Assessment of Caregiver Preferences for Malaria Prevention Strategies

Assessment of Caregiver Preferences for Malaria Prevention Strategies | 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 Assessment of Caregiver Preferences for Malaria Prevention Strategies Erick Wesley Hedima, Nathan Karah Gospel, David Emmanuel Agada, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9123227/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background: Malaria remains one of the leading causes of death worldwide among children under five. Effective prevention strategies remain crucial, but their implementation faces various challenges, notably the choice of the method of malaria prevention. Objective: This study aimed to elicit the preferences for malaria prevention among caregivers of children under five years. Method: A discrete choice experiment (DCE) was designed and administered to 250 caregivers at the Federal Teaching Hospital, Gombe, Nigeria. Six attributes were identified from relevant studies. Each participant was presented with two (2) choice sets, from which they selected one, while a Chi-square test was employed to estimate the preference parameters and willingness to pay for the malaria vaccine. A p-value of <0.05 was considered statistically significant at a 95% confidence interval. Data were analysed using John's Macintosh Project software (JMP) version 18.0. Results: Marginal utility estimates indicated that the caregivers preferred malaria vaccine (0.34) over chemoprophylaxis tablets (-0.34) (p=0.0001, X²=67.21), with community pharmacy (0.12) being the favoured location compared to home (0.10) or clinic (-0.22) (p=0.0001, X²=26.03). The most important attribute was 90% efficacy (1.15, p=0.0001, X²=863.46) and a waiting time of 20 minutes (0.25, p=0.0001, X²=45.52). Participants were willing to pay $0.33 more for vaccination at a community pharmacy compared to vaccination at home. Conclusion: This study found community pharmacy as the preferred location for vaccination, and efficacy to be the most important study attribute for vaccine preferences. Insights from this study can inform malaria vaccine implementation programs Figures Figure 1 Background Malaria remains one of the most pressing public health challenges in Nigeria, particularly in the North-East region, where the incidence of the disease is notably high. [1, 2] This area faces a unique combination of factors that contribute to the burden of malaria, including socioeconomic disparities, limited healthcare access, and the prevalence of environmental conditions conducive to malaria transmission. [3] The importance of effective malaria prevention strategies cannot be overstated, as they are critical in reducing morbidity and mortality associated with the disease. Caregivers, typically parents or guardians of children under five years, play a pivotal role in malaria prevention and control. [4] Their preferences in the selection and use of preventive measures can significantly influence the effectiveness of malaria interventions. Despite the availability of various malaria prevention strategies, including insecticide-treated bed nets (ITNs), indoor residual spraying (IRS), and seasonal malaria chemoprevention (SMC), understanding caregiver preferences is essential for achieving higher acceptability and adherence to these interventions. Assessing caregiver preferences for malaria prevention in North-East Nigeria is essential for tailoring public health programs to the specific needs and cultural contexts of the community, particularly given that this region is considered meso-endemic for malaria transmission. Factors influencing these preferences may include economic considerations, cultural beliefs, past experiences with malaria treatment, and awareness of prevention methods.[5, 6] Engaging caregivers in the development and implementation of malaria prevention strategies can enhance community trust, increase uptake of recommended practices, and ultimately lead to better health outcomes. Nigeria has begun rolling out the Oxford R21 malaria vaccine, starting with pilot programs in Kebbi and Bayelsa states, but there is a paucity of studies to inform policymakers and health practitioners. Malaria treatment seeking behaviour and attitude have been assessed in a relevant study among caregivers.[7] Similarly, the willingness to receive the malaria vaccine has also been assessed among with children under five.[8] However, there a paucity of evidence for malaria prevention strategies among this vulnerable groups. By understanding these preferences, targeted interventions can be designed to improve compliance and effectiveness in the ongoing battle against malaria in this vulnerable region. This evaluation aims to gather insights into caregivers' experiences regarding malaria prevention, providing valuable data to inform policymakers and health practitioners. By understanding these preferences, targeted interventions can be designed to improve compliance and effectiveness in the ongoing battle against malaria in this vulnerable region. Objectives To assess caregiver preferences for malaria prevention. To quantify the relative importance of the study attributes To estimate the willingness to pay for malaria prevention among caregivers. Methods Study Design A cross-sectional study design was employed in this study, using a discrete choice experiment. Study Area The study area was the Federal Teaching Hospital, Gombe (FTHG), located in Gombe, the capital of Gombe State. The study area is a tertiary health facility with a 500-bed capacity, established in 1996 by the Federal Government of Nigeria. This facility is among the largest and most comprehensive healthcare centers in the northeast, serving the citizens of Gombe and nearby areas. Study Population The study involved caregivers of children eligible for the malaria vaccine at the Federal Teaching Hospital, Gombe. Eligibility Criteria Caregivers of a child or children between the ages of 5 months and 5 years. Willingness to provide informed consent. Child must be a registered patient at the teaching hospital. Caregivers of full-term infants. Sample Size Determination The sample size for this study was calculated using the Johnson and Orme rule of thumb formula.