Community perceptions of malaria and vaccines in the South Coast and Busia regions of Kenya

Abstract

BackgroundMalaria is a leading cause of morbidity and mortality in children younger than 5 years in Kenya. Within the context of planning for a vaccine to be used alongside existing malaria control methods, this study explores sociocultural and health communications issues among individuals who are responsible for or influence decisions on childhood vaccination at the community level.MethodsThis qualitative study was conducted in two malaria-endemic regions of Kenya--South Coast and Busia. Participant selection was purposive and criterion based. A total of 20 focus group discussions, 22 in-depth interviews, and 18 exit interviews were conducted.ResultsParticipants understand that malaria is a serious problem that no single tool can defeat. Communities would welcome a malaria vaccine, although they would have questions and concerns about the intervention. While support for local child immunization programs exists, limited understanding about vaccines and what they do is evident among younger and older people, particularly men. Even as health care providers are frustrated when parents do not have their children vaccinated, some parents have concerns about access to and the quality of vaccination services. Some women, including older mothers and those less economically privileged, see themselves as the focus of health workers' negative comments associated with either their parenting choices or their children's appearance. In general, parents and caregivers weigh several factors--such as personal opportunity costs, resource constraints, and perceived benefits--when deciding whether or not to have their children vaccinated, and the decision often is influenced by a network of people, including community leaders and health workers.ConclusionsThe study raises issues that should inform a communications strategy and guide policy decisions within Kenya on eventual malaria vaccine introduction. Unlike the current practice, where health education on child welfare and immunization focuses on women, the communications strategy should equally target men and women in ways that are appropriate for each gender. It should involve influential community members and provide needed information and reassurances about immunization. Efforts also should be made to address concerns about the quality of immunization services--including health workers' interpersonal communication skills.

Acceptance of a malaria vaccine by caregivers of sick children in Kenya

“…Upon investigating the acceptability and attitudes of child caregivers toward a malaria vaccine in all eight regions of Kenya, it was found that the majority of caregivers would support the introduction of a malaria vaccine. Previous studies in Kenya, Tanzania, Mozambique, and Ghana similarly demonstrated a widespread support for a possible new malaria vaccine [11-13]. Reduced mortality and morbidity were the main reasons stated for acceptance of the vaccine, whereas many would not accept the vaccine due to a combination of possible side effects and incomplete vaccine protection.…”

Malaria vaccine

“…These groups receive 3 doses of RTS,S/AS01 vaccine at 1 mo intervals. 9,[19][20][21] Initial results show that the RTS,S/AS01 vaccine reduced malaria by 50% in children 5-17 mo of age during the 12 mo after vaccination. These results are promising and consistent with findings from phase 2 trials.…”

RTS,S malaria vaccine development: progress and considerations for postapproval introduction

“…However, the burden of malaria is very well known to the community members and there is a critical community demand for a malaria vaccine. 67,68 This demand for a vaccine is likely to make community acceptance of a new vaccine easier. On the other hand, the high demand for a malaria vaccine may make community members perceive a partially efficacious malaria vaccine as a magic bullet for malaria control that could lead to a reduction in the use of other malaria control interventions such as bednets.…”