Preliminary Insights into Knowledge and Attitudes Toward Malaria Vaccination among Sudanese Healthcare Workers: An Exploratory Cross-Sectional Study

Preliminary Insights into Knowledge and Attitudes Toward Malaria Vaccination among Sudanese Healthcare Workers: An Exploratory Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Preliminary Insights into Knowledge and Attitudes Toward Malaria Vaccination among Sudanese Healthcare Workers: An Exploratory Cross-Sectional Study Duaa Hamza, Omnia Kamaleldin Bashar Suliman, Abrar Adam Khatir Sam, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7606195/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 20 Dec, 2025 Read the published version in Malaria Journal → Version 1 posted 7 You are reading this latest preprint version Abstract Background Malaria continues to impose a significant public health burden in Sudan, where fragile health systems and conflict exacerbate transmission. The introduction of RTS,S/AS01 and R21/Matrix-M vaccines offers a potential breakthrough. However, the success of such programs depends heavily on healthcare workers (HCWs), whose knowledge and attitudes can influence vaccine uptake; this study explored these factors among Sudanese HCWs’ knowledge and attitudes toward malaria vaccination. Methods An exploratory cross-sectional survey was conducted between January and April 2025 among HCWs across Sudan. A total of 222 eligible participants were recruited via an online, self-administered questionnaire. Knowledge was assessed using eight malaria vaccine–related items, with scores ≥ 70% indicating adequate knowledge. Attitudes were measured through six Likert-scale items, with ≥ 70% considered positive. Descriptive statistics, Chi-square tests, independent t-tests, and regression analyses were applied. Results The mean age of respondents was 31.5 years, and 66.7% were female. Pharmacists represented the largest professional group (44.6%). Only 9% (n = 20) demonstrated adequate knowledge of malaria vaccination, and 21.6% (n = 48) displayed positive attitudes. While 66.2% (n = 147) had heard of malaria vaccines, 71.2% (n = 158) were unaware of WHO recommendations, and 76.6% (n = 170) did not know the vaccine’s target parasite. Negative attitudes were reported by 78.4% (n = 174), particularly concerning safety, affordability, and trust in authorities. Positive attitudes were more common among males, HCWs with > 5 years of experience, and those in the private sector (all p < 0.05). Conclusion The study highlights critical gaps in knowledge and predominantly unfavorable attitudes toward malaria vaccination among Sudanese HCWs, indicating a risk of vaccine hesitancy in frontline delivery. Targeted training and awareness programs are urgently needed to strengthen HCWs’ capacity, dispel misconceptions, and build trust in the malaria vaccine as Sudan scales up immunization efforts. malaria vaccine healthcare workers Sudan knowledge attitude RTS S R21 vaccine hesitancy public health Figures Figure 1 Introduction Malaria remains a critical global health challenge, with 249 million cases and 608,000 deaths reported in 2022, disproportionately affecting children under five years of age ( 1 ). In Sudan, malaria transmission peaks seasonally from June to November, compounded by conflict-driven displacement and a fragmented healthcare infrastructure ( 2 , 3 ). Recently, Sudan has started using new malaria vaccines like RTS,S/AS01 and R21/Matrix-M, making it one of the first African countries to do so ( 4 , 5 ). This initiative aligns with the WHO's ambitious global strategy to reduce malaria incidence and mortality by at least 90% by 2030, and to eliminate the disease in 35 new countries ( 5 ). However, progress has been uneven. While global malaria mortality rates fell by 60% between 2000 and 2015, this advancement has since stalled; the 2022 case rate was 58 per 1000 people at risk, far from the 2030 target of 10 per 1000 ( 5 , 6 ). Sudan's situation reflects this challenging landscape: with an estimated 4.8 million cases and 11,800 deaths in 2021, it is one of Africa’s 11 highest-burden countries, contributing to nearly 70% of the global burden alongside Nigeria, the DRC, and others ( 6 , 7 ). Key vaccine-relevant indicators reveal critical gaps: in 2022, only 47% of Sudanese children under five slept under an insecticide-treated net (ITN), and the percentage of children with fever receiving antimalarial treatment was just 47%, both well below WHO targets and sub-Saharan African regional averages ( 7 , 8 ). The success of vaccination programs hinges on HCWs, who play pivotal roles in advocacy, administration, and community education ( 9 ). Despite significant progress in global malaria control—which saw mortality rates slashed by 60% between 2000 and 2015 and the distribution of over 2 billion insecticide-treated nets (ITNs) since 2015—critical gaps persist ( 5 , 7 ). First, while seasonal malaria chemoprevention (SMC) and vaccines are central to malaria control, emerging drug resistance and logistical barriers in Sudan limit their impact ( 10 , 11 ). Second, HCWs' knowledge and attitudes toward new vaccines remain understudied, particularly in conflict settings where misinformation, training gaps, and systemic challenges may hinder implementation ( 9 ). For instance, in similar contexts, HCWs' skepticism or lack of awareness has reduced public trust in vaccines ( 12 ). In Sudan, where malaria vaccines target over 148,000 children amid ongoing conflict, understanding HCWs' perspectives is essential to optimize delivery and address barriers such as cold-chain management and equitable access ( 4 ). These systemic gaps persist due to a confluence of factors severely exacerbated by the ongoing conflict: chronic underinvestment in health systems, significant funding shortfalls for malaria control, massive population displacement disrupting service delivery, and the destruction of health infrastructure ( 7 , 13 ). Known strategies to address these challenges include the scale-up of core interventions like ITN distribution, effective diagnosis and treatment, and the strategic integration of new tools like vaccines and SMC. Furthermore, strengthening community-based health services and implementing robust surveillance systems are identified as critical for rebuilding and reaching underserved populations in conflict-affected areas ( 5 , 13 ). This study aims to enhance the understanding of Sudanese healthcare workers' knowledge and attitudes regarding malaria vaccination. The insights generated will inform targeted policies and capacity-building efforts, ensuring that vaccination programs are responsive to identified gaps and needs. Materials and Methods Study Design and Setting This is an exploratory cross-sectional study to evaluate the knowledge and attitudes of Sudanese healthcare workers toward malaria vaccines and identify factors influencing these perceptions. The study was conducted from January 16,2025 until April 23, 2025. A total of 255 complete responses were collected. Under time and resource constraints, this number was considered enough for data collection. According to the eligibility criteria, 222 were included in the analysis. The eligibility criteria were as follows: -Graduates of a healthcare profession field with at least one year of healthcare practice following graduation. -Voluntary agreement and written informed consent. Data collection was conducted through a web-based, self-administered questionnaire, designed to ensure anonymity and facilitate wide geographic reach across Sudan. Ethical considerations Ethical approval for this study was obtained from the Ethics Committee of the Research and Publication Office, Dental Alumni and Students Affairs Office, Karary University, approval number 24008. The study complied with the principles outlined in the Declaration of Helsinki. Prior to participating in the study, all participants were provided with detailed information about the study’s objectives and use of the findings; their participation in the study was entirely voluntary, and they had the right to withdraw at any point. They were assured of their anonymity and the confidentiality of their responses. Written Informed consent was obtained from all participants, who agreed to participate in the study, only those who provided consent were able to proceed with the survey. No identifying information was collected, and the data were stored securely and used exclusively for academic research purposes. informed consent was approved by the Ethics Committee of the Research and Publication Office of Karary University. Instrument and data collection Data were collected using a questionnaire developed in English and Arabic and administered through Google Forms. The survey had three parts demographics, knowledge and attitudes. The demographic and knowledge sections were developed from the WHO malaria position paper ( 14 ),while the attitudes were developed from a previous study ( 15 ). The content validity of the questionnaire was established by a panel of healthcare professionals. The first section elicited demographic details of the participants (age, gender, profession, working sector, educational attainment and years of experience), and the second section included 11 questions about awareness, malaria and malaria vaccination. A correct answer was given a score of 1. The scores were summed to obtain a total knowledge score (i.e., range of 0–8). with respect to knowledge scores, a cut-off point of 70% (answering 6 of the 8 questions) represented adequate knowledge about the malaria vaccine ( 16 ). In the third section, attitudes toward the malaria vaccine were measured through vaccine effectiveness, safety, affordability, trust in authorities, risk of adverse reactions, and willingness to recommend. A composite score of 6 items was given via a five-point Likert scale ranging from strongly disagree :1 to strongly agree : 5. The total score of a participant was calculated by summing the scores of 6 items in this section with a maximum score of 30. Higher scores reflected more favourable attitudes. In terms of attitude scores, a cut-off point of 70% (scoring 21 or above out of 30) represented a positive attitude toward malaria vaccination ( 16 ). Data collection tool and procedure The data were analysed using the Statistical Package for the Social Sciences (SPSS) version 24. Descriptive