[9] $$N>\frac{500\text{c}}{\text{t}\text{a}}$$ where: n is the number of respondents, t is the number of choice sets a is number of alternatives per choice set c is equal to the largest number of levels for any one attribute. Substituting: c = 4; t = 2; a = 5 Therefore; N> (500x3)/(2x3) = 1500/6 = 250 Respondents Study Instrument The study instrument contained two sections. The first section obtained the sociodemographic information of the respondents, while the second section sought to obtain the preferences of caregivers for malaria prevention. To inform the study design, published works addressing vaccine preferences facilitated the development of attributes and their corresponding levels for the discrete choice experiment. [10–14] The discrete choice experiment was guided by the International Society of Pharmacoeconomics and Outcomes Research (ISPOR). [15] Data Collection The R21 matrix vaccine was chosen over the RTS,S vaccine, considering that Nigeria is a lower-middle-income country with an average daily wage of 2,500 Naira for 28 working days. [16, 17] The price for the R21 matrix vaccine was obtained from UNICEF and GAVI, using the core-financing model for malaria vaccines, which includes a country contribution of $0.20 per dose. [18] Additionally, a 25% graded increase in the vaccine price was applied for this discrete choice model. Each participant had two (2) choice sets from which the participant selected one. Eligible caregivers were approached for possible inclusion into the study at the public health unit of the Federal Teaching Hospital, Gombe. Ethical Consideration Ethical approval was obtained from the Department of Research and Statistics, Gombe State Ministry of Health (REF No. NHREC/25/10/2013 ). In addition, informed consent was obtained from caregivers before administration of the study instrument. Data Analysis The data was analyzed using JMP version 18.0 (SAS Institute). Categorical data were expressed as frequencies and percentages. The choice design was used to determine the parameter estimate of the preferences and willingness for the malaria vaccine using Chi chi-square test. A p-value of < 0.05 was considered statistically significant at a 95% confidence interval. Results Socio-demographic data of respondents As illustrated in Table 1 below, the majority of participants were over the age of 30 years (106, 42.4%) and had three or fewer children (212, 84.8%). Nearly all participants had fewer than two children under the age of five (247, 98.8%). The respondents were predominantly female (180, 72.0%) and largely self-employed (80, 32.0%). A significant majority were married (221, 88.4%) and possessed at least a secondary education (116, 46.4%). 4.2 Child Malaria History and Health-Seeking Behavior of Caregivers As shown in Table 2 below, nearly all children of the caregivers had experienced malaria (246, 98.4%), with the majority receiving treatment at a clinic or hospital (133, 53.2%). A significant proportion had undergone Seasonal Malaria Chemoprevention (152, 60.8%), indicating moderate awareness and utilization of this malaria prevention strategy. The use of long-lasting insecticidal nets, LLINs (223, 89.2%) was widespread, reflecting high adoption of preventive measures. Additionally, a lower proportion of caregivers were vaccinated against COVID-19 (237, 94.8%). Preference for malaria prevention Table 3 below presents the marginal utility estimates for various attributes derived from the Discrete Choice Experiment. The caregivers prefer the malaria vaccine (0.34388) over SMC, and community pharmacy (0.12439) as the preferred location for receiving the vaccine. Additionally, a vaccine efficacy of 90% (1.1577) was the most preferred, along with no side effects (0.48634) and a waiting time of 20 minutes (0.25518). p values for all the attributes were less than 0.0001 and considered statistically significant. Relative Importance of the Attributes As depicted in Table 3 above, all the attributes were significantly important for the caregivers. However, Efficacy ( p < 0.001, X 2 = 863.4622) was the most important attribute to the study population. Willingness to Pay Table 4 below presents the willingness to pay (WTP) estimates derived from the Discrete Choice Experiment. These estimates represent monetary values that participants were willing to assign to the various attributes of the DCE. The highest WTP was for a vaccine having 90% efficacy, an attribute of the vaccine that respondents were willing to pay an additional $2.14 for. For a vaccine with mild side effects, respondents were willing to pay an extra $0.77. Additionally, participants showed willingness to pay up to $0.56 more for a waiting time of 20 minutes and $0.30 more if the vaccine were administered at home. The baselines in the table are reference points against which comparisons are made between attributes and their levels. Discussion This study assessed caregiver preferences for malaria prevention. There exist a few studies to make a comparison with. However, the current study shows that the majority of the caregivers had children with a history of malaria infection. This is not surprising, as Nigeria is generally considered a malaria-endemic region with the northeastern part of the country experiencing high transmission and meso-endemic conditions. This correlates with the findings of previous reports . [19–21] The findings of this study indicate that a significant proportion of caregivers reported that their children had previously received Seasonal Malaria Chemoprevention (SMC), suggesting a relatively good deployment of the SMC program within the study area. Comparable findings have been observed in other regions of Nigeria, with a recent study indicating that up to 76.8% of eligible children in the country have received SMC at least once. [22] Other preventive measures, such as the use of long-lasting insecticidal nets (LLINs) by the majority of the participants, propose that it is the most widely adopted and trusted malaria prevention strategy among respondents. This study identified community pharmacies as the preferred site for vaccine administration, highlighting the vital role of community pharmacists in mitigating vaccine-related morbidity and mortality. Their prominence as the most accessible first point of care further reinforces their significance in expanding vaccination coverage. [23] A study in 2024 showed that community pharmacists administered the COVID-19 vaccine at much higher rates compared to other healthcare professionals. [24] In recent years, vaccination services in community pharmacies have been expanding, offering a potential solution to address vaccine disparities. Pharmacists are increasingly acknowledged as accessible, reliable, convenient, and cost-effective providers of immunization. [25] Based on the results of this study, waiting time played a crucial role in caregiver preferences for malaria vaccine administration. Among the available options, respondents showed a preference for a moderate waiting period when receiving the vaccine. Despite being contradictory to normative expectations that the shortest possible waiting time would have been preferred, as evidenced in other