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