Peer-reviewed article
Integration of the RTS,S/AS01 malaria vaccine into the Essential Programme on Immunisation in western Kenya: a qualitative longitudinal study from the health system perspective.
Hill J, Bange T, Hoyt J, Kariuki S, Jalloh MF et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined how the RTS,S/AS01 malaria vaccine was integrated into Kenya's routine immunisation programme in western Kenya from 2019 to 2022. Researchers interviewed health workers, managers, and policymakers to understand the practical challenges and opportunities of vaccine delivery. While initial operational challenges existed, particularly around the four-dose schedule and low uptake of the fourth dose, health workers' confidence in the vaccine grew as they gained experience and saw reductions in malaria cases.
Key points
- Health-care providers initially struggled with the complexity of the four-dose RTS,S/AS01 schedule requiring administration up to 24 months of age
- Low uptake of the fourth dose remained a persistent challenge throughout the pilot period
- Self-efficacy among health-care providers increased over time as they gained experience with vaccine delivery
- Health managers identified insufficient trained immunisation staff and inadequate funding for supervision as major barriers
- Confidence in the vaccine increased across all participant groups due to observed reductions in malaria frequency and severity
Limitations
This is a qualitative study based on interviews and observations; it does not provide epidemiological data on malaria outcomes or vaccine efficacy. The study was conducted during a pilot phase with concurrent evaluation, which may not reflect routine programme conditions after full integration.
Abstract
Background Malaria accounts for over half a million child deaths annually. WHO recommends RTS,S/AS01 to prevent malaria in children living in moderate-to-high malaria transmission regions. We conducted a qualitative longitudinal study to investigate the contextual and dynamic factors shaping vaccine delivery and uptake during a pilot introduction in western Kenya. Methods The study was conducted between Oct 3, 2019, and Mar 24, 2022. We conducted participant and non-participant observations and in-depth interviews with health-care providers, health managers, and national policymakers at three timepoints using an iterative approach and observations of practices and processes of malaria vaccine delivery. Transcripts were coded by content analysis using the consolidated framework for implementation research, to which emerging themes were added deductively and categorised into challenges and opportunities. Findings We conducted 112 in-depth interviews with 60 participants (25 health-care providers, 27 managers, and eight policy makers). Health-care providers highlighted limitations in RTS,S/AS01 integration into routine immunisation services due to the concurrent pilot evaluation and temporary adaptations for health reporting. Initial challenges related to the complexity of the four-dose schedule (up to 24-months); however, self-efficacy increased over time as the health-care providers gained experience in vaccine delivery. Low uptake of the fourth dose remained a challenge. Health managers cited insufficient trained immunisation staff and inadequate funding for supervision. Confidence in the vaccine increased among all participant groups owing to reductions in malaria frequency and severity. Interpretation Integration of RTS,S/AS01 into immunisation services in western Kenya presented substantial operational challenges most of which were overcome in the first 2 years, providing important lessons for other countries. Programme expansion is feasible with intensive staff training and retention, enhanced supervision, and defaulter-tracing to ensure uptake of all doses. Funding PATH via World Health Organization; Gavi, the Vaccine Alliance; The Global Fund; and Unitaid.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Integration of RTS,S/AS01 malaria vaccine into routine immunisation services
- Population
- Children in western Kenya in areas with moderate-to-high malaria transmission
Key finding
Initial operational challenges included complexity of the four-dose schedule and low uptake of the fourth dose