studies. [26, 27] The results represent the complexities that surround time use in vaccination programs. The time clients spend waiting during immunization visits in low- and middle-income countries is a factor that is underexplored and may hinder vaccine completion, significantly defeating the purpose and utility of the intervention. [28] This study identified vaccine efficacy as the most preferred attribute among respondents, consistent with findings from research on other vaccines, including COVID-19 and pneumococcal vaccines. [29–31] In these studies, efficacy emerged as the primary factor influencing vaccine choice, with individuals showing lower willingness to accept vaccines perceived as less effective. One study reported that increasing vaccine efficacy from 50% to 90% significantly raised the likelihood of selecting the vaccine. [32] A direct correlation can be observed between the findings of this study and a study on the leptospirosis vaccine, where efficacy was also the most influential factor in vaccine acceptability. Increasing the baseline efficacy of the leptospirosis vaccine was presupposed to significantly enhance its marginal utility by approximately 47–50%. [33] Other studies on COVID-19 and influenza vaccines, participants expressed willingness to be vaccinated if the vaccine had at least 90% efficacy. [30, 34] The current study also revealed that respondents showed a high preference for a malaria vaccine with no side effects. A study in Australia found that respondents valued lower instances of severe side effects and shorter waiting periods for vaccine availability. [35] Similarly, a survey in the United States revealed that 72% of respondents preferred vaccines with a lower likelihood of serious side effects, while 55% favored those with fewer minor side effects. [36] In Japan, decreasing the risk of severe adverse effects from 1 in 10,000 to 1 in 1 million increased vaccine choice probability by 16.9 percentage points. A significant number of participants in this study reported not having received the COVID-19 vaccine, suggesting a high level of vaccine hesitancy. While multiple factors may have contributed to this, concerns about side effects likely played a significant role, as supported by previous studies in sub-Saharan Africa, which indicate that vaccine acceptance in the region remains relatively low. Concerns about side effects have been consistently identified as one of the primary reasons for hesitancy among both individuals and their children, further emphasizing the need for effective public health strategies to address safety concerns and improve vaccine uptake. [37, 38] The findings of this study indicate that price played a significant role in participants’ preferences for malaria vaccination, as reflected in the willingness-to-pay (WTP) estimates. The results show a direct relationship between price and vaccine preference, with participants exhibiting greater willingness to pay for vaccines with higher efficacy and fewer side effects. The respondents expressed willingness to pay more if the vaccine included their most preferred attributes. For example, they were willing to pay an additional $ 2.14 for a vaccine with 90% efficacy compared to $ 1.11 for 80% efficacy. Studies show people are willing to pay more for higher efficacy vaccines, with one study finding participants would pay an additional $ 67.71 for a 99% vs 79% protection rate. [39] Another study found adolescents and parents would pay AU $ 90.70 or AU $ 127.20 for 90% vaccine effectiveness compared to AU $ 18.50 or AU $ 16.70 for 70% effectiveness. [40] In this study, caregivers would prefer a vaccine with mild side effects; participants were willing to pay $ 0.77 more, whereas they would only pay an additional $ 0.56 for a vaccine with moderate side effects. This is consistent with the findings of other choice studies for COVD-19 and the human papillomavirus vaccines. [41, 42] Despite showing a preference for community pharmacy over home for the vaccination, the caregivers were willing to pay more if it was administered at home, probably due to convenience and the fact that home administration might be more cost-saving for them. Research suggests that community pharmacies can play an important role in expanding vaccination services and managing minor ailments. Studies have found that some patients prefer to pay for flu vaccinations at pharmacies due to convenience and accessibility, even when eligible for free NHS vaccinations. [43] While many people are open to pharmacy-based vaccinations, concerns exist about proper training and certification. [44] Cost is a significant factor, with most preferring free or insurance-covered pharmacy vaccinations. [45] A systematic review demonstrated that individuals were more inclined to invest in vaccines that offered higher efficacy and minimal side effects, highlighting the importance of these attributes in vaccine acceptance. [46] This study establishes a foundation for a policy framework aimed at combating malaria. However, it is important to acknowledge its limitations. First, the cross-sectional design of the study may constrain the findings. Second, the sample size could potentially diminish the effect size of the outcomes. Lastly, the preferences expressed by the participants may vary due to regional or individual differences. Conclusion This discrete choice experiment has assessed preferences for malaria vaccine among caregivers. The study identified that efficacy was the most important attribute in a malaria vaccine, with community pharmacy being the preferred location for the administration, at a waiting time of 20 minutes, and with no side effects after receiving the intervention. Participants showed willingness to pay more for attributes that captured their preferences or increased their convenience in one way or another. Insights from the study can inform malaria vaccine implementation programs of the National Malaria Elimination Program (NMEP) and future design efforts for malaria vaccine, enhancing acceptability in Nigeria and other malaria-endemic regions of Africa. Declarations Funding This work did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Author Contribution EWH, NKG: Writing – review & editing, Writing – original draft, Visualization, Methodology, Formal analysis, Conceptualization. 