Acceptance of and Adherence to a Four-Dose RTS,S/AS01 Schedule: Findings from a Longitudinal Qualitative Evaluation Study for the Malaria Vaccine Implementation Programme
Jessica Price,
Nikki Gurley,
Margaret Gyapong,
Evelyn Korkor Ansah,
Kofi Awusabo-Asare,
Samuel Fosu Gyasi,
Pearson Nkhoma,
Alinane Linda Nyondo-Mipando,
George Okello,
Jayne Webster,
Nicola Desmond,
Jenny Hill,
W. Scott Gordon
Affiliations
Jessica Price
PATH, 2201 Westlake Ave, Seattle, WA 98102, USA
Nikki Gurley
King County Department of Community and Human Services, 401 5th Ave #500, Seattle, WA 98104, USA
Margaret Gyapong
Institute of Health Research, University of Health and Allied Sciences, PMB 31, Ho, Volta Region, Ghana
Evelyn Korkor Ansah
Center for Malaria Research, University of Health and Allied Sciences, PMB 31, Ho, Volta Region, Ghana
Kofi Awusabo-Asare
Department of Population and Health, University of Cape Coast, New Administration Block, Cape Coast, Ghana
Samuel Fosu Gyasi
Center for Research in Applied Biology, School of Sciences, University of Energy and Natural Resources, P.O. Box 214, Sunyani, Ghana
Pearson Nkhoma
Goldsmiths, University of London, 8 Lewisham Way, New Cross, London SE14 6NW, UK
Alinane Linda Nyondo-Mipando
Department of Health Systems and Policy, Kamuzu University of Health Sciences, Private Bag 360, Blantyre 3, Malawi
George Okello
Kenya Medical Research Institute, Centre for Geographic Medicine, Kisumu P.O. Box 1578, Kenya
Jayne Webster
London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
Nicola Desmond
Department of International Public Health, Liverpool School of Tropical Medicine, University of Liverpool, Pembroke Pl, Liverpool L3 5QA, UK
Jenny Hill
Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Pl, Liverpool L3 5QA, UK
Background: The WHO recommended the use of the RTS,S/AS01 malaria vaccine (RTS,S) based on a pilot evaluation in routine use in Ghana, Kenya, and Malawi. A longitudinal qualitative study was conducted to examine facilitators and barriers to uptake of a 4-dose RTS,S schedule. Methods: A cohort of 198 caregivers of RTS,S-eligible children from communities where RTS,S was provided through the pilot were interviewed three times over a ≈22-month, 4-dose schedule. The interviews examined caregiver perceptions and behaviors. Children’s vaccination history was obtained to determine dose uptake. Results: 162 caregivers remained at round 3 (R3); vaccination history was available for 152/162 children. Despite early rumors/fears, the uptake of initial doses was high, driven by vaccine trust. Fears dissipated by R2, replaced with an enthusiasm for RTS,S as caregivers perceived its safety and less frequent and severe malaria. By R3, 98/152 children had received four doses; 34 three doses; 9 one or two doses; and 11 zero doses. The health system and information barriers were important across all under-dose cases. Fears about AEFIs/safety were important in zero-, one-, and two-dose cases. Competing life/livelihood demands and complacency were found in three-dose cases. Regardless of the doses received, caregivers had positive attitudes towards RTS,S by R3. Conclusions: Findings from our study will help countries newly introducing the vaccine to anticipate and preempt reasons for delayed acceptance and missed RTS,S doses.
