Knowledge without Conviction: Education, Information Pathways, and Paradoxical Attitudes toward Malaria Vaccination among Pregnant Women and Mothers in a High-burden Setting

International audience Background: Malaria vaccines complement established control measures, but their population-level impact depends on caregiver acceptance.Aims: This study examined how education, awareness, information sources, risk perception, and beliefs about effectiveness were related to maternal knowledge and willingness to accept malaria vaccination.Methods: A cross-sectional survey of 530 mothers assessed knowledge of malaria vaccination, awareness of the RTS, S vaccine, perceptions of safety, beliefs regarding effectiveness, and willingness to vaccinate. Associations were examined using chi-square tests, one-way analysis of variance, Pearson correlation, and multivariable regression analyses.Results: Overall, 72.8% of mothers demonstrated knowledge of malaria vaccination (mean knowledge score = 0.73 ± 0.45). Knowledge was significantly associated with educational level (χ² = 9.15, df = 3, p = 0.027), although the effect size was weak (Φ = 0.13). Notably, 28.7% of mothers with tertiary education lacked knowledge. Awareness of the RTS, S vaccine did not significantly predict knowledge (OR = 1.18, p = 0.457; Nagelkerke R² = 0.002). Information sources explained 12.7% of the variance in knowledge (F = 7.54, p < 0.001), with television (β = 0.22, p = 0.015), friends (β = 0.26, p = 0.003), family (β = 0.16, p = 0.001), and posters (β = 0.12, p = 0.027) emerging as significant predictors. Despite a relatively high perception of vaccine safety (73.0%), only 21.7% of mothers expressed willingness to receive the vaccine. Awareness of malaria-related mortality was paradoxically associated with lower willingness (χ² = 10.13, p = 0.001). Belief in vaccine effectiveness was negatively correlated with willingness (r = −0.11, p = 0.013).Conclusions: High maternal knowledge of malaria vaccination did not translate into acceptance. Informal and media-based information channels exerted greater influence than formal health systems, while risk awareness may have unintentionally increased resistance. Addressing cognitive–attitudinal disconnects is essential for scaling up malaria vaccination.