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Anderson C, Thornley T. “It’s easier in pharmacy”: why some patients prefer to pay for flu jabs rather than use the National Health Service. BMC Health Serv Res 2014; 14: 35. Koskan AM, Dominick LN, Helitzer DL. Rural Caregivers’ Willingness for Community Pharmacists to Administer the HPV Vaccine to Their Age-Eligible Children. J Cancer Educ 2021; 36: 189–198. Rusic D, Nanasi D, Bozic J, et al. Attitudes of Community Pharmacy Service Users towards Vaccination Programs in Pharmacy: A Cross-Sectional Survey-Based Study in Croatia. Pharmacy 2022; 10: 167. Diks ME, Hiligsmann M, van der Putten IM. Vaccine preferences driving vaccine-decision making of different target groups: a systematic review of choice-based experiments. BMC Infect Dis 2021; 21: 879. Tables Tables 1 to 4 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Tables.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 18 May, 2026 Reviewers agreed at journal 07 May, 2026 Reviewers agreed at journal 07 May, 2026 Reviewers invited by journal 01 Apr, 2026 Editor assigned by journal 17 Mar, 2026 Submission checks completed at journal 17 Mar, 2026 First submitted to journal 14 Mar, 2026 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. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9123227","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":617619520,"identity":"aee6f496-0a86-42c6-9aa5-5c5ff320424f","order_by":0,"name":"Erick Wesley Hedima","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5ElEQVRIiWNgGAWjYFACHiAyYGDgh/CYSdAi2UCaFiBlcIBYLQbHew8+eFOwTd74/PJnEgwV1okN0u0X8Gs5cy7ZcI7BbcNtN96YSTCcSU9skDlTgFeL2Y0cM2keg9uM226cYZNgbDuc2CCRk4Bfy/035r+BWuw3zzj+TILxHzFabvCYMQO1JG7gbzCTYGwAaUk/gFeL/ZkcY0mgX5Jn3OAxtkg4lm7cJpGDVweDZPsZww9v/ty27e8//vDGhxpr2X6J9Af49cCBBNAHIE+wgWOWKMB/AMZiJ9aWUTAKRsEoGCEAAALtSyhQ+PYYAAAAAElFTkSuQmCC","orcid":"","institution":"Gombe State University","correspondingAuthor":true,"prefix":"","firstName":"Erick","middleName":"Wesley","lastName":"Hedima","suffix":""},{"id":617619521,"identity":"2d77ba1b-ead0-411e-a531-fc2efaa53759","order_by":1,"name":"Nathan Karah Gospel","email":"","orcid":"","institution":"Gombe State University","correspondingAuthor":false,"prefix":"","firstName":"Nathan","middleName":"Karah","lastName":"Gospel","suffix":""},{"id":617619522,"identity":"117ea840-c36b-4dd3-9bff-90d3c34c95b3","order_by":2,"name":"David Emmanuel Agada","email":"","orcid":"","institution":"Gombe State University","correspondingAuthor":false,"prefix":"","firstName":"David","middleName":"Emmanuel","lastName":"Agada","suffix":""},{"id":617619523,"identity":"048634b4-c881-4701-ab1e-5f62caa276e0","order_by":3,"name":"Haruna Adamu Bitrus","email":"","orcid":"","institution":"Gombe State University","correspondingAuthor":false,"prefix":"","firstName":"Haruna","middleName":"Adamu","lastName":"Bitrus","suffix":""},{"id":617619524,"identity":"494314d5-af1f-462b-af1a-18f41b283d18","order_by":4,"name":"Tang’an Zughumnaan","email":"","orcid":"","institution":"Department of Pharmaceutical Services, Federal Teaching Hospital, Gombe State","correspondingAuthor":false,"prefix":"","firstName":"Tang’an","middleName":"","lastName":"Zughumnaan","suffix":""}],"badges":[],"createdAt":"2026-03-14 14:23:03","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9123227/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9123227/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106308685,"identity":"df45ac40-0528-4ece-9366-18bc6f24da62","added_by":"auto","created_at":"2026-04-07 10:12:41","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":98938,"visible":true,"origin":"","legend":"\u003cp\u003eA sample choice task from the study\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9123227/v1/60e644253fd5369b16f3dcdc.jpg"},{"id":106309097,"identity":"82a179f9-2f38-48fe-a60e-d8087d3599b0","added_by":"auto","created_at":"2026-04-07 10:14:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":583070,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9123227/v1/cfd51911-d89f-4843-b2bc-4125e222420e.pdf"},{"id":106308896,"identity":"141d2d02-eb16-4ba5-9580-5a053a145165","added_by":"auto","created_at":"2026-04-07 10:14:10","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":29308,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-9123227/v1/17362f31b69b1c1f236218dc.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Assessment of Caregiver Preferences for Malaria Prevention Strategies","fulltext":[{"header":"Background","content":"\u003cp\u003eMalaria remains one of the most pressing public health challenges in Nigeria, particularly in the North-East region, where the incidence of the disease is notably high. [1, 2] This area faces a unique combination of factors that contribute to the burden of malaria, including socioeconomic disparities, limited healthcare access, and the prevalence of environmental conditions conducive to malaria transmission. [3] The importance of effective malaria prevention strategies cannot be overstated, as they are critical in reducing morbidity and mortality associated with the disease.\u003c/p\u003e \u003cp\u003eCaregivers, typically parents or guardians of children under five years, play a pivotal role in malaria prevention and control. [4] Their preferences in the selection and use of preventive measures can significantly influence the effectiveness of malaria interventions. Despite the availability of various malaria prevention strategies, including insecticide-treated bed nets (ITNs), indoor residual spraying (IRS), and seasonal malaria chemoprevention (SMC), understanding caregiver preferences is essential for achieving higher acceptability and adherence to these interventions.\u003c/p\u003e \u003cp\u003eAssessing caregiver preferences for malaria prevention in North-East Nigeria is essential for tailoring public health programs to the specific needs and cultural contexts of the community, particularly given that this region is considered meso-endemic for malaria transmission. Factors influencing these preferences may include economic considerations, cultural beliefs, past experiences with malaria treatment, and awareness of prevention methods.[5, 6] Engaging caregivers in the development and implementation of malaria prevention strategies can enhance community trust, increase uptake of recommended practices, and ultimately lead to better health outcomes.\u003c/p\u003e \u003cp\u003eNigeria has begun rolling out the Oxford R21 malaria vaccine, starting with pilot programs in Kebbi and Bayelsa states, but there is a paucity of studies to inform policymakers and health practitioners. Malaria treatment seeking behaviour and attitude have been assessed in a relevant study among caregivers.[7] Similarly, the willingness to receive the malaria vaccine has also been assessed among with children under five.