statistics, (including frequencies, percentages, means, and standard deviations), were used to summarize participant characteristics. Bivariate associations between categorical independent variables (age, gender, profession, education, years of experience, working sector, training, and awareness) and knowledge/attitude outcomes were examined using chi-square tests, with odds ratios (ORs) and confidence interval (CI) of 95% where applicable. A p-value of less than 0.05 was considered statistically significant. Results Descriptive statistics: Participant demographics, professional background, and experience: A total of 222 healthcare workers (HCWs) completed the survey. The mean age was 31.5 years. Almost half of the respondents were aged 26–30 years (48.6%, n = 108), followed by 31–40 years (34.2%, n = 76), while those aged 20–25 years accounted for 9% (n = 20) and those aged over 40 years accounted for 8.1% (n = 18). A total of 66.7% (n = 148) of the participants were female, and 33.3% (n = 74) were male. By profession, pharmacists constituted the largest group (44.6%, n = 99), followed by medical doctors (27.0%, n = 60), dentists (14.9%, n = 33), public health workers (5.4%, n = 12), nurses (4.1%, n = 9), and laboratory technicians (4.1%, n = 9). With respect to educational attainment, 68% (n = 151) held a bachelor’s degree, 25.7% (n = 57) held a master’s degree, 5% (n = 11) held a doctorate, and 1.4% (n = 3) held a postgraduate diploma. With respect to work experience, most respondents reported 1–5 years (59.9%, n = 133), 19.8% (n = 44) had 6–10 years and 20.3% (n = 45) had more than 10 years. Employment was nearly evenly distributed between the private sector (51.8%, n = 115) and the governmental sector (48.2%, n = 107). Only 7.7% (n = 17) of HCWs reported receiving any formal training on malaria vaccination. Table 1 Table 1 Demographic characteristics of the participants Variable Frequency Percent % Age (years) 20–25 20 9 26–30 108 48.6 31–40 76 34.2 More than 40 18 8.1 Gender Female 148 66.7 Male 74 33.3 Profession Dentist 33 14.9 Doctor 60 27 Medical lab technician 9 4.1 Nurse 9 4.1 Pharmacist 99 44.6 Public health worker 12 5.4 Education qualification Bachelor’s Degree 151 68 Doctorate Degree 11 5 Master’s Degree 57 25.7 Postgraduate Diploma (e.g., Public Health, Tropical Medicine, etc.) 3 1.4 Years of experience 1 to 5 years 133 59.9 6 to 10 years 44 19.8 More than 10 45 20.3 1 to 5 years 133 59.9 Working sector Governmental sector 94 42.3 Primary health care 13 5.9 Private sector 115 51.8 Have you received training or workshops on malaria vaccination? No 205 92.3 Yes 17 7.7 Awareness and Knowledge of Malaria Vaccination: The knowledge scores ranged from 0 to 8, with a mean of 3.02 (SD = 1.6). Table 2 Only 9% (n = 20) demonstrated adequate knowledge, with scores of 70% and higher, whereas 91% (n = 202) reported inadequate knowledge. Awareness of the malaria vaccine was reported by 66.2% (n = 147) of the participants, and unawareness of the WHO recommendations was high (71.2%, n = 158). Table 2 Nearly all respondents (95%, n = 211) correctly identified the Plasmodium parasite as the cause of malaria. Approximately two-thirds (65.3%, n = 145) knew that Plasmodium falciparum is the most dominant species in Sudan, while the same proportion (65.3%, n = 145) did not know the age group most vulnerable to malaria. Table 2 Fewer than one-quarter (21.2%, n = 47) knew the currently approved malaria vaccines, and more than three- quarters (76.6%, n = 170) were unaware that malaria vaccines are effective against P. falciparum . Approximately one-third (30.6%, n = 68) knew the targeted group for vaccination, and most of the respondents (88.7%, n = 197) were unaware of the recommended number of vaccination doses. With respect to protection, nearly two-thirds (64%, n = 142) incorrectly responded to the statement: “The malaria vaccine provides 100% protection against malaria.” Table 2 Table 2 Knowledge distributions about malaria vaccines. Variables Correct answer frequency Percent % Knowledge questions What is the primary cause of malaria? 211 95 Most dominant plasmodium species in Sudan 145 65.3 Which age group is most vulnerable to malaria in Sudan? 77 34.6 malaria vaccine currently approved by WHO 47 21.1 Malaria vaccines are effective against which of the following? 52 23.4 Which group is the target population for approved malaria vaccines? 68 30.6 How many doses of the malaria vaccine does WHO recommend as part of the standard schedule? 25 11.2 The malaria vaccine provides 100% protection against malaria. 80 36 Knowledge category Adequate knowledge 20 9 Inadequate knowledge 202 91 Knowledge Mean (Standard deviation) - 3.02 (+\- 1.6) Attitudes Towards Malaria Vaccination The attitude scores ranged from 6 to 30, with a mean of 16.59 (SD = 5.56). Most respondents had scores of less than 70% (78.4%, n = 174), whereas only 21.6% (n = 48) displayed positive attitudes. Figure 1 Regarding effectiveness, 44.6% (n = 99) disagreed/strongly disagreed that the vaccine would reduce malaria incidence, whereas 25.7% (n = 57) agreed/strongly agreed. In terms of safety, 23.0% (n = 51) agreed/strongly agreed that the vaccine was as safe as other public health vaccines were, whereas 38.7% (n = 86) disagreed/strongly disagreed. Concerns about severe allergic reactions were noted by 31.7% (n = 70), while 30.0% (n = 67) disagreed/strongly disagreed with this concern. Table 3 In terms of vaccine advocacy, 44.1% (n = 98) reported that they would not recommend the vaccine to family or friends, whereas 26.2% (n = 58) stated that they would. Regarding trust in health authorities, 27.9% (n = 62) agreed/strongly agreed, whereas 42.2% (n = 94) disagreed/strongly disagreed. Perceptions of affordability were mixed, with 32% (n = 71) agreeing/strongly agreeing the vaccine would be affordable in their community, whereas 41.4% (n = 92) disagreed/strongly disagreed. Table 3 Table 3 Distribution of the participants on the attitude scale. Attitude toward malaria vaccine Mean ± Std Strongly disagree No (%) Disagree No (%) Neutral No (%) Agree No (%) Strongly agree No (%) 1. The malaria vaccine will effectively reduce the prevalence of malaria. 2.61 ± 1.373 71 (32.0) 28 (12.6) 66 (29.7) 30 (13.5) 27 (12.2) 2. The malaria vaccine is as safe as other vaccines used in public health campaigns 2.73 ± 1.287 54 (24.3) 32 (14.4) 85 (38.3) 23 (10.4) 28 (12.6) 3. I am worried about severe allergic reactions due to the malaria vaccine 2.97 ± 1.306 45 (20.3) 22 (9.9) 85 (38.3) 35 (15.8) 35 (15.8) 4. I trust the organizations and the health authorities involved in developing the malaria vaccine 2.77 ± 1.394 57 (25.7) 37 (16.7) 66 (29.7) 24 (10.8) 38 (17.1) 5. I would recommend the malaria vaccine to my family and friends. 2.69 ± 1.417 66 (29.7) 32 (14.4) 66 (29.7) 21 (9.5) 37 (16.7) 6. I believe malaria vaccine will be accessible and affordable for people in my community. 2.82 ± 1.383 54 (24.3) 38 (17.1) 59 (26.6) 36 (16.2) 35 (15.8) Total attitude 16.59 ± 5.56 - - - - - Knowledge–Attitude Relationships The chi-square test results revealed that knowledge and attitudes were significantly associated with age (p = 0.023, p = 0.029). The crosstabulation revealed that within the group of participants with inadequate knowledge, the largest proportion were aged 26–30 years (44.1%). The groups aged 20–25 years and > 40 years had the smallest percentages of inadequate knowledge (8.6% and 5.9% respectively). The age group with the highest percentage of negative attitudes was 26–30 years (41.4%). For knowledge, there was no significant association with gender (X²=1.346, p = 0.246; OR = 0.58, 95% CI: 0.229–1.468). However, gender and attitude were significantly associated (X²=4.306, p = 0.038), with greater proportion of females (55%) demonstrating negative attitudes than males 23.4% Receiving formal training, having knowledge about malaria vaccines, and being aware of WHO recommendations about vaccine were significantly associated with participant’s knowledge and attitudes. HCWs who had not received training on malaria vaccination were more than five times more likely to have inadequate knowledge than were those who had received training (OR = 5.278, 95% CI: 1.641–16.975, p = 0.002). Table 4 All participants with adequate knowledge had previous knowledge about the malaria vaccine, however, those who had not heard about the malaria vaccine had inadequate knowledge that was eleven times greater than that of participants who had previously heard about the malaria vaccine (X² = 11.214, p = 0.001). Awareness of WHO recommendations played important role; participant unaware of the WHO recommendations were seven times more likely to have inadequate knowledge (OR = 7.093, 95% CI: 2.588–19.443, p < 0.001) and two times more likely to have negative attitude (OR = 2.11, 95% CI: 1.082–4.112, P = 0.027), in comparison to those who were aware. Table 4 The analysis revealed that several demographics characteristic were not significantly associated with knowledge or attitude toward the malaria vaccine. Knowledge level was not significantly associated with gender (X²= 1.346, p = 0.246; OR = 0.58 95% CI: 0.229–1.46), education level (X²=2.601, p = 0.457), profession (X²=5.757, p = 0.331), years of experience (X²=5.651, p = 0.059), or working sector (X²=0.593, p = 0.744). Similarly, attitude did not significantly differ by education level (X²=3.688, p = 0.297), having received formal training on malaria vaccination (X²=0.659, p = 0.417), or having previous knowledge about the vaccine (X²=0.584, p = 0.445). Table 4 In terms of profession, pharmacists (31.5%) and doctors (23.9%) had the highest levels of negative attitudes. Negative attitudes were more common among HCWs with 1–5 years of experience (50.9%) than among those with 6–10 years (14%) and more than 10 years of experience (13.5%). HCWs in the governmental sector (41%%,) had more negative attitudes than did those in the private sector (37.4%). Table 4 Association between knowledge and attitudes toward the malaria vaccine and participants' demographics and information- related characteristic . variables Knowledge X² (p-value) OR (95% CI) for knowledge Attitude X² (p-value) OR (95% CI) for attitude Age 9.436 (0.024) - 9.044 (0.029) - Gender 1.346 (0.246) 0.580 (0.229–1.468) 4.306 (0.038) 0.504 (0.262–0.969 Profession 5.757 (0.331) - 12.853 (0.025) - Education 2.601 (0.457) - 3.688 (0.297) - Years