Abstract
Respiratory Syncytial Virus (RSV) represents a predominant etiological agent of severe acute lower respiratory tract infections (ALRTIs) among infants and young children in The Gambia, contributing substantially to seasonal peaks in paediatric hospitalizations and mortality during the annual rainy season [1-3]. Despite recent global approvals of maternal RSV vaccines, their operational feasibility and sociocultural acceptability in resource-constrained settings remain inadequately characterized. This cross-sectional, mixed-methods study evaluated these parameters among 179 antenatal and lactating mothers attending Edward Francis Small Teaching Hospital (EFSTH) between June and August 2025, utilizing structured questionnaires complemented by qualitative insights from healthcare providers. Findings revealed critically deficient maternal awareness of RSV: merely 12.8% of participants acknowledged familiarity with the virus, and only 10.6% recognized its potential for life-threatening infant respiratory disease. Healthcare workers constituted the primary information source (82.6%). Paradoxically, willingness to accept maternal RSV vaccination was elevated (81.6% during pregnancy; 74.9% during lactation), predominantly motivated by trust in clinical recommendations. Primary barriers included safety apprehensions (88.8%), vaccine unavailability (41.9%), and limited awareness (79.3%). Multiparity significantly correlated with gestational vaccine acceptance (p = 0.004), while tertiary education predicted RSV awareness (p = 0.022). Hospital-based administration was preferred (88.3%). This study concludes that while maternal RSV vaccination is broadly acceptable in The Gambia, profound knowledge deficits and systemic impediments especially safety concerns and supply chain limitations compromise feasibility. Programmatic success necessitates integration into antenatal care (ANC) frameworks, provider-driven education initiatives, and fortified cold chain logistics. These evidence-based insights offer actionable guidance for policymakers developing context-specific maternal immunization strategies to mitigate infant RSV burden in analogous low-resource settings.