[8] However, there a paucity of evidence for malaria prevention strategies among this vulnerable groups. By understanding these preferences, targeted interventions can be designed to improve compliance and effectiveness in the ongoing battle against malaria in this vulnerable region. This evaluation aims to gather insights into caregivers' experiences regarding malaria prevention, providing valuable data to inform policymakers and health practitioners. By understanding these preferences, targeted interventions can be designed to improve compliance and effectiveness in the ongoing battle against malaria in this vulnerable region.\u003c/p\u003e \u003cp\u003e \u003cb\u003eObjectives\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTo assess caregiver preferences for malaria prevention.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTo quantify the relative importance of the study attributes\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTo estimate the willingness to pay for malaria prevention among caregivers.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e "},{"header":"Methods","content":"\u003cp\u003eStudy Design\u003c/p\u003e\n\u003cp\u003eA cross-sectional study design was employed in this study, using a discrete choice experiment.\u003c/p\u003e\n\u003cp\u003eStudy Area\u003c/p\u003e\n\u003cp\u003eThe study area was the Federal Teaching Hospital, Gombe (FTHG), located in Gombe, the capital of Gombe State. The study area is a tertiary health facility with a 500-bed capacity, established in 1996 by the Federal Government of Nigeria. This facility is among the largest and most comprehensive healthcare centers in the northeast, serving the citizens of Gombe and nearby areas.\u003c/p\u003e\n\u003cp\u003eStudy Population\u003c/p\u003e\n\u003cp\u003eThe study involved caregivers of children eligible for the malaria vaccine at the Federal Teaching Hospital, Gombe.\u003c/p\u003e\n\u003cp\u003eEligibility Criteria\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eCaregivers of a child or children between the ages of 5 months and 5 years.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eWillingness to provide informed consent.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eChild must be a registered patient at the teaching hospital.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eCaregivers of full-term infants.\u003c/p\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eSample Size Determination\u003c/p\u003e\n\u003cp\u003eThe sample size for this study was calculated using the Johnson and Orme rule of thumb formula.[9]\u003c/p\u003e\n\u003cdiv id=\"Equa\"\u003e\n \u003cdiv id=\"FileID_Equa\" name=\"EquationSource\"\u003e$$N\u0026gt;\\frac{500\\text{c}}{\\text{t}\\text{a}}$$\u003c/div\u003e\n\u003c/div\u003e\n\u003cp\u003ewhere:\u003c/p\u003e\n\u003cp\u003en is the number of respondents,\u003c/p\u003e\n\u003cp\u003et is the number of choice sets\u003c/p\u003e\n\u003cp\u003ea is number of alternatives per choice set\u003c/p\u003e\n\u003cp\u003ec is equal to the largest number of levels for any one attribute.\u003c/p\u003e\n\u003cp\u003eSubstituting:\u003c/p\u003e\n\u003cp\u003ec = 4; t = 2; a = 5\u003c/p\u003e\n\u003cp\u003eTherefore; N\u0026gt; (500x3)/(2x3)\u003c/p\u003e\n\u003cp\u003e= 1500/6\u003c/p\u003e\n\u003cp\u003e= 250 Respondents\u003c/p\u003e\n\u003cp\u003eStudy Instrument\u003c/p\u003e\n\u003cp\u003eThe study instrument contained two sections. The first section obtained the sociodemographic information of the respondents, while the second section sought to obtain the preferences of caregivers for malaria prevention. To inform the study design, published works addressing vaccine preferences facilitated the development of attributes and their corresponding levels for the discrete choice experiment. [10–14] The discrete choice experiment was guided by the International Society of Pharmacoeconomics and Outcomes Research (ISPOR). [15]\u003c/p\u003e\n\u003cdiv id=\"Sec3\"\u003e\n \u003ch2\u003eData Collection\u003c/h2\u003e\n \u003cp\u003eThe R21 matrix vaccine was chosen over the RTS,S vaccine, considering that Nigeria is a lower-middle-income country with an average daily wage of 2,500 Naira for 28 working days. [16, 17] The price for the R21 matrix vaccine was obtained from UNICEF and GAVI, using the core-financing model for malaria vaccines, which includes a country contribution of $0.20 per dose. [18] Additionally, a 25% graded increase in the vaccine price was applied for this discrete choice model.\u003c/p\u003e\n \u003cp\u003eEach participant had two (2) choice sets from which the participant selected one. Eligible caregivers were approached for possible inclusion into the study at the public health unit of the Federal Teaching Hospital, Gombe.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eEthical Consideration\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u0026nbsp;\u003c/strong\u003ewas obtained from the Department of Research and Statistics, Gombe State Ministry of Health (REF No. \u003cem\u003eNHREC/25/10/2013\u003c/em\u003e). In addition, informed consent was obtained from caregivers before administration of the study instrument.\u003c/p\u003e\n\u003cdiv id=\"Sec5\"\u003e\n \u003ch2\u003eData Analysis\u003c/h2\u003e\n \u003cp\u003eThe data was analyzed using JMP version 18.0 (SAS Institute). Categorical data were expressed as frequencies and percentages. The choice design was used to determine the parameter estimate of the preferences and willingness for the malaria vaccine using Chi chi-square test. A \u003cem\u003ep-value\u003c/em\u003e of \u0026lt; 0.05 was considered statistically significant at a 95% confidence interval.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\"\u003e\n \u003cdiv id=\"Sec7\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocio-demographic data of respondents\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eAs illustrated in Table 1 below, the majority of participants were over the age of 30 years (106, 42.4%) and had three or fewer children (212, 84.8%). Nearly all participants had fewer than two children under the age of five (247, 98.8%). The respondents were predominantly female (180, 72.0%) and largely self-employed (80, 32.0%). A significant majority were married (221, 88.4%) and possessed at least a secondary education (116, 46.4%).\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e4.2 Child Malaria History and Health-Seeking Behavior of Caregivers\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eAs shown in Table 2 below, nearly all children of the caregivers had experienced malaria (246, 98.4%), with the majority receiving treatment at a clinic or hospital (133, 53.2%). A significant proportion had undergone Seasonal Malaria Chemoprevention (152, 60.8%), indicating moderate awareness and utilization of this malaria prevention strategy. The use of long-lasting insecticidal nets, LLINs (223, 89.2%) was widespread, reflecting high adoption of preventive measures. Additionally, a lower proportion of caregivers were vaccinated against COVID-19 (237, 94.8%).