Preliminary insights into knowledge and attitudes toward malaria vaccination among Sudanese healthcare workers: an exploratory cross-sectional study

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.

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.

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).

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.