Sarah Karanja1,David Ojakaa2, Jordan Jarvis3, Mary Matilu4 and Sylla Thiam5
1.AMREF Kenya2.Formerly with AMREF Kenya3.AMREF Canada4.KEMRI5.Amref Health in Africa Headquarters
Amref Health in Africa International Conference24th – 26th October, Nairobi, Kenya
Acceptance of a Malaria Vaccine by Caregivers of Sick Children in Kenya
Overview of Presentation • Introduction• Background • Study objectives• Methods• Variables captured • Results • Conclusion and recommendations
Introduction• Malaria a life threatening parasitic disease • About 70% of Kenyan population at risk
(NMCP)• Kenyan response is broad - four pronged• Nevertheless KMIS 2010 shows gaps
persist: – ITN coverage is one net for five people– 25% of expectant women received IPT
at ANC • Malaria vaccine – close gap left by these
interventions
Background • Several malaria vaccines are currently in
clinical trials.
• GSK’s RTS,S is currently in Phase 3 clinical development
• Consider sociocultural environment of region for widespread approval.
• In 2010 AMREF conducted this study on behalf of PATH Malaria Vaccine Initiative
Study Objectives• General:
To analyse and share complimentary information on attitudes of individuals in Kenya towards a possible malaria vaccine
• Specific:
Determine attitudes of caregivers towards a malaria vaccine
Identify key factors influencing attitudes of caregivers
Methods
• Exit interviews with 2003 caregivers in 695 health facilities across Kenya during the 2010 KSPA
• Descriptive statistics (cross-tabulation) and multinomial regression were used to analyze the determinants of accepting a child to be immunized with the malaria vaccine.
List of Variables for Analysis• Facility /Community– level factors:
– Facility type; Operating authority; Fees for services?; Opinion on services
• Sick child – characteristics – Type of visit; Diagnosis for malaria; Taking malaria
drug; Problems causing visit • Caregiver – characteristics
– Opinion of services received; Relationship to the sick child; Socio-demographic characteristics
• Malaria vaccine questions – Whether would accept young child in community or own
child getting the malaria vaccine.
Characteristics of CaregiversCharacteristics of respondents
Per cent
Sex Female 93.5Male 6.5Age <20 8.220-34 76.635-49 13.650+ 1.6Relationship to child Mother 90.3Father 5.9Other 3.8
Characteristics of Sick ChildrenCharacteristic PercentageSex Female 53Male 47Age (years) <1 33.71-2 302-3 17.23-4 11.64-5 7.5Malaria diagnosis (clinical) Yes 38.1No 61.9Malaria test (blood smear or rapid test)
Positive 16.1Negative 83.9
Acceptance of Child Vaccination
Child in community
Own child
% %
Yes 88.7 88.0
No 4.6 4.6
Don’t know 6.7 7.4
Caregivers educational factor and acceptance of vaccine
Factors Vaccination in community
Vaccination of own child
Yes
No Don't know
Yes No Don't know
% Ever attended school
Yes (85.9%) 94 3 3 93 4 3
No (14.1%) 56 13 31 55 7 38 Literacy Read and write (64%) 96 2 2 95 3 2 Read only (4.08%)
74 6 20 71 8 21 None (32%) 69 9 22 69 5 26
Approval of Vaccine by Region
Region Approval of Vaccine (%)
Nyanza 98.9
Coast 98.7
Eastern 97.8
Central 96.7
Western 95.4
Rift Valley 91
Nairobi 87
North Eastern 23
Factors associated with acceptance of malaria vaccine Variable RRR P-value
Region:
Central 4.0 **
Coast 13.1 ***
Eastern 8.7 ***
North Eastern 0.3 *
Nyanza 12.0 ***
Rift Valley 3.2 **
Western 3.7 **
Satisfaction with health services:
Somewhat 0.5 **
Age of Caretaker:
35-49 0.3 *
50+ 0.1 *
Ever Attended school
No 0.4 *
*** p<0.001 **p<0.01 *p<0.05
Conclusion and recommendations
• The results show high endorsement and expectations of the vaccine, except for North Eastern Province.
• This calls for the need to carefully manage the expectations as the vaccine is released
• Target specific segments of child caregivers with relevant messages and education on the malaria vaccine
• Target audiences include residents where acceptance is low; older caregivers and those with low literacy levels; service providers
Acknowledgements • PATH MVI: for funding• National Council for Population and
Development (NCPD) for coordination of KSPA
• Division of Vaccines and Immunization: Advice on priority research questions
• Division of Malaria Control: Support• ICF Macro: Providing the datasets • AMREF: Technical/Administrative Support
THANK YOU