\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePreference for malaria prevention\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eTable 3 below presents the marginal utility estimates for various attributes derived from the Discrete Choice Experiment. The caregivers prefer the malaria vaccine (0.34388) over SMC, and community pharmacy (0.12439) as the preferred location for receiving the vaccine. Additionally, a vaccine efficacy of 90% (1.1577) was the most preferred, along with no side effects (0.48634) and a waiting time of 20 minutes (0.25518). \u003cem\u003ep\u003c/em\u003e values for all the attributes were less than 0.0001 and considered statistically significant.\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec8\"\u003e\n \u003cp\u003e\u003cstrong\u003eRelative Importance of the Attributes\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eAs depicted in Table 3 above, all the attributes were significantly important for the caregivers. However, Efficacy (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001, X\u003csup\u003e2\u003c/sup\u003e= 863.4622) was the most important attribute to the study population.\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cstrong\u003eWillingness to Pay\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eTable 4 below presents the willingness to pay (WTP) estimates derived from the Discrete Choice Experiment. These estimates represent monetary values that participants were willing to assign to the various attributes of the DCE. The highest WTP was for a vaccine having 90% efficacy, an attribute of the vaccine that respondents were willing to pay an additional $2.14 for. For a vaccine with mild side effects, respondents were willing to pay an extra $0.77. Additionally, participants showed willingness to pay up to $0.56 more for a waiting time of 20 minutes and $0.30 more if the vaccine were administered at home. The baselines in the table are reference points against which comparisons are made between attributes and their levels.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study assessed caregiver preferences for malaria prevention. There exist a few studies to make a comparison with. However, the current study shows that the majority of the caregivers had children with a history of malaria infection. This is not surprising, as Nigeria is generally considered a malaria-endemic region with the northeastern part of the country experiencing high transmission and meso-endemic conditions. This correlates with the findings of previous reports . [19\u0026ndash;21] The findings of this study indicate that a significant proportion of caregivers reported that their children had previously received Seasonal Malaria Chemoprevention (SMC), suggesting a relatively good deployment of the SMC program within the study area. Comparable findings have been observed in other regions of Nigeria, with a recent study indicating that up to 76.8% of eligible children in the country have received SMC at least once. [22] Other preventive measures, such as the use of long-lasting insecticidal nets (LLINs) by the majority of the participants, propose that it is the most widely adopted and trusted malaria prevention strategy among respondents.\u003c/p\u003e \u003cp\u003eThis study identified community pharmacies as the preferred site for vaccine administration, highlighting the vital role of community pharmacists in mitigating vaccine-related morbidity and mortality. Their prominence as the most accessible first point of care further reinforces their significance in expanding vaccination coverage. [23] A study in 2024 showed that community pharmacists administered the COVID-19 vaccine at much higher rates compared to other healthcare professionals. [24] In recent years, vaccination services in community pharmacies have been expanding, offering a potential solution to address vaccine disparities. Pharmacists are increasingly acknowledged as accessible, reliable, convenient, and cost-effective providers of immunization. [25]\u003c/p\u003e \u003cp\u003eBased on the results of this study, waiting time played a crucial role in caregiver preferences for malaria vaccine administration. Among the available options, respondents showed a preference for a moderate waiting period when receiving the vaccine. Despite being contradictory to normative expectations that the shortest possible waiting time would have been preferred, as evidenced in other studies. [26, 27] The results represent the complexities that surround time use in vaccination programs. The time clients spend waiting during immunization visits in low- and middle-income countries is a factor that is underexplored and may hinder vaccine completion, significantly defeating the purpose and utility of the intervention. [28]\u003c/p\u003e \u003cp\u003eThis study identified vaccine efficacy as the most preferred attribute among respondents, consistent with findings from research on other vaccines, including COVID-19 and pneumococcal vaccines. [29\u0026ndash;31] In these studies, efficacy emerged as the primary factor influencing vaccine choice, with individuals showing lower willingness to accept vaccines perceived as less effective. One study reported that increasing vaccine efficacy from 50% to 90% significantly raised the likelihood of selecting the vaccine. [32] A direct correlation can be observed between the findings of this study and a study on the leptospirosis vaccine, where efficacy was also the most influential factor in vaccine acceptability. Increasing the baseline efficacy of the leptospirosis vaccine was presupposed to significantly enhance its marginal utility by approximately 47\u0026ndash;50%. [33] Other studies on COVID-19 and influenza vaccines, participants expressed willingness to be vaccinated if the vaccine had at least 90% efficacy. [30, 34]\u003c/p\u003e \u003cp\u003eThe current study also revealed that respondents showed a high preference for a malaria vaccine with no side effects. A study in Australia found that respondents valued lower instances of severe side effects and shorter waiting periods for vaccine availability. [35] Similarly, a survey in the United States revealed that 72% of respondents preferred vaccines with a lower likelihood of serious side effects, while 55% favored those with fewer minor side effects. [36] In Japan, decreasing the risk of severe adverse effects from 1 in 10,000 to 1 in 1\u0026nbsp;million increased vaccine choice probability by 16.9 percentage points. A significant number of participants in this study reported not having received the COVID-19 vaccine, suggesting a high level of vaccine hesitancy. While multiple factors may have contributed to this, concerns about side effects likely played a significant role, as supported by previous studies in sub-Saharan Africa, which indicate that vaccine acceptance in the region remains relatively low. Concerns about side effects have been consistently identified as one of the primary reasons for hesitancy among both individuals and their children, further emphasizing the need for effective public health strategies to address safety concerns and improve vaccine uptake. [37, 38]\u003c/p\u003e \u003cp\u003eThe findings of this study indicate that price played a significant role in participants\u0026rsquo; preferences for malaria vaccination, as reflected in the willingness-to-pay (WTP) estimates. The results show a direct relationship between price and vaccine preference, with participants exhibiting greater willingness to pay for vaccines with higher efficacy and fewer side effects.