Perceived safety, effectiveness and acceptability of R21/Matrix-M malaria vaccine among pediatric health practitioners and caregivers in Southeast Nigeria: a cross-sectional study

Abstract Background Nigeria has the highest number of malaria deaths globally, and children bear the greatest burden. Although major investments have supported the development and clinical trials of the novel R21/Matrix-M malaria vaccine, little attention has been given to how frontline pediatric health practitioners and caregivers perceive this new intervention, especially in high-burden settings. Their confidence and acceptance are critical to successful vaccine rollout. This study therefore explored the perceptions of safety, effectiveness, and acceptability of the R21/Matrix-M malaria vaccine among pediatric health practitioners and caregivers in Southeast Nigeria, with the goal of generating context-specific evidence to guide implementation strategies in malaria-endemic regions. Methods The study adopted a descriptive cross-sectional design using a quantitative approach. 406 pediatric health practitioners and caregivers in Awka, Southeast Nigeria, were recruited for the study by stratified sampling. Data were collected using structured questionnaire that assessed socio-demographic characteristics, awareness of the R21/Matrix-M malaria vaccine, perceived safety, perceived effectiveness, acceptability, and perceived barriers and facilitators to vaccine uptake. Data were analyzed using IBM SPSS version 20. Descriptive statistics summarized key variables, while Chi-square tests examined associations between perceptions and willingness to recommend or accept the vaccine, with statistical significance set at p < 0.05. Results Awareness of the R21/Matrix-M vaccine was relatively low among pediatric health practitioners (52.7%) and caregivers (38.6%). Most pediatric practitioners perceived the vaccine as safe (83.8%) and effective (86.9%), and 75.7% were willing to recommend it. Caregivers demonstrated moderate perceptions of safety (57.1%) and effectiveness (54.9%), with 53.3% expressing willingness to vaccinate their children. Perceived safety was significantly associated with willingness to recommend the vaccine among practitioners (p < 0.001) and with acceptability among caregivers (p < 0.001). Key facilitators for vaccine acceptance included targeted health education, positive media coverage, and government endorsement, while major barriers encompassed insufficient information, safety concerns, and parental resistance. Conclusions Perceptions of safety and effectiveness are key drivers of advocacy and acceptability of the R21/Matrix-M malaria vaccine. Targeted health education, proactive management of misinformation, and reliable vaccine access are essential to support effective rollout. Policy-driven interventions engaging both healthcare professionals and caregivers can accelerate uptake and strengthen malaria control efforts in Nigeria.