Vaccination is not the only, but the best solution to controlling infectious diseases [30]. However, while most people vaccinate according to the recommended schedule, the success is being challenged by individuals and groups who choose to delay or refuse vaccines [31]. Vaccine hesitancy is believed to be responsible for decreasing vaccine coverage and an increased risk of vaccine-preventable disease outbreaks and epidemics [32]. Ethiopia has been exerting enormous efforts to eliminate malaria by 2030. The country is working to eliminate the disease in 565 selected malaria-prone woreda [11]. The innovation of the malaria vaccine will have a significant effect on the malaria elimination strategy. Understanding communities’ willingness to receive a malaria vaccine and the main factors influencing their willingness towards it will help to develop and implement effective means of promoting malaria vaccine uptake and to facilitate the recent malaria elimination programme in the country.

In this study, 131 (32.3%) of respondents were willing to vaccinate their child for malaria in the future when the vaccine was available. The finding of this study was lower than a study done in Abuja Nigeria (98%), Calabar Nigeria (53%), Ibadan Nigeria (87%), Tanzania (94.5%), Kenya (88%), and the rural community of Nigeria (91.6%) [24,25,26,27,28,29]. he difference may be due to differences in sociodemographic features of study respondents, time of the study, sample size, and study design.

The malaria vaccine is an innovative health intervention in Ethiopia [33]. PATH MVI stated that experience has shown that the development of an innovative health intervention does not necessarily mean that it will be adopted, delivered, accepted, and used immediately in a way that will make a significant impact on people’s health. There are several, interrelated technical, individual, political, financial, and social issues that influence the adoption and implementation of new health interventions. Late attention to these issues is likely to result in a delayed policy decision regarding a health technology or in a decision being taken without enough information to support it and facilitate its use [16].

The main causes of hesitancy to vaccinate their child towards malaria vaccine were; the vaccine may paralyzed the child if not given orally, expensiveness of the vaccine, refusal of partners. The finding was consistent with a study done in Ibadan, Nigeria [26]. Respondents in this study requested that the vaccine be given free, suggesting that they might not be able to afford the costs or that they are not willing to pay for the vaccine. This could have been borne out of the fact that vaccines for child immunization in the country are currently free. However, findings of research conducted in Ethiopia [22], 60.6% of caregivers of under-five children were willing to pay for the childhood malaria vaccine for US$ 23.11 per full dose.

In this study, caregivers’ marital status, knowledge, and previous experience with childhood vaccination were found to be significantly associated with willingness to accept malaria vaccine at p < 0.05.

Caregivers of the child under the age of five who were married were 1.2 times more likely to have willingness to vaccinate their child compared to unmarried caregivers. The finding was consistent with a study done in Nigeria, India, Kenya and Japan [34,35,36,37]. This may be due to single mothers lack time for child healthcare [37]. To solve this problem, improvement in the working conditions among single mothers is needed. Furthermore, for example, simplification of vaccination systems, institutionalization of paid leave for child healthcare, and vaccination programmes at the mother’s workplace can facilitate access to child vaccination for single mothers who are busy with both home and work.

Caregivers of the child under the age of five who had good knowledge about the malaria vaccine were three times more likely to have willingness to vaccinate their child compared to those who had poor knowledge about the vaccine. The finding was consistent with a study done in Calabar Nigeria, Tanzania, and Kenya [25, 27, and 36]. This is because the effectiveness of vaccines relies on both clinical efficacy and a community’s knowledge [38]. During vaccine promotion, lack of community support due to poor knowledge and perceptions resulted in poor community uptake while others reject vaccines [39]. Therefore, health education and communication from government sources are very crucial methods to alleviate the poor knowledge about malaria vaccine.

Caregivers of the child under the age of five who had previous experience with childhood vaccination were 2.7 times more likely to have willingness to vaccinate their child compared to those who had no previous experience. The finding was consistent with a study done in Ibadan Nigeria, Ethiopia, and Vietnam [22, 26, and 40]. The possible reasons might be that caregivers who had previous experience might have adequate information about the advantage and side effect of the vaccine to prevent vaccine preventable diseases. Therefore, understanding which factors are consistently associated with the decision to vaccinate one’s child is important to identify messages, which should be targeted by public health communications about routine child vaccinations.

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