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

Abstract

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 3^rd and 4^th 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.