Acceptance of and Adherence to a Four-Dose RTS,S/AS01 Schedule: Findings from a Longitudinal Qualitative Evaluation Study for the Malaria Vaccine Implementation Programme

Price, Jessica; Gurley, Nikki; Gyapong, Margaret; Ansah, Evelyn Korkor; Awusabo-Asare, Kofi; Gyasi, Samuel Fosu; Nkhoma, Pearson; Nyondo-Mipando, Alinane Linda; Okello, George; Webster, Jayne; Desmond, Nicola; Hill, Jenny; Gordon, W. Scott

doi:10.3390/vaccines11121801

Cited by 2 publications

(1 citation statement)

References 44 publications

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“…This finding is similar to reports by Price et al . [ 22 ] which reported that in first three implementing countries of malaria vaccine, information barrier contributed to no or partial uptake of malaria vaccine. Additionally, in Kenya, a recent study by Hoyt et al .…”

Section: Discussionmentioning

confidence: 99%

Factors associated with malaria vaccine uptake in Nsanje district, Malawi

Simbeye,

Kumwenda,

Cohee

et al. 2024

Malar J

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Background Malaria remains a significant global health burden affecting millions of people, children under 5 years and pregnant women being most vulnerable. In 2019, the World Health Organization (WHO) endorsed the introduction of RTS,S/AS01 malaria vaccine as Phase IV implementation evaluation in three countries: Malawi, Kenya and Ghana. Acceptability and factors influencing vaccination coverage in implementing areas is relatively unknown. In Malawi, only 60% of children were fully immunized with malaria vaccine in Nsanje district in 2021, which is below 80% WHO target. This study aimed at exploring factors influencing uptake of malaria vaccine and identify approaches to increase vaccination. Methods In a cross-sectional study conducted in April–May, 2023, 410 mothers/caregivers with children aged 24–36 months were selected by stratified random sampling and interviewed using a structured questionnaire. Vaccination data was collected from health passports, for those without health passports, data was collected using recall history. Regression analyses were used to test association between independent variables and full uptake of malaria vaccine. Results Uptake of malaria vaccine was 90.5% for dose 1, but reduced to 87.6%, 69.5% and 41.2% for dose 2, 3, and 4 respectively. Children of caregivers with secondary or upper education and those who attended antenatal clinic four times or more had increased odds of full uptake of malaria vaccine [OR: 2.43, 95%CI 1.08–6.51 and OR: 1.89, 95%CI 1.18–3.02], respectively. Children who ever suffered side-effects following immunization and those who travelled long distances to reach the vaccination centre had reduced odds of full uptake of malaria vaccine [OR: 0.35, 95%CI 0.06–0.25 and OR: 0.30, 95%CI 0.03–0.39] respectively. Only 17% (n = 65) of mothers/caregivers knew the correct schedule for vaccination and 38.5% (n = 158) knew the correct number of doses a child was to receive. Conclusion Only RTS,S dose 1 and 2 uptake met WHO coverage targets. Mothers/caregivers had low level of information regarding malaria vaccine, especially on numbers of doses to be received and dosing schedule. The primary modifiable factor influencing vaccine uptake was mother/caregiver knowledge about the vaccine. Thus, to increase the uptake Nsanje District Health Directorate should strengthen communities’ education about malaria vaccine. Programmes to strengthen mother/caregiver knowledge should be included in scale-up of the vaccine in Malawi and across sub-Saharan Africa.

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Section: Discussionmentioning

confidence: 99%

Factors associated with malaria vaccine uptake in Nsanje district, Malawi

Simbeye,

Kumwenda,

Cohee

et al. 2024

Malar J

View full text Add to dashboard Cite

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Gaps in the implementation of RTS, S malaria vaccine contributing to the low uptake in an endemic area of western Kenya

Okanda,

Kwach,

Abuonji

et al. 2024

Preprint

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Background: Globally in 2021, there were an estimated 247 million malaria cases in 85 malaria-endemic countries which accounted for over 619,000 deaths worldwide. In every 1000 live births, 84 die before attaining 5 years in Kenya. Nonetheless, presently, there is a malaria vaccine which an affordable intervention for children under 5 years of age. However, there is low uptake of 3rd and 4th doses with very limited information on the gaps in the implementation of this vaccine to inform strategies to improve the uptake. Materials and Methods: Study design: The study employed an exploratory study design. Purposive sampling method was used to select participants for focus group discussions (FGDs) and key informant interviews (KIIs). Four FGDs were conducted, 3 of them were 25 parent/guardian whose children either completed or didn’t complete the recommended 4 doses of RTS, S or didn’t receive the vaccine at all, and one with 11 community health volunteers (CHVs). The KII involved 11 healthcare providers(nurses) in charge of maternal and child health (MCH) clinics. Open ended interview guides were used for the FGDs and KIIs. Data was analyzed thematically using NVIVO software version 12. Results: The gaps in malaria vaccine implementation are inadequate information/knowledge about the vaccine to both parents/guardians and healthcare providers, less confidence in the vaccine due to side effects and high number of doses. Others are the poor attitude of health care providers, vaccine unavailability, understaffing of the health providers resulting in long waiting times, and migration to non-implementing sub-counties. Conclusion: The gaps in the implementation of the malaria vaccine; Inadequate knowledge about the vaccine, less confidence about the vaccine, poor attitude of health care providers, migrations, vaccine unavailability, long waiting queue due to staff understaffing, economic activities, cultural beliefs and inadequate trainings of health care providers. Recommendation: Adequate health education, adequate support of the vaccine implementation program, adequate staffing and continuous training of healthcare provider. There’s need to develop strategies for implementation of the vaccine in specific settings in malaria-endemic areas for improved and sustainable RTS, S vaccine uptake.

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Acceptance of and Adherence to a Four-Dose RTS,S/AS01 Schedule: Findings from a Longitudinal Qualitative Evaluation Study for the Malaria Vaccine Implementation Programme

Cited by 2 publications

References 44 publications

Factors associated with malaria vaccine uptake in Nsanje district, Malawi

Factors associated with malaria vaccine uptake in Nsanje district, Malawi

Gaps in the implementation of RTS, S malaria vaccine contributing to the low uptake in an endemic area of western Kenya

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