MisGenMas project: Understanding the drivers of vaccination decision-making in sub-Saharan Africa

Abstract

The MisGenMas project (2022–2024) investigated how gender dynamics, masculinity, and misinformation influence childhood vaccination decision-making in Kenya, Nigeria, and Malawi, using both qualitative and quantitative methods. The project confirmed its central hypothesis: gender disparity, masculine attitudes, and misinformation are critical determinants of vaccination behaviour in sub-Saharan Africa (SSA). Qualitative findings highlighted that caregivers’ decisions are shaped by inadequate knowledge of vaccine-preventable diseases, the attitudes of fathers (which can either support or block immunisation), the gender of the child (perceptions of girls as weaker and boys as stronger), and widespread misinformation (e.g., beliefs that vaccines contain harmful sterilising agents). Additional barriers included stock-outs of vaccines, weak reminder systems, poor communication of schedules, negative attitudes among healthcare workers, and limited trust between communities and providers. Quantitative analysis supported these insights. Gendered beliefs were strongly linked to vaccination behaviour: fathers’ approval increased the likelihood of child immunisation, while patriarchal norms reduced it. Misinformation was consistently associated with negative vaccination attitudes and lower uptake. Household income and religion also shaped perceptions, with Muslim participants showing stronger vaccine hesitancy. National comparisons revealed that Kenyan and Malawian caregivers generally showed higher vaccination intention and uptake than Nigerians. For example, the odds of child vaccination were 3.6 times higher in Kenya and 13.1 times higher in Malawi compared to Nigeria. The project also demonstrated that positive vaccination behaviour was strongly associated with trust in media sources, favourable attitudes, peer and community influence, and reduced costs. In contrast, low demand was linked to misinformation, fathers’ decision-making dominance, pandemic-related effects, and household gender bias. The MisGenMas project produced three manuscripts for open-access publication and provided valuable capacity-building, deepening understanding of how social norms such as gender, misinformation, and masculinity intersect to influence vaccination decisions in SSA.