 0.05.

RESULTS: Among the 310 participants included in this study, most were aged 22-33 years (n = 232, 75.0%) and had at least one child aged 3 years and below (n = 180, 58.1%). Also, the majority of the participants were not aware of the R21/Matrix-M malaria vaccine (n = 262, 84.5%), accepted to vaccinate their child (n = 292, 94.2%), and were willing to pay for the vaccine (n = 247, 79.7%). The mean and median maximum WTP values were US$0.82 ± 1.41 (₦639.27 ± 1097) and US$0.38 (₦300) respectively. Health insurance (OR: 0.417, 95% CI: 0.19–0.92) was a predictor of WTP.

CONCLUSIONS: This study found poor awareness but a high acceptance of the vaccine; hence, more awareness must be created for wide vaccine coverage. The participants were also willing to pay for the R21/Matrix-M malaria vaccine with health insurance predicting WTP.