\u003c/p\u003e \u003cp\u003eThe respondents expressed willingness to pay more if the vaccine included their most preferred attributes. For example, they were willing to pay an additional \u003cspan\u003e$\u003c/span\u003e2.14 for a vaccine with 90% efficacy compared to \u003cspan\u003e$\u003c/span\u003e1.11 for 80% efficacy. Studies show people are willing to pay more for higher efficacy vaccines, with one study finding participants would pay an additional \u003cspan\u003e$\u003c/span\u003e67.71 for a 99% vs 79% protection rate. [39] Another study found adolescents and parents would pay AU\u003cspan\u003e$\u003c/span\u003e90.70 or AU\u003cspan\u003e$\u003c/span\u003e127.20 for 90% vaccine effectiveness compared to AU\u003cspan\u003e$\u003c/span\u003e18.50 or AU\u003cspan\u003e$\u003c/span\u003e16.70 for 70% effectiveness. [40] In this study, caregivers would prefer a vaccine with mild side effects; participants were willing to pay \u003cspan\u003e$\u003c/span\u003e0.77 more, whereas they would only pay an additional \u003cspan\u003e$\u003c/span\u003e0.56 for a vaccine with moderate side effects. This is consistent with the findings of other choice studies for COVD-19 and the human papillomavirus vaccines. [41, 42]\u003c/p\u003e \u003cp\u003eDespite showing a preference for community pharmacy over home for the vaccination, the caregivers were willing to pay more if it was administered at home, probably due to convenience and the fact that home administration might be more cost-saving for them. Research suggests that community pharmacies can play an important role in expanding vaccination services and managing minor ailments. Studies have found that some patients prefer to pay for flu vaccinations at pharmacies due to convenience and accessibility, even when eligible for free NHS vaccinations. [43] While many people are open to pharmacy-based vaccinations, concerns exist about proper training and certification. [44] Cost is a significant factor, with most preferring free or insurance-covered pharmacy vaccinations. [45] A systematic review demonstrated that individuals were more inclined to invest in vaccines that offered higher efficacy and minimal side effects, highlighting the importance of these attributes in vaccine acceptance. [46]\u003c/p\u003e \u003cp\u003eThis study establishes a foundation for a policy framework aimed at combating malaria. However, it is important to acknowledge its limitations. First, the cross-sectional design of the study may constrain the findings. Second, the sample size could potentially diminish the effect size of the outcomes. Lastly, the preferences expressed by the participants may vary due to regional or individual differences.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis discrete choice experiment has assessed preferences for malaria vaccine among caregivers. The study identified that efficacy was the most important attribute in a malaria vaccine, with community pharmacy being the preferred location for the administration, at a waiting time of 20 minutes, and with no side effects after receiving the intervention. Participants showed willingness to pay more for attributes that captured their preferences or increased their convenience in one way or another. Insights from the study can inform malaria vaccine implementation programs of the National Malaria Elimination Program (NMEP) and future design efforts for malaria vaccine, enhancing acceptability in Nigeria and other malaria-endemic regions of Africa.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis work did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eEWH, NKG: Writing \u0026ndash; review \u0026amp; editing, Writing \u0026ndash; original draft, Visualization, Methodology, Formal analysis, Conceptualization. EWH, EAD, HA Writing \u0026ndash; review \u0026amp; editing, Supervision, Data curation. BTZ: Project administration, Data curation.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eStudy data will be made available upon request to the corresponding author ([email protected])\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eChimezie RO. Malaria Hyperendemicity: The Burden and Obstacles to Eradication in Nigeria. \u003cem\u003eJ Biosci Med\u003c/em\u003e 2020; 8: 165\u0026ndash;178.\u003c/li\u003e\n\u003cli\u003eHouben C, Fleischmann H, G\u0026uuml;ckel M. Malaria prevalence in north\u0026ndash;eastern Nigeria: A cross\u0026ndash;sectional study. \u003cem\u003eAsian Pac J Trop Med\u003c/em\u003e 2013; 6: 865\u0026ndash;868.\u003c/li\u003e\n\u003cli\u003eChiziba C, Mercer LD, Diallo O, et al. 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COVID-19 Vaccination Preferences of University Students and Staff in Hong Kong. \u003cem\u003eJAMA Netw Open\u003c/em\u003e; 5. Epub ahead of print 2 May 2022. DOI: 10.1001/jamanetworkopen.2022.12681.\u003c/li\u003e\n\u003cli\u003eKreps S, Prasad S, Brownstein JS, et al. Factors Associated With US Adults\u0026rsquo; Likelihood of Accepting COVID-19 Vaccination. \u003cem\u003eJAMA Netw Open\u003c/em\u003e 2020; 3: e2025594.\u003c/li\u003e\n\u003cli\u003eArbiol J, Yabe M, Nomura H, et al. Using discrete choice modeling to evaluate the preferences and willingness to pay for leptospirosis vaccine. \u003cem\u003eHum Vaccines Immunother\u003c/em\u003e 2015; 11: 1046\u0026ndash;1056.\u003c/li\u003e\n\u003cli\u003eBono SA, Faria de Moura Villela E, Siau CS, et al. Factors Affecting COVID-19 Vaccine Acceptance: An International Survey among Low- and Middle-Income Countries. \u003cem\u003eVaccines\u003c/em\u003e 2021; 9: 515.\u003c/li\u003e\n\u003cli\u003eBorriello A, Master D, Pellegrini A, et al. Preferences for a COVID-19 vaccine in Australia. \u003cem\u003eVaccine\u003c/em\u003e 2021; 39: 473\u0026ndash;479.