of experience 5.651 (0.059) - 8.675 (0.013) - Working sector 0.593 (0.744) - 7.604 (0.022) - Received formal training 9.349 (0.002) 5.278 (1.641–16.975) 0.659 (0.417) 1.570(0.525–4.698) Previous knowledge about malaria vaccine 11.214 (0.001) 0.629 (0.565–0.699) 0.584 (0.445) 1.311 (0.654–2.629 Awareness of WHO recommendation 18.159 (< 0.001) 7.093 (2.588–19.443) 4.919 (0.027) 2.110 (1.082–4.116) Knowledge - - 1.361 (0.243) 1.776 (0.670–4.708) Discussion This study evaluated the knowledge and attitudes of Sudanese healthcare workers (HCWs) toward malaria vaccines and explored how these were associated with demographic and professional factors. A total of 222 HCWs completed the survey online. The sample size was smaller than that of Mohammed et al. (2022) ( 17 ), who studied COVID-19 vaccine acceptance among Sudanese HCWs, and Shakurnia et al. (2025) ( 16 ), who assessed HPV vaccine knowledge and attitudes among Iranian providers. However, the sample in this study was larger than that in study of Pinto et al. (2018) ( 18 ) who explored emergency health care providers' knowledge and attitudes in the assessment of child maltreatment in Mozambique. To our knowledge, there are no national or official reports addressing HCWs’ knowledge and attitudes toward malaria vaccines in Sudan. This study therefore provides rare empirical insights into malaria vaccine readiness in the country. Knowledge of Malaria Vaccines In the present study, 66.2% of HCWs reported that they had heard of malaria vaccines. This awareness level is higher than that reported by Nnaji & Ozdal (2023) ( 9 ), who reported that 48.9% of health policy actors in Nigeria were aware of malaria vaccines, and Mwingira et al. (2025) ( 19 ), reported a lower awareness level of 14.7% among caregivers about malaria vaccines in Dar es Salaam, Tanzania. The relatively higher awareness of malaria vaccines in this study may be because of the recent rollout of malaria vaccines in the country. On the other hand, only 9% of HCWs achieved adequate knowledge in this study, with a mean score of 3.02 out of 8. This finding contrasts with the study by Mugasia et al. (2024) ( 20 ) in Kenya, where nurses from 63 facilities providing malaria vaccination demonstrated high levels of knowledge about malaria vaccine protocols. Similarly, Shakurnia et al. (2025) ( 16 ), reported that Iranian healthcare providers scored a mean of 13.41 out of 19 on HPV vaccine knowledge, indicating greater baseline understanding. Our findings suggest that, while Sudanese HCWs are broadly aware of malaria vaccines, detailed knowledge of vaccination types, targeted groups, number of doses, and effectiveness remains limited. Furthermore, improving knowledge gaps is crucial, as HCWs play a central role in patient education, public trust, and vaccine uptake (Dubé et al., 2021) ( 21 ). Attitudes toward Malaria Vaccines Most respondents (78.4%) expressed negative attitudes toward malaria vaccines, with a mean attitude score of 16.59 (SD = 5.56). In this study, only 23.0% agreed or strongly agreed that malaria vaccines were as safe as other public health vaccines were. Similar concerns were reported in Sudan by Mohammed et al. (2022) ( 17 ), who reported that 48% of HCWs worried about the side effects of the COVID-19 vaccine, whereas Yassin et al. (2022) ( 22 ) reported that 29.4% cited inadequate safety information and 23.1% cited side effect concerns as reasons for COVID-19 vaccine refusal. In the present study, 41.4% of respondents did not believe that malaria vaccines would be affordable in their community, and only 27.9% expressed trust (agree/strongly agree) in health authorities. Similar results were reported by Nnaji & Ozdal (2023) ( 9 ), where only half of Nigerian policy actors believed that the malaria vaccine would be easily adopted in Nigeria. Additionally, Mohammed et al. (2022) ( 17 ) reported that 46.4% of Sudanese HCWs believed that the COVID-19 pandemic was exaggerated to benefit pharmaceutical companies. These findings support our findings of low levels of trust in health authorities, which may contribute to scepticism toward the malaria vaccine in Sudan among HCWs. The ability to recommend malaria vaccines is another issue. In this study, 44.1% of HCWs disagreed or strongly disagreed with recommending the vaccine to friends and family. In contrast, Shakurnia et al. (2025)( 16 ) reported that 88.7% of Iranian healthcare providers recommended HPV vaccines to their friends. Shakurnia and colleagues further noted that greater knowledge was one of the strongest predictors of recommendation practices, suggest that the low knowledge levels in our study may explain the reluctance of HCWs to recommend malaria vaccines. Other studies in Sudan and the region reported more favourable attitudes. Yassin et al. (2022) ( 22 ) reported a 63.8% acceptance rate of COVID-19 vaccines among Sudanese HCWs, whereas Mwingira et al. (2025) ( 19 ) reported that 92.8% of Tanzanian caregivers were willing to vaccinate their children under five against malaria. These contrasts indicate that further research into the barriers and misconceptions that reduce Sudanese HCWs’ willingness to recommend malaria vaccination is needed. Relationship between Knowledge and Attitudes This study revealed that attitudes were not significantly related to knowledge, a finding that differs from that of Shakurnia et al. (2025), who reported that adequate knowledge among Iranian providers predicted favourable attitudes. The lack of association in our study suggests that HCW hesitancy in Sudan may be shaped more by trust and institutional reliability than by factual knowledge alone ( 16 ). Awareness, training, and age emerged as significant predictors of knowledge. The lowest proportion of inadequate knowledge was observed among HCWs over 40 years of age (5.9%). Lack of training was also a critical factor: HCWs who had not received malaria vaccine training were more than five times more likely to have inadequate knowledge than those who had training. These results are consistent with those of Mugasia et al. (2024), who reported that older nurses with higher education and training in malaria vaccine administration were more likely to have strong knowledge ( 20 ). Attitudes, on the other hand, were significantly associated with demographic and professional variables. Profession, gender, age, and years of experience influenced attitudes, unlike Mugasia et al. (2024), who reported no such statistical associations in Kenya. In this study, pharmacists and doctors reported greater negative attitudes than other cadres did, a finding supported by Yassin et al.’s (2022) study, where doctors and pharmacists were the least accepting of COVID-19 vaccines. Female HCWs were also more likely to express negative attitudes, a pattern that contrasts with Shakurnia et al. (2025), who reported more positive attitudes toward HPV vaccination among female HCWs in Iran ( 16 , 20 , 22 ). Our study was not without limitations. The use of convenience sampling and online-only distribution limits representativeness and may introduce selection bias. This approach was necessitated by the volatile security situation. The achieved sample size was below the calculated requirement owing to limited responsiveness. Nevertheless, the study provides rare and valuable insights from a conflict-affected setting where empirical data are scarce. Conclusion This study revealed preliminary evidence of knowledge and attitudes toward malaria vaccines among healthcare workers in Sudan. This study revealed critically low levels of knowledge and predominantly negative attitudes toward malaria vaccination among Sudanese HCWs. Although most participants had heard of the vaccine, detailed awareness, including knowledge of WHO recommendations, was limited. Hesitancy appeared to be more strongly linked to concerns over safety, affordability, and institutional trust than to factual knowledge. Importantly, awareness, training, age and familiarity with global recommendations were strongly associated with better knowledge, whereas gender, age, experience and workplace sector influenced attitudes. These findings underscore the urgent need for structured awareness programs by health authorities to increase HCWs’ capacity and confidence. These programmes can include recent WHO recommendations and evidence of malaria vaccine safety and effectiveness. Moreover, more studies are needed to investigate the vaccine acceptance rate and affecting factors. Preparing HCWs through these interventions will be essential for the successful rollout and acceptance of malaria vaccination in Sudan. Declarations Funding No funding was received. Author Contribution Author list:1-Duaa Abdelrahim Aldoud Hamza. 2-Omnia Kamaleldin Bashar Suliman. 3-Abrar Adam Khatir Sam. 4-Azza Omer Osman Abdelrahman. 5-Tasneem Abdelmutalab Alobaid Elemam. 6-Elaf Mohammed Ali Mohammed Fadul.Author contributions:Conceptualisation was carried out by authors 1, 2, 3, and 4. Data curation and formal analysis were performed by author 2. Investigation was conducted by all authors. Methodology was developed by authors 1, 2, 3, and 4. Project administration was managed by author 1. Resources were provided by authors 2 and 6, while supervision was undertaken by author 6. Validation and visualisation were completed by authors 1 and 2. Writing the original draft and reviewing and editing the manuscript were performed by all authors. All authors have read and approved the final version of the manuscript. Acknowledgment No acknowledgment Data Availability All relevant data are available within the manuscript and supporting files. 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Integration of the RTS, S/AS01 malaria vaccine into the Essential Programme on Immunisation in western Kenya: a qualitative longitudinal study from the health system perspective. Lancet Global Health. 2024;12(4):e672–84. https://doi.org/10.1016/S2214-109X . (24)00013-5, Retreived from. https://pubmed.ncbi.nlm.nih.gov/38430916/ . Ajayi MY, Emeto DC. Awareness and acceptability of malaria vaccine among caregivers of under-5 children in Northern Nigeria. Malaria Journal. 2023;22(1):329. https://doi.org/10.1186/s12936-023-04768-z , Retreived from https://pubmed.ncbi.nlm.nih.gov/37907916/ Dubé È, Ward JK, Verger P, MacDonald NE. Vaccine hesitancy, acceptance, and anti-vaccination: trends and future prospects for public health. Annu Rev Public Health. 