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Published on: November 1, 2011
RTS,S/AS01 malaria vaccine pilot implementation in western Kenya: a qualitative longitudinal study to understand
Jenna Hoyt1, George Okello2,3, Teresa Bange3
1Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. jennahoyt@gmail.com.
Insights
Caregiver motivation for the RTS,S/AS01 malaria vaccine was high, but health system barriers, including negative provider attitudes, hindered uptake. Improving healthcare provider communication is crucial for increasing childhood malaria vaccination coverage.
Area of Science:
- Global Health
- Vaccinology
- Public Health Policy
Background:
- Malaria remains a critical public health issue in sub-Saharan Africa, disproportionately affecting children.
- The RTS,S/AS01 malaria vaccine offers protection against malaria in young children.
- Real-world feasibility, safety, and cost-effectiveness of RTS,S/AS01 were assessed through pilot programs in Ghana, Kenya, and Malawi.
Purpose of the Study:
- To explore barriers and motivators for RTS,S/AS01 malaria vaccine uptake among caregivers in western Kenya.
- To identify factors influencing vaccine acceptance and utilization in a real-world setting.
- To understand caregiver perspectives on malaria vaccination over time.
Main Methods:
- A qualitative longitudinal study involving 63 caregivers over 24 months.
- Sub-analysis of 11 caregivers with partially or non-vaccinated children using the 5A Taxonomy.
- Inductive coding of data and trajectory analysis to track changes in influencing factors.
Main Results:
- Initial delays in RTS,S/AS01 uptake were linked to lack of awareness and logistical challenges.
- Caregiver concerns about vaccine side effects decreased over time, replaced by motivation due to perceived benefits.
- Persistent health system barriers, such as stockouts and negative provider attitudes, led to missed vaccination opportunities.
Conclusions:
- Caregivers perceived the RTS,S/AS01 malaria vaccine as effective and were motivated to vaccinate their children.
- Health system constraints, particularly negative healthcare provider attitudes, significantly impeded vaccine uptake.
- Enhancing interpersonal communication skills of healthcare providers is essential to improve malaria vaccine access and utilization.
Background:
Malaria is a significant public health threat in sub-Saharan Africa, particularly among children. The RTS,S/AS01 malaria vaccine reduces the risk and severity of malaria in children. RTS,S/AS01 was piloted in three African countries, Ghana, Kenya and Malawi, to assess safety, feasibility and cost-effectiveness in real-world settings. A qualitative longitudinal study was conducted as part of the feasibility assessment. This analysis explores RTS,S/AS01 vaccination barriers and identifies potential motivators among caregivers in three sub-counties in western Kenya.
Methods:
A cohort of 63 caregivers with a malaria vaccine eligible child was interviewed at three time points over 24 months. A sub-set of 11 caregivers whose eligible children were either partially or non-vaccinated were selected for this sub-analysis. The 5A Taxonomy for root causes of under-vaccination was used to organise the inductively-coded data into categories (awareness, acceptance, access, affordability, and activation) and identify the factors influencing uptake across caregivers. A trajectory analysis was conducted to understand changes in factors over time within each caregiver experience. Caregiver narratives are used to illustrate how the factors influencing uptake were interrelated and changed over time.
Results:
Lack of awareness, previous negative experiences with routine childhood immunisations and the burden of getting to the health facility contributed to caregivers initially delaying uptake of the vaccine. Over time concerns about vaccine side effects diminished and anticipated vaccination benefits strongly motivated caregivers to vaccinate their children. Persistent health system barriers (e.g., healthcare provider strikes, vaccine stockouts, negative provider attitudes) meant some children missed the first-dose eligibility window by aging-out.
Conclusions:
Caregivers in this study believed the RTS,S/AS01 to be effective and were motivated to have their children vaccinated. Despite these positive perceptions of the malaria vaccine, uptake was substantially hindered by persistent health system constraints. Negative provider attitudes emerged as a powerful deterrent to attending immunisation services and hampered uptake of the vaccine. Strategies that focus on improving interpersonal communication skills among healthcare providers are needed.
