Typhoid knowledge, prevention practices, and vaccine awareness in high-risk communities of Lilongwe, Malawi

Typhoid fever remains a significant public health challenge in Malawi, particularly in urban and peri-urban areas with limited access to safe water, sanitation and hygiene. Although the typhoid conjugate vaccine has been introduced into the national immunization schedule, data on community knowledge, attitudes and practices (KAP) toward typhoid and its prevention remain scarce. This study assessed KAP levels among high-risk populations in Lilongwe to inform targeted public health interventions.

A cross-sectional community-based study was conducted in May 2025 across selected urban and peri-urban areas of Lilongwe. A total of 390 participants were interviewed using a structured KAP questionnaire guided by the Health Belief Model. Data were analysed using SPSS and Stata, with logistic regression applied to identify sociodemographic predictors of KAP outcomes.

Only 8.2% of respondents demonstrated adequate knowledge of typhoid, 17.7% had positive attitudes and 6.7% reported good preventive practices. Older age (adjusted odds ratio [AOR] 1.65 [95% confidence interval {CI} 1.07 to 2.55]) and higher education (AOR 3.67 [95% CI 1.62 to 8.30]) were positively associated with knowledge and attitudes toward typhoid prevention. Gender (AOR 0.24 [95% CI 0.08 to 0.72]) and higher household income (AOR 2.61 [95% CI 1.17 to 6.02]) were significantly associated with better preventive practices. Awareness of the typhoid conjugate vaccine was low at 16.7%, although 64.4% expressed a willingness to vaccinate their children.

Substantial gaps exist in community KAP and vaccine awareness related to typhoid. Strengthened health education and improved community sensitization on typhoid vaccination are urgently needed.