2021;42(1):175 – 91. https://doi.org/10.1146/annurev-publhealth-090419-102240 , Retreived from https://pubmed.ncbi.nlm.nih.gov/33798403/ World Health Organization. Malaria vaccine: WHO position paper –. May 2024. 2024, https://doi.org/, Retreived from https://www.who.int/publications/i/item/who-wer-9919-225-248 Mukhtar AF, Abdul Kadir A, Mohd Noor N, Mohammad AH. Knowledge and attitude on childhood vaccination among healthcare workers in hospital universiti Sains Malaysia. Vaccines. 2022;10(7):1017. https://doi.org/10.3390/vaccines10071017 , Retreived from https://pubmed.ncbi.nlm.nih.gov/35891181/ Shakurnia A, Salehpoor F, Ghafourian M, Nashibi R. Knowledge and attitudes toward HPV, cervical cancer and HPV vaccine among healthcare providers in Ahvaz, Southwest Iran. Infect Agents Cancer. 2025;20(1):44. https://doi.org/10.1186/s13027-025 . -00669-9, Retreived from. https://infectagentscancer.biomedcentral.com/articles/10.1186/s13027-025-00669-9 . Mohmmed HA, Alawad RA, Awad AK, Alobied AA. Knowledge, attitude, and acceptance regarding COVID-19 vaccines in Sudan. Frontiers in Public Health. 2022;10:954810, https://doi.org/, Retreived from. Pinto L, Lein A, Mahoque R, Wright DW, Sasser SM, Staton CA. A cross-sectional exploratory study of knowledge, attitudes, and practices of emergency health care providers in the assessment of child maltreatment in Maputo, Mozambique. BMC emergency medicine. 2018;18(1):11, https://doi.org/, Retreived from. Mwingira F, Matiya D, Chacky F. Knowledge and willingness towards malaria vaccines among caregivers in Dar es Salaam, Tanzania. Malar J. 2025;24(1):35. https://doi.org/10.1186/s12936-024 . -05183-8, Retreived from. https://malariajournal.biomedcentral.com/articles/10.1186/s12936-024-05183-8 . Mugasia TC, Were FN, Mutai B. Nurses’ Characteristics Associated with Good Knowledge, Attitude, and Practices (KAP) of the Malaria Vaccine in Bungoma County, Kenya. Journal of medicine, nursing & public health. 2024;7(2):104, https://doi.org/, Retreived from. Dubé È, Ward JK, Verger P, MacDonald NE. Vaccine hesitancy, acceptance, and anti-vaccination: trends and future prospects for public health. Annual review of public health. 2021;42(1):175 – 91. https://doi.org/ , Retreived from. Yassin EOM, Faroug HAA, Ishaq ZBY, Mustafa MMA, Idris MMA, Widatallah SEK, et al. COVID-19 vaccination acceptance among healthcare staff in Sudan, 2021. J Immunol Res. 2022;2022(1):3392667. https://doi.org/10.1155. https://pubmed.ncbi.nlm.nih.gov/35155687/ . /2022/3392667, Retreived from. Additional Declarations No competing interests reported. Supplementary Files additionalfile.odt Cite Share Download PDF Status: Published Journal Publication published 20 Dec, 2025 Read the published version in Malaria Journal → Version 1 posted Editorial decision: Revision requested 05 Nov, 2025 Reviews received at journal 18 Oct, 2025 Reviewers agreed at journal 05 Oct, 2025 Reviewers invited by journal 29 Sep, 2025 Editor assigned by journal 16 Sep, 2025 Submission checks completed at journal 16 Sep, 2025 First submitted to journal 13 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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02:13:17","extension":"html","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":101485,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7606195/v1/8a1f2465e933896d0875e784.html"},{"id":93541184,"identity":"5b389a00-ca47-4ff6-994b-abec0bcde076","added_by":"auto","created_at":"2025-10-15 02:29:16","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":72649,"visible":true,"origin":"","legend":"\u003cp\u003eAttitude distributions.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7606195/v1/c4efcafa603e8902a8512b5d.jpg"},{"id":98814832,"identity":"6ee896ef-454f-41bb-9259-d8a91916cac9","added_by":"auto","created_at":"2025-12-22 16:12:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1169945,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7606195/v1/c537b76b-ee33-4928-8ea0-e38d7fcd63a1.pdf"},{"id":93539004,"identity":"35f178f4-3661-4832-91bd-d773ed4a77e3","added_by":"auto","created_at":"2025-10-15 02:13:16","extension":"odt","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":37507,"visible":true,"origin":"","legend":"","description":"","filename":"additionalfile.odt","url":"https://assets-eu.researchsquare.com/files/rs-7606195/v1/bc35d8692aa0c28926297467.odt"}],"financialInterests":"No competing interests reported.","formattedTitle":"Preliminary Insights into Knowledge and Attitudes Toward Malaria Vaccination among Sudanese Healthcare Workers: An Exploratory Cross-Sectional Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMalaria remains a critical global health challenge, with 249\u0026nbsp;million cases and 608,000 deaths reported in 2022, disproportionately affecting children under five years of age (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In Sudan, malaria transmission peaks seasonally from June to November, compounded by conflict-driven displacement and a fragmented healthcare infrastructure (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Recently, Sudan has started using new malaria vaccines like RTS,S/AS01 and R21/Matrix-M, making it one of the first African countries to do so (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). This initiative aligns with the WHO's ambitious global strategy to reduce malaria incidence and mortality by at least 90% by 2030, and to eliminate the disease in 35 new countries (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). However, progress has been uneven. While global malaria mortality rates fell by 60% between 2000 and 2015, this advancement has since stalled; the 2022 case rate was 58 per 1000 people at risk, far from the 2030 target of 10 per 1000 (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Sudan's situation reflects this challenging landscape: with an estimated 4.8\u0026nbsp;million cases and 11,800 deaths in 2021, it is one of Africa\u0026rsquo;s 11 highest-burden countries, contributing to nearly 70% of the global burden alongside Nigeria, the DRC, and others (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Key vaccine-relevant indicators reveal critical gaps: in 2022, only 47% of Sudanese children under five slept under an insecticide-treated net (ITN), and the percentage of children with fever receiving antimalarial treatment was just 47%, both well below WHO targets and sub-Saharan African regional averages (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). The success of vaccination programs hinges on HCWs, who play pivotal roles in advocacy, administration, and community education (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Despite significant progress in global malaria control\u0026mdash;which saw mortality rates slashed by 60% between 2000 and 2015 and the distribution of over 2\u0026nbsp;billion insecticide-treated nets (ITNs) since 2015\u0026mdash;critical gaps persist (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). First, while seasonal malaria chemoprevention (SMC) and vaccines are central to malaria control, emerging drug resistance and logistical barriers in Sudan limit their impact (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Second, HCWs' knowledge and attitudes toward new vaccines remain understudied, particularly in conflict settings where misinformation, training gaps, and systemic challenges may hinder implementation (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). For instance, in similar contexts, HCWs' skepticism or lack of awareness has reduced public trust in vaccines (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). In Sudan, where malaria vaccines target over 148,000 children amid ongoing conflict, understanding HCWs' perspectives is essential to optimize delivery and address barriers such as cold-chain management and equitable access (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). These systemic gaps persist due to a confluence of factors severely exacerbated by the ongoing conflict: chronic underinvestment in health systems, significant funding shortfalls for malaria control, massive population displacement disrupting service delivery, and the destruction of health infrastructure (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Known strategies to address these challenges include the scale-up of core interventions like ITN distribution, effective diagnosis and treatment, and the strategic integration of new tools like vaccines and SMC. Furthermore, strengthening community-based health services and implementing robust surveillance systems are identified as critical for rebuilding and reaching underserved populations in conflict-affected areas (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis study aims to enhance the understanding of Sudanese healthcare workers' knowledge and attitudes regarding malaria vaccination. The insights generated will inform targeted policies and capacity-building efforts, ensuring that vaccination programs are responsive to identified gaps and needs.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design and Setting\u003c/h2\u003e\u003cp\u003eThis is an exploratory cross-sectional study to evaluate the knowledge and attitudes of Sudanese healthcare workers toward malaria vaccines and identify factors influencing these perceptions. The study was conducted from January 16,2025 until April 23, 2025. A total of 255 complete responses were collected. Under time and resource constraints, this number was considered enough for data collection. According to the eligibility criteria, 222 were included in the analysis. The eligibility criteria were as follows:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e-Graduates of a healthcare profession field with at least one year of healthcare practice following graduation.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e-Voluntary agreement and written informed consent.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eData collection was conducted through a web-based, self-administered questionnaire, designed to ensure anonymity and facilitate wide geographic reach across Sudan.