\u003c/li\u003e\n\u003cli\u003eEffler PV, Tomlin S, Joyce S, et al. Adult preferences for influenza vaccines with lower likelihood of side effects. \u003cem\u003eHum Vaccines Immunother\u003c/em\u003e. Epub ahead of print 1 February 2014. DOI: 10.4161/hv.26835.\u003c/li\u003e\n\u003cli\u003eHlongwa M, Afolabi AA, Dzinamarira T. Hesitancy towards a COVID-19 vaccine in selected countries in Africa: Causes, effects and strategies for improving COVID-19 vaccine uptake. \u003cem\u003eGlob Biosecurity\u003c/em\u003e; 3. Epub ahead of print 2021. DOI: 10.31646/gbio.130.\u003c/li\u003e\n\u003cli\u003eMwiinde AM, Kaonga P, Jacobs C, et al. Determinants of COVID-19 vaccine acceptance and hesitancy among adolescents and youths aged 10-35 years in sub-Saharan African countries: A systematic review and meta-analysis. \u003cem\u003ePLOS ONE\u003c/em\u003e 2024; 19: e0310827.\u003c/li\u003e\n\u003cli\u003eGuo N, Zhang G, Zhu D, et al. The effects of convenience and quality on the demand for vaccination: Results from a discrete choice experiment. \u003cem\u003eVaccine\u003c/em\u003e 2017; 35: 2848\u0026ndash;2854.\u003c/li\u003e\n\u003cli\u003eMarshall HS, Chen G, Clarke M, et al. Adolescent, parent and societal preferences and willingness to pay for meningococcal B vaccine: A Discrete Choice Experiment. \u003cem\u003eVaccine\u003c/em\u003e 2016; 34: 671\u0026ndash;677.\u003c/li\u003e\n\u003cli\u003eSun X, Wagner AL, Ji J, et al. A conjoint analysis of stated vaccine preferences in Shanghai, China. \u003cem\u003eVaccine\u003c/em\u003e 2020; 38: 1520\u0026ndash;1525.\u003c/li\u003e\n\u003cli\u003eWong CKH, Man KKC, Ip P, et al. Mothers\u0026rsquo; Preferences and Willingness to Pay for Human Papillomavirus Vaccination for Their Daughters: A Discrete Choice Experiment in Hong Kong. \u003cem\u003eValue Health\u003c/em\u003e 2018; 21: 622\u0026ndash;629.\u003c/li\u003e\n\u003cli\u003eAnderson C, Thornley T. \u0026ldquo;It\u0026rsquo;s easier in pharmacy\u0026rdquo;: why some patients prefer to pay for flu jabs rather than use the National Health Service. \u003cem\u003eBMC Health Serv Res\u003c/em\u003e 2014; 14: 35.\u003c/li\u003e\n\u003cli\u003eKoskan AM, Dominick LN, Helitzer DL. Rural Caregivers\u0026rsquo; Willingness for Community Pharmacists to Administer the HPV Vaccine to Their Age-Eligible Children. \u003cem\u003eJ Cancer Educ\u003c/em\u003e 2021; 36: 189\u0026ndash;198.\u003c/li\u003e\n\u003cli\u003eRusic D, Nanasi D, Bozic J, et al. Attitudes of Community Pharmacy Service Users towards Vaccination Programs in Pharmacy: A Cross-Sectional Survey-Based Study in Croatia. \u003cem\u003ePharmacy\u003c/em\u003e 2022; 10: 167.\u003c/li\u003e\n\u003cli\u003eDiks ME, Hiligsmann M, van der Putten IM. Vaccine preferences driving vaccine-decision making of different target groups: a systematic review of choice-based experiments. \u003cem\u003eBMC Infect Dis\u003c/em\u003e 2021; 21: 879.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 4 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"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":"","lastPublishedDoi":"10.21203/rs.3.rs-9123227/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9123227/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground:\u003c/p\u003e\n\u003cp\u003eMalaria remains one of the leading causes of death worldwide among children under five. Effective prevention strategies remain crucial, but their implementation faces various challenges, notably the choice of the method of malaria prevention.\u003c/p\u003e\n\u003cp\u003eObjective:\u003c/p\u003e\n\u003cp\u003eThis study aimed to elicit the preferences for malaria prevention among caregivers of children under five years.\u003c/p\u003e\n\u003cp\u003eMethod: A discrete choice experiment (DCE) was designed and administered to 250 caregivers at the Federal Teaching Hospital, Gombe, Nigeria. Six attributes were identified from relevant studies. Each participant was presented with two (2) choice sets, from which they selected one, while a Chi-square test was employed to estimate the preference parameters and willingness to pay for the malaria vaccine. A p-value of \u0026lt;0.05 was considered statistically significant at a 95% confidence interval. Data were analysed using John's Macintosh Project software (JMP) version 18.0.\u003c/p\u003e\n\u003cp\u003eResults:\u003c/p\u003e\n\u003cp\u003eMarginal utility estimates indicated that the caregivers preferred malaria vaccine (0.34) over chemoprophylaxis tablets (-0.34) (p=0.0001, X²=67.21), with community pharmacy (0.12) being the favoured location compared to home (0.10) or clinic (-0.22) (p=0.0001, X²=26.03). The most important attribute was 90% efficacy (1.15, p=0.0001, X²=863.46) and a waiting time of 20 minutes (0.25, p=0.0001, X²=45.52). Participants were willing to pay $0.33 more for vaccination at a community pharmacy compared to vaccination at home.\u003c/p\u003e\n\u003cp\u003eConclusion:\u003c/p\u003e\n\u003cp\u003eThis study found community pharmacy as the preferred location for vaccination, and efficacy to be the most important study attribute for vaccine preferences. Insights from this study can inform malaria vaccine implementation programs\u003c/p\u003e","manuscriptTitle":"Assessment of Caregiver Preferences for Malaria Prevention Strategies","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-07 10:10:28","doi":"10.21203/rs.3.rs-9123227/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-18T21:26:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"102046891486272955420232032302557887819","date":"2026-05-08T02:10:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"279519232826701387951938904973618610492","date":"2026-05-07T10:36:09+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-01T07:48:55+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-17T05:30:43+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-17T05:30:17+00:00","index":"","fulltext":""},{"type":"submitted","content":"Malaria Journal","date":"2026-03-14T14:06:04+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":"4048c032-9f82-4086-a04c-d29c4efeab2a","owner":[],"postedDate":"April 7th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-18T21:26:45+00:00","index":37,"fulltext":""},{"type":"reviewerAgreed","content":"102046891486272955420232032302557887819","date":"2026-05-08T02:10:35+00:00","index":35,"fulltext":""},{"type":"reviewerAgreed","content":"279519232826701387951938904973618610492","date":"2026-05-07T10:36:09+00:00","index":34,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-07T10:10:28+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-07 10:10:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9123227","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9123227","identity":"rs-9123227","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}