High Second-Year Immunisation Coverage Alongside Persistent Newer Vaccine Hesitancy: A Mixed-Methods Study in Three Districts of Malawi

Background/Objectives: Vaccines delivered after infancy remain vulnerable to missed uptake. Less is known about the determinants of second-year-of-life vaccine uptake in Malawi. This study assessed the completion of vaccines due after 12 months of age, caregiver confidence in newer vaccines, and associated factors in three districts of Malawi. Methods: A mixed-methods cross-sectional study surveyed 1177 caregivers. Logistic regression examined factors associated with caregiver-reported completion of vaccines due after 12 months among age-eligible children. Focus group discussions with caregivers and key-informant interviews with community volunteers and leaders were then analysed thematically to explain the survey findings. Results: Among 1287 age-eligible children, 94.2% completed second-year vaccines, although coverage of the Human papillomavirus (HPV) vaccine was lower. Distance over 5 kilometres from a facility was associated with lower odds of completion, while health worker reminders were associated with higher odds of vaccine completion (adjusted odds ratio 3.03, 95% confidence interval 1.61 to 5.88). Qualitative accounts highlighted defaulter tracing and infertility concerns about HPV (22.2%). Conclusions: Second-year coverage was high among caregivers reached by immunisation services, but distance and lower uptake of newer vaccines remained important gaps. Strengthening geographical access, communication about newer vaccines, and adequately resourced health-worker follow-up may improve completion.