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEthical considerations\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003cp\u003efor this study was obtained from the Ethics Committee of the Research and Publication Office, Dental Alumni and Students Affairs Office, Karary University, approval number 24008. The study complied with the principles outlined in the Declaration of Helsinki. Prior to participating in the study, all participants were provided with detailed information about the study\u0026rsquo;s objectives and use of the findings; their participation in the study was entirely voluntary, and they had the right to withdraw at any point. They were assured of their anonymity and the confidentiality of their responses. Written Informed consent was obtained from all participants, who agreed to participate in the study, only those who provided consent were able to proceed with the survey. No identifying information was collected, and the data were stored securely and used exclusively for academic research purposes. informed consent was approved by the Ethics Committee of the Research and Publication Office of Karary University.\u003c/p\u003e\u003c/p\u003e\n\u003ch3\u003eInstrument and data collection\u003c/h3\u003e\n\u003cp\u003eData were collected using a questionnaire developed in English and Arabic and administered through Google Forms.\u003c/p\u003e\u003cp\u003eThe survey had three parts demographics, knowledge and attitudes. The demographic and knowledge sections were developed from the WHO malaria position paper (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e),while the attitudes were developed from a previous study (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). The content validity of the questionnaire was established by a panel of healthcare professionals. The first section elicited demographic details of the participants (age, gender, profession, working sector, educational attainment and years of experience), and the second section included 11 questions about awareness, malaria and malaria vaccination. A correct answer was given a score of 1. The scores were summed to obtain a total knowledge score (i.e., range of 0\u0026ndash;8). with respect to knowledge scores, a cut-off point of 70% (answering 6 of the 8 questions) represented adequate knowledge about the malaria vaccine (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). In the third section, attitudes toward the malaria vaccine were measured through vaccine effectiveness, safety, affordability, trust in authorities, risk of adverse reactions, and willingness to recommend. A composite score of 6 items was given via a five-point Likert scale ranging from \u003cem\u003estrongly disagree\u003c/em\u003e:1 to \u003cem\u003estrongly agree\u003c/em\u003e: 5. The total score of a participant was calculated by summing the scores of 6 items in this section with a maximum score of 30. Higher scores reflected more favourable attitudes. In terms of attitude scores, a cut-off point of 70% (scoring 21 or above out of 30) represented a positive attitude toward malaria vaccination (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eData collection tool and procedure\u003c/h3\u003e\n\u003cp\u003eThe data were analysed using the Statistical Package for the Social Sciences (SPSS) version 24. Descriptive statistics, (including frequencies, percentages, means, and standard deviations), were used to summarize participant characteristics. Bivariate associations between categorical independent variables (age, gender, profession, education, years of experience, working sector, training, and awareness) and knowledge/attitude outcomes were examined using chi-square tests, with odds ratios (ORs) and confidence interval (CI) of 95% where applicable. A p-value of less than 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eDescriptive statistics: Participant demographics, professional background, and experience:\u003c/p\u003e\u003cp\u003eA total of 222 healthcare workers (HCWs) completed the survey. The mean age was 31.5 years. Almost half of the respondents were aged 26\u0026ndash;30 years (48.6%, n\u0026thinsp;=\u0026thinsp;108), followed by 31\u0026ndash;40 years (34.2%, n\u0026thinsp;=\u0026thinsp;76), while those aged 20\u0026ndash;25 years accounted for 9% (n\u0026thinsp;=\u0026thinsp;20) and those aged over 40 years accounted for 8.1% (n\u0026thinsp;=\u0026thinsp;18). A total of 66.7% (n\u0026thinsp;=\u0026thinsp;148) of the participants were female, and 33.3% (n\u0026thinsp;=\u0026thinsp;74) were male.\u003c/p\u003e\u003cp\u003eBy profession, pharmacists constituted the largest group (44.6%, n\u0026thinsp;=\u0026thinsp;99), followed by medical doctors (27.0%, n\u0026thinsp;=\u0026thinsp;60), dentists (14.9%, n\u0026thinsp;=\u0026thinsp;33), public health workers (5.4%, n\u0026thinsp;=\u0026thinsp;12), nurses (4.1%, n\u0026thinsp;=\u0026thinsp;9), and laboratory technicians (4.1%, n\u0026thinsp;=\u0026thinsp;9).\u003c/p\u003e\u003cp\u003eWith respect to educational attainment, 68% (n\u0026thinsp;=\u0026thinsp;151) held a bachelor\u0026rsquo;s degree, 25.7% (n\u0026thinsp;=\u0026thinsp;57) held a master\u0026rsquo;s degree, 5% (n\u0026thinsp;=\u0026thinsp;11) held a doctorate, and 1.4% (n\u0026thinsp;=\u0026thinsp;3) held a postgraduate diploma. With respect to work experience, most respondents reported 1\u0026ndash;5 years (59.9%, n\u0026thinsp;=\u0026thinsp;133), 19.8% (n\u0026thinsp;=\u0026thinsp;44) had 6\u0026ndash;10 years and 20.3% (n\u0026thinsp;=\u0026thinsp;45) had more than 10 years. Employment was nearly evenly distributed between the private sector (51.8%, n\u0026thinsp;=\u0026thinsp;115) and the governmental sector (48.2%, n\u0026thinsp;=\u0026thinsp;107). Only 7.7% (n\u0026thinsp;=\u0026thinsp;17) of HCWs reported receiving any formal training on malaria vaccination. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic characteristics of the participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercent %\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20\u0026ndash;25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26\u0026ndash;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e108\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e48.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31\u0026ndash;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMore than 40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e148\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e66.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProfession\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDentist\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDoctor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMedical lab technician\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePharmacist\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePublic health worker\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducation qualification\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBachelor\u0026rsquo;s Degree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e151\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e68\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDoctorate Degree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMaster\u0026rsquo;s Degree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePostgraduate Diploma (e.g., Public Health, Tropical Medicine, etc.)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYears of experience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 to 5 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e133\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e59.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 to 10 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMore than 10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 to 5 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e133\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e59.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWorking sector\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGovernmental sector\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e42.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrimary health care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrivate sector\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e115\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e51.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHave you received training or workshops on malaria vaccination?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e205\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e92.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eAwareness and Knowledge of Malaria Vaccination:\u003c/h2\u003e\u003cp\u003eThe knowledge scores ranged from 0 to 8, with a mean of 3.02 (SD\u0026thinsp;=\u0026thinsp;1.6). Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003c/p\u003e\u003cp\u003eOnly 9% (n\u0026thinsp;=\u0026thinsp;20) demonstrated adequate knowledge, with scores of 70% and higher, whereas 91% (n\u0026thinsp;=\u0026thinsp;202) reported inadequate knowledge. Awareness of the malaria vaccine was reported by 66.2% (n\u0026thinsp;=\u0026thinsp;147) of the participants, and unawareness of the WHO recommendations was high (71.2%, n\u0026thinsp;=\u0026thinsp;158). Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e Nearly all respondents (95%, n\u0026thinsp;=\u0026thinsp;211) correctly identified the \u003cem\u003ePlasmodium\u003c/em\u003e parasite as the cause of malaria. Approximately two-thirds (65.3%, n\u0026thinsp;=\u0026thinsp;145) knew that \u003cem\u003ePlasmodium falciparum\u003c/em\u003e is the most dominant species in Sudan, while the same proportion (65.3%, n\u0026thinsp;=\u0026thinsp;145) did not know the age group most vulnerable to malaria. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003c/p\u003e\u003cp\u003eFewer than one-quarter (21.2%, n\u0026thinsp;=\u0026thinsp;47) knew the currently approved malaria vaccines, and more than three- quarters (76.6%, n\u0026thinsp;=\u0026thinsp;170) were unaware that malaria vaccines are effective against \u003cem\u003eP. falciparum\u003c/em\u003e. Approximately one-third (30.6%, n\u0026thinsp;=\u0026thinsp;68) knew the targeted group for vaccination, and most of the respondents (88.7%, n\u0026thinsp;=\u0026thinsp;197) were unaware of the recommended number of vaccination doses. With respect to protection, nearly two-thirds (64%, n\u0026thinsp;=\u0026thinsp;142) incorrectly responded to the statement: \u003cem\u003e\u0026ldquo;The malaria vaccine provides 100% protection against malaria.\u0026rdquo;\u003c/em\u003e Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eKnowledge distributions about malaria vaccines.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCorrect answer frequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercent %\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eKnowledge questions\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWhat is the primary cause of malaria?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e211\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMost dominant plasmodium species in Sudan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e145\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e65.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWhich age group is most vulnerable to malaria in Sudan?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003emalaria vaccine currently approved by WHO\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMalaria vaccines are effective against which of the following?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWhich group is the target population for approved malaria vaccines?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHow many doses of the malaria vaccine does WHO recommend as part of the standard schedule?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThe malaria vaccine provides 100% protection against malaria.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eKnowledge category\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAdequate knowledge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInadequate knowledge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e202\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e91\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eKnowledge Mean (Standard deviation)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.02 (+\\- 1.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eAttitudes Towards Malaria Vaccination\u003c/h3\u003e\n\u003cp\u003eThe attitude scores ranged from 6 to 30, with a mean of 16.59 (SD\u0026thinsp;=\u0026thinsp;5.56). Most respondents had scores of less than 70% (78.4%, n\u0026thinsp;=\u0026thinsp;174), whereas only 21.6% (n\u0026thinsp;=\u0026thinsp;48) displayed positive attitudes. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003c/p\u003e\u003cp\u003eRegarding effectiveness, 44.6% (n\u0026thinsp;=\u0026thinsp;99) disagreed/strongly disagreed that the vaccine would reduce malaria incidence, whereas 25.7% (n\u0026thinsp;=\u0026thinsp;57) agreed/strongly agreed. In terms of safety, 23.0% (n\u0026thinsp;=\u0026thinsp;51) agreed/strongly agreed that the vaccine was as safe as other public health vaccines were, whereas 38.7% (n\u0026thinsp;=\u0026thinsp;86) disagreed/strongly disagreed. Concerns about severe allergic reactions were noted by 31.7% (n\u0026thinsp;=\u0026thinsp;70), while 30.0% (n\u0026thinsp;=\u0026thinsp;67) disagreed/strongly disagreed with this concern. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003c/p\u003e\u003cp\u003eIn terms of vaccine advocacy, 44.1% (n\u0026thinsp;=\u0026thinsp;98) reported that they would not recommend the vaccine to family or friends, whereas 26.2% (n\u0026thinsp;=\u0026thinsp;58) stated that they would. Regarding trust in health authorities, 27.9% (n\u0026thinsp;=\u0026thinsp;62) agreed/strongly agreed, whereas 42.2% (n\u0026thinsp;=\u0026thinsp;94) disagreed/strongly disagreed. Perceptions of affordability were mixed, with 32% (n\u0026thinsp;=\u0026thinsp;71) agreeing/strongly agreeing the vaccine would be affordable in their community, whereas 41.4% (n\u0026thinsp;=\u0026thinsp;92) disagreed/strongly disagreed. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDistribution of the participants on the attitude scale.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAttitude toward malaria vaccine\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;Std\u003ca class=\"FNLink\" href=\"#Fn1\" id=\"#FNLinkFn1\"\u003e\u003c/a\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStrongly disagree No (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDisagree No (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNeutral No (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eAgree No (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eStrongly agree No (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1. The malaria vaccine will effectively reduce the prevalence of malaria.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e2.61\u0026thinsp;\u0026plusmn;\u0026thinsp;1.373\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e71 (32.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28 (12.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e66 (29.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e30 (13.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e27 (12.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2. The malaria vaccine is as safe as other vaccines used in public health campaigns\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e2.73\u0026thinsp;\u0026plusmn;\u0026thinsp;1.287\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e54 (24.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32 (14.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e85 (38.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e23 (10.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e28 (12.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3. I am worried about severe allergic reactions due to the malaria vaccine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e2.97\u0026thinsp;\u0026plusmn;\u0026thinsp;1.306\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45 (20.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22 (9.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e85 (38.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e35 (15.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e35 (15.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4. I trust the organizations and the health authorities involved in developing the malaria vaccine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e2.77\u0026thinsp;\u0026plusmn;\u0026thinsp;1.394\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e57 (25.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37 (16.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e66 (29.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e24 (10.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e38 (17.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5. I would recommend the malaria vaccine to my family and friends.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e2.69\u0026thinsp;\u0026plusmn;\u0026thinsp;1.417\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66 (29.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32 (14.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e66 (29.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e21 (9.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e37 (16.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6. I believe malaria vaccine will be accessible and affordable for people in my community.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e2.82\u0026thinsp;\u0026plusmn;\u0026thinsp;1.383\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e54 (24.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38 (17.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e59 (26.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e36 (16.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e35 (15.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal attitude\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e16.59\u0026thinsp;\u0026plusmn;\u0026thinsp;5.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eKnowledge–Attitude Relationships\u003c/h3\u003e\n\u003cp\u003eThe chi-square test results revealed that knowledge and attitudes were significantly associated with age (p\u0026thinsp;=\u0026thinsp;0.023, p\u0026thinsp;=\u0026thinsp;0.029). The crosstabulation revealed that within the group of participants with inadequate knowledge, the largest proportion were aged 26\u0026ndash;30 years (44.1%). The groups aged 20\u0026ndash;25 years and \u0026gt;\u0026thinsp;40 years had the smallest percentages of inadequate knowledge (8.6% and 5.9% respectively). The age group with the highest percentage of negative attitudes was 26\u0026ndash;30 years (41.4%).\u003c/p\u003e\u003cp\u003eFor knowledge, there was no significant association with gender (X\u0026sup2;=1.346, p\u0026thinsp;=\u0026thinsp;0.246; OR\u0026thinsp;=\u0026thinsp;0.58, 95% CI: 0.229\u0026ndash;1.468). However, gender and attitude were significantly associated (X\u0026sup2;=4.306, p\u0026thinsp;=\u0026thinsp;0.038), with greater proportion of females (55%) demonstrating negative attitudes than males 23.4%\u003c/p\u003e\u003cp\u003eReceiving formal training, having knowledge about malaria vaccines, and being aware of WHO recommendations about vaccine were significantly associated with participant\u0026rsquo;s knowledge and attitudes. HCWs who had not received training on malaria vaccination were more than five times more likely to have inadequate knowledge than were those who had received training (OR\u0026thinsp;=\u0026thinsp;5.278, 95% CI: 1.641\u0026ndash;16.975, p\u0026thinsp;=\u0026thinsp;0.002). Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003c/p\u003e\u003cp\u003eAll participants with adequate knowledge had previous knowledge about the malaria vaccine, however, those who had not heard about the malaria vaccine had inadequate knowledge that was eleven times greater than that of participants who had previously heard about the malaria vaccine (X\u0026sup2; = 11.214, p\u0026thinsp;=\u0026thinsp;0.001). Awareness of WHO recommendations played important role; participant unaware of the WHO recommendations were seven times more likely to have inadequate knowledge (OR\u0026thinsp;=\u0026thinsp;7.093, 95% CI: 2.588\u0026ndash;19.443, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and two times more likely to have negative attitude (OR\u0026thinsp;=\u0026thinsp;2.11, 95% CI: 1.082\u0026ndash;4.112, P\u0026thinsp;=\u0026thinsp;0.027), in comparison to those who were aware. Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003c/p\u003e\u003cp\u003eThe analysis revealed that several demographics characteristic were not significantly associated with knowledge or attitude toward the malaria vaccine. Knowledge level was not significantly associated with gender (X\u0026sup2;= 1.346, p\u0026thinsp;=\u0026thinsp;0.246; OR\u0026thinsp;=\u0026thinsp;0.58 95% CI: 0.229\u0026ndash;1.46), education level (X\u0026sup2;=2.601, p\u0026thinsp;=\u0026thinsp;0.457), profession (X\u0026sup2;=5.757, p\u0026thinsp;=\u0026thinsp;0.331), years of experience (X\u0026sup2;=5.651, p\u0026thinsp;=\u0026thinsp;0.059), or working sector (X\u0026sup2;=0.593, p\u0026thinsp;=\u0026thinsp;0.744). Similarly, attitude did not significantly differ by education level (X\u0026sup2;=3.688, p\u0026thinsp;=\u0026thinsp;0.297), having received formal training on malaria vaccination (X\u0026sup2;=0.659, p\u0026thinsp;=\u0026thinsp;0.417), or having previous knowledge about the vaccine (X\u0026sup2;=0.584, p\u0026thinsp;=\u0026thinsp;0.445). Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003c/p\u003e\u003cp\u003eIn terms of profession, pharmacists (31.5%) and doctors (23.9%) had the highest levels of negative attitudes.\u003c/p\u003e\u003cp\u003eNegative attitudes were more common among HCWs with 1\u0026ndash;5 years of experience (50.9%) than among those with 6\u0026ndash;10 years (14%) and more than 10 years of experience (13.5%).\u003c/p\u003e\u003cp\u003eHCWs in the governmental sector (41%%,) had more negative attitudes than did those in the private sector (37.4%).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cb\u003eAssociation between knowledge and attitudes toward the malaria vaccine and participants' demographics and information- related characteristic\u003c/b\u003e.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003evariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eKnowledge X\u0026sup2;\u003ca class=\"FNLink\" href=\"#Fn2\" id=\"#FNLinkFn2\"\u003e\u003c/a\u003e (p-value)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOR (95% CI) for knowledge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAttitude X\u0026sup2; (p-value)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eOR (95% CI) for attitude\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9.436 (0.024)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9.044 (0.029)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.346 (0.246)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.580 (0.229\u0026ndash;1.468)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.306 (0.038)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.504 (0.262\u0026ndash;0.969\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eProfession\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.757 (0.331)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e12.853 (0.025)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.601 (0.457)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.688 (0.297)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eYears of experience\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.651 (0.059)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8.675 (0.013)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWorking sector\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.593 (0.744)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7.604 (0.022)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReceived formal training\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9.349 (0.002)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.278 (1.641\u0026ndash;16.975)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.659 (0.417)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.570(0.525\u0026ndash;4.698)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePrevious knowledge about malaria vaccine\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11.214 (0.001)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.629 (0.565\u0026ndash;0.699)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.584 (0.445)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.311 (0.654\u0026ndash;2.629\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAwareness of WHO recommendation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18.159 (\u0026lt;\u0026thinsp;0.001)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.093 (2.588\u0026ndash;19.443)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.919 (0.027)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.110 (1.082\u0026ndash;4.116)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eKnowledge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.361 (0.243)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.776 (0.670\u0026ndash;4.708)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study evaluated the knowledge and attitudes of Sudanese healthcare workers (HCWs) toward malaria vaccines and explored how these were associated with demographic and professional factors. A total of 222 HCWs completed the survey online. The sample size was smaller than that of Mohammed et al. (2022) (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), who studied COVID-19 vaccine acceptance among Sudanese HCWs, and Shakurnia et al. (2025) (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), who assessed HPV vaccine knowledge and attitudes among Iranian providers. However, the sample in this study was larger than that in study of Pinto et al. (2018) (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) who explored emergency health care providers' knowledge and attitudes in the assessment of child maltreatment in Mozambique. To our knowledge, there are no national or official reports addressing HCWs\u0026rsquo; knowledge and attitudes toward malaria vaccines in Sudan. This study therefore provides rare empirical insights into malaria vaccine readiness in the country.\u003c/p\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eKnowledge of Malaria Vaccines\u003c/h2\u003e\u003cp\u003eIn the present study, 66.2% of HCWs reported that they had heard of malaria vaccines. This awareness level is higher than that reported by Nnaji \u0026amp; Ozdal (2023) (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), who reported that 48.9% of health policy actors in Nigeria were aware of malaria vaccines, and Mwingira et al. (2025) (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), reported a lower awareness level of 14.7% among caregivers about malaria vaccines in Dar es Salaam, Tanzania. The relatively higher awareness of malaria vaccines in this study may be because of the recent rollout of malaria vaccines in the country.\u003c/p\u003e\u003cp\u003eOn the other hand, only 9% of HCWs achieved adequate knowledge in this study, with a mean score of 3.02 out of 8. This finding contrasts with the study by Mugasia et al. (2024) (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) in Kenya, where nurses from 63 facilities providing malaria vaccination demonstrated high levels of knowledge about malaria vaccine protocols. Similarly, Shakurnia et al. (2025) (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), reported that Iranian healthcare providers scored a mean of 13.41 out of 19 on HPV vaccine knowledge, indicating greater baseline understanding. Our findings suggest that, while Sudanese HCWs are broadly aware of malaria vaccines, detailed knowledge of vaccination types, targeted groups, number of doses, and effectiveness remains limited. Furthermore, improving knowledge gaps is crucial, as HCWs play a central role in patient education, public trust, and vaccine uptake (Dub\u0026eacute; et al., 2021) (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eAttitudes toward Malaria Vaccines\u003c/h2\u003e\u003cp\u003eMost respondents (78.4%) expressed negative attitudes toward malaria vaccines, with a mean attitude score of 16.59 (SD\u0026thinsp;=\u0026thinsp;5.56). In this study, only 23.0% agreed or strongly agreed that malaria vaccines were as safe as other public health vaccines were. Similar concerns were reported in Sudan by Mohammed et al. (2022) (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), who reported that 48% of HCWs worried about the side effects of the COVID-19 vaccine, whereas Yassin et al. (2022) (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) reported that 29.4% cited inadequate safety information and 23.1% cited side effect concerns as reasons for COVID-19 vaccine refusal.\u003c/p\u003e\u003cp\u003eIn the present study, 41.4% of respondents did not believe that malaria vaccines would be affordable in their community, and only 27.9% expressed trust (agree/strongly agree) in health authorities. Similar results were reported by Nnaji \u0026amp; Ozdal (2023) (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), where only half of Nigerian policy actors believed that the malaria vaccine would be easily adopted in Nigeria. Additionally, Mohammed et al. (2022) (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) reported that 46.4% of Sudanese HCWs believed that the COVID-19 pandemic was exaggerated to benefit pharmaceutical companies. These findings support our findings of low levels of trust in health authorities, which may contribute to scepticism toward the malaria vaccine in Sudan among HCWs.\u003c/p\u003e\u003cp\u003eThe ability to recommend malaria vaccines is another issue. In this study, 44.1% of HCWs disagreed or strongly disagreed with recommending the vaccine to friends and family. In contrast, Shakurnia et al. (2025)(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) reported that 88.7% of Iranian healthcare providers recommended HPV vaccines to their friends. Shakurnia and colleagues further noted that greater knowledge was one of the strongest predictors of recommendation practices, suggest that the low knowledge levels in our study may explain the reluctance of HCWs to recommend malaria vaccines.\u003c/p\u003e\u003cp\u003eOther studies in Sudan and the region reported more favourable attitudes. Yassin et al. (2022) (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) reported a 63.8% acceptance rate of COVID-19 vaccines among Sudanese HCWs, whereas Mwingira et al. (2025) (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) reported that 92.8% of Tanzanian caregivers were willing to vaccinate their children under five against malaria. These contrasts indicate that further research into the barriers and misconceptions that reduce Sudanese HCWs\u0026rsquo; willingness to recommend malaria vaccination is needed.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eRelationship between Knowledge and Attitudes\u003c/h2\u003e\u003cp\u003eThis study revealed that attitudes were not significantly related to knowledge, a finding that differs from that of Shakurnia et al. (2025), who reported that adequate knowledge among Iranian providers predicted favourable attitudes. The lack of association in our study suggests that HCW hesitancy in Sudan may be shaped more by trust and institutional reliability than by factual knowledge alone (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAwareness, training, and age emerged as significant predictors of knowledge. The lowest proportion of inadequate knowledge was observed among HCWs over 40 years of age (5.9%). Lack of training was also a critical factor: HCWs who had not received malaria vaccine training were more than five times more likely to have inadequate knowledge than those who had training. These results are consistent with those of Mugasia et al. (2024), who reported that older nurses with higher education and training in malaria vaccine administration were more likely to have strong knowledge (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAttitudes, on the other hand, were significantly associated with demographic and professional variables. Profession, gender, age, and years of experience influenced attitudes, unlike Mugasia et al. (2024), who reported no such statistical associations in Kenya. In this study, pharmacists and doctors reported greater negative attitudes than other cadres did, a finding supported by Yassin et al.\u0026rsquo;s (2022) study, where doctors and pharmacists were the least accepting of COVID-19 vaccines. Female HCWs were also more likely to express negative attitudes, a pattern that contrasts with Shakurnia et al. (2025), who reported more positive attitudes toward HPV vaccination among female HCWs in Iran (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOur study was not without limitations. The use of convenience sampling and online-only distribution limits representativeness and may introduce selection bias. This approach was necessitated by the volatile security situation. The achieved sample size was below the calculated requirement owing to limited responsiveness. Nevertheless, the study provides rare and valuable insights from a conflict-affected setting where empirical data are scarce.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study revealed preliminary evidence of knowledge and attitudes toward malaria vaccines among healthcare workers in Sudan. This study revealed critically low levels of knowledge and predominantly negative attitudes toward malaria vaccination among Sudanese HCWs. Although most participants had heard of the vaccine, detailed awareness, including knowledge of WHO recommendations, was limited. Hesitancy appeared to be more strongly linked to concerns over safety, affordability, and institutional trust than to factual knowledge. Importantly, awareness, training, age and familiarity with global recommendations were strongly associated with better knowledge, whereas gender, age, experience and workplace sector influenced attitudes.\u003c/p\u003e\u003cp\u003eThese findings underscore the urgent need for structured awareness programs by health authorities to increase HCWs\u0026rsquo; capacity and confidence. These programmes can include recent WHO recommendations and evidence of malaria vaccine safety and effectiveness. Moreover, more studies are needed to investigate the vaccine acceptance rate and affecting factors. Preparing HCWs through these interventions will be essential for the successful rollout and acceptance of malaria vaccination in Sudan.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eNo funding was received.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAuthor list:1-Duaa Abdelrahim Aldoud Hamza. 2-Omnia Kamaleldin Bashar Suliman. 3-Abrar Adam Khatir Sam. 4-Azza Omer Osman Abdelrahman. 5-Tasneem Abdelmutalab Alobaid Elemam. 6-Elaf Mohammed Ali Mohammed Fadul.Author contributions:Conceptualisation was carried out by authors 1, 2, 3, and 4. Data curation and formal analysis were performed by author 2. Investigation was conducted by all authors. Methodology was developed by authors 1, 2, 3, and 4. Project administration was managed by author 1. Resources were provided by authors 2 and 6, while supervision was undertaken by author 6. Validation and visualisation were completed by authors 1 and 2. Writing the original draft and reviewing and editing the manuscript were performed by all authors. All authors have read and approved the final version of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgment\u003c/h2\u003e\u003cp\u003eNo acknowledgment\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eAll relevant data are available within the manuscript and supporting files.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. Fact sheet about malaria 2022, December 8. 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J Immunol Res. 2022;2022(1):3392667. https://doi.org/10.1155. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/35155687/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/35155687/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. /2022/3392667, Retreived from.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"malaria-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"malj","sideBox":"Learn more about [Malaria Journal](http://malariajournal.biomedcentral.com/)","snPcode":"12936","submissionUrl":"https://submission.nature.com/new-submission/12936/3","title":"Malaria Journal","twitterHandle":"@malariajournal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"malaria vaccine, healthcare workers, Sudan, knowledge, attitude, RTS, S, R21, vaccine hesitancy, public health","lastPublishedDoi":"10.21203/rs.3.rs-7606195/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7606195/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eMalaria continues to impose a significant public health burden in Sudan, where fragile health systems and conflict exacerbate transmission. The introduction of RTS,S/AS01 and R21/Matrix-M vaccines offers a potential breakthrough. However, the success of such programs depends heavily on healthcare workers (HCWs), whose knowledge and attitudes can influence vaccine uptake; this study explored these factors among Sudanese HCWs\u0026rsquo; knowledge and attitudes toward malaria vaccination.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eAn exploratory cross-sectional survey was conducted between January and April 2025 among HCWs across Sudan. A total of 222 eligible participants were recruited via an online, self-administered questionnaire. Knowledge was assessed using eight malaria vaccine\u0026ndash;related items, with scores\u0026thinsp;\u0026ge;\u0026thinsp;70% indicating adequate knowledge. Attitudes were measured through six Likert-scale items, with \u0026ge;\u0026thinsp;70% considered positive. Descriptive statistics, Chi-square tests, independent t-tests, and regression analyses were applied.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe mean age of respondents was 31.5 years, and 66.7% were female. Pharmacists represented the largest professional group (44.6%). Only 9% (n\u0026thinsp;=\u0026thinsp;20) demonstrated adequate knowledge of malaria vaccination, and 21.6% (n\u0026thinsp;=\u0026thinsp;48) displayed positive attitudes. While 66.2% (n\u0026thinsp;=\u0026thinsp;147) had heard of malaria vaccines, 71.2% (n\u0026thinsp;=\u0026thinsp;158) were unaware of WHO recommendations, and 76.6% (n\u0026thinsp;=\u0026thinsp;170) did not know the vaccine\u0026rsquo;s target parasite. Negative attitudes were reported by 78.4% (n\u0026thinsp;=\u0026thinsp;174), particularly concerning safety, affordability, and trust in authorities. Positive attitudes were more common among males, HCWs with \u0026gt;\u0026thinsp;5 years of experience, and those in the private sector (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe study highlights critical gaps in knowledge and predominantly unfavorable attitudes toward malaria vaccination among Sudanese HCWs, indicating a risk of vaccine hesitancy in frontline delivery. Targeted training and awareness programs are urgently needed to strengthen HCWs\u0026rsquo; capacity, dispel misconceptions, and build trust in the malaria vaccine as Sudan scales up immunization efforts.\u003c/p\u003e","manuscriptTitle":"Preliminary Insights into Knowledge and Attitudes Toward Malaria Vaccination among Sudanese Healthcare Workers: An Exploratory Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-15 02:13:12","doi":"10.21203/rs.3.rs-7606195/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-05T23:45:29+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-18T11:59:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"217162129694100562025063048525587850531","date":"2025-10-05T04:54:17+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-30T02:27:26+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-16T05:51:18+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-16T05:49:27+00:00","index":"","fulltext":""},{"type":"submitted","content":"Malaria Journal","date":"2025-09-13T09:10:33+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"malaria-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"malj","sideBox":"Learn more about [Malaria Journal](http://malariajournal.biomedcentral.com/)","snPcode":"12936","submissionUrl":"https://submission.nature.com/new-submission/12936/3","title":"Malaria Journal","twitterHandle":"@malariajournal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c78ea857-0cb1-471f-a988-ae23df06afc0","owner":[],"postedDate":"October 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-22T16:08:40+00:00","versionOfRecord":{"articleIdentity":"rs-7606195","link":"https://doi.org/10.1186/s12936-025-05758-z","journal":{"identity":"malaria-journal","isVorOnly":false,"title":"Malaria Journal"},"publishedOn":"2025-12-20 15:57:49","publishedOnDateReadable":"December 20th, 2025"},"versionCreatedAt":"2025-10-15 02:13:12","video":"","vorDoi":"10.1186/s12936-025-05758-z","vorDoiUrl":"https://doi.org/10.1186/s12936-025-05758-z","workflowStages":[]},"version":"v1","identity":"rs-7606195","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7606195","identity":"rs-7606195","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}