PDF(Pubmed)
Abstract：
Malaria is a significant public health threat in sub-Saharan Africa, particularly among children. The RTS,S/AS01 malaria vaccine reduces the risk and severity of malaria in children. RTS,S/AS01 was piloted in three African countries, Ghana, Kenya and Malawi, to assess safety, feasibility and cost-effectiveness in real-world settings. A qualitative longitudinal study was conducted as part of the feasibility assessment. This analysis explores RTS,S/AS01 vaccination barriers and identifies potential motivators among caregivers in three sub-counties in western Kenya.
A cohort of 63 caregivers with a malaria vaccine eligible child was interviewed at three time points over 24 months. A sub-set of 11 caregivers whose eligible children were either partially or non-vaccinated were selected for this sub-analysis. The 5A Taxonomy for root causes of under-vaccination was used to organise the inductively-coded data into categories (awareness, acceptance, access, affordability, and activation) and identify the factors influencing uptake across caregivers. A trajectory analysis was conducted to understand changes in factors over time within each caregiver experience. Caregiver narratives are used to illustrate how the factors influencing uptake were interrelated and changed over time.
Lack of awareness, previous negative experiences with routine childhood immunisations and the burden of getting to the health facility contributed to caregivers initially delaying uptake of the vaccine. Over time concerns about vaccine side effects diminished and anticipated vaccination benefits strongly motivated caregivers to vaccinate their children. Persistent health system barriers (e.g., healthcare provider strikes, vaccine stockouts, negative provider attitudes) meant some children missed the first-dose eligibility window by aging-out.
Caregivers in this study believed the RTS,S/AS01 to be effective and were motivated to have their children vaccinated. Despite these positive perceptions of the malaria vaccine, uptake was substantially hindered by persistent health system constraints. Negative provider attitudes emerged as a powerful deterrent to attending immunisation services and hampered uptake of the vaccine. Strategies that focus on improving interpersonal communication skills among healthcare providers are needed.
A cohort of 63 caregivers with a malaria vaccine eligible child was interviewed at three time points over 24 months. A sub-set of 11 caregivers whose eligible children were either partially or non-vaccinated were selected for this sub-analysis. The 5A Taxonomy for root causes of under-vaccination was used to organise the inductively-coded data into categories (awareness, acceptance, access, affordability, and activation) and identify the factors influencing uptake across caregivers. A trajectory analysis was conducted to understand changes in factors over time within each caregiver experience. Caregiver narratives are used to illustrate how the factors influencing uptake were interrelated and changed over time.
Lack of awareness, previous negative experiences with routine childhood immunisations and the burden of getting to the health facility contributed to caregivers initially delaying uptake of the vaccine. Over time concerns about vaccine side effects diminished and anticipated vaccination benefits strongly motivated caregivers to vaccinate their children. Persistent health system barriers (e.g., healthcare provider strikes, vaccine stockouts, negative provider attitudes) meant some children missed the first-dose eligibility window by aging-out.
Caregivers in this study believed the RTS,S/AS01 to be effective and were motivated to have their children vaccinated. Despite these positive perceptions of the malaria vaccine, uptake was substantially hindered by persistent health system constraints. Negative provider attitudes emerged as a powerful deterrent to attending immunisation services and hampered uptake of the vaccine. Strategies that focus on improving interpersonal communication skills among healthcare providers are needed.
摘要：
背景：疟疾是撒哈拉以南非洲的重大公共卫生威胁，尤其是在儿童中。RTS,S/AS01疟疾疫苗可降低儿童疟疾的风险和严重程度。RTS,S/AS01在三个非洲国家试行，加纳,肯尼亚和马拉维,为了评估安全性，在现实环境中的可行性和成本效益。作为可行性评估的一部分，进行了定性纵向研究。本分析探讨了RTS，S/AS01疫苗接种障碍，并确定肯尼亚西部三个县护理人员的潜在动机。
方法：在24个月的三个时间点对63名接受疟疾疫苗合格儿童照顾者进行了访谈。选择其合格儿童部分接种或未接种疫苗的11个照顾者的子集用于该子分析。疫苗接种不足的根本原因的5A分类法用于将感应编码的数据组织为类别（意识，接受,access,负担能力，和激活)，并确定影响护理人员摄取的因素。进行了轨迹分析，以了解每个照顾者经历中因素随时间的变化。照顾者的叙述用于说明影响摄取的因素如何相互关联并随时间变化。
结果：缺乏意识，以往儿童常规免疫接种的负面经验和前往医疗机构的负担导致护理人员最初延迟接种疫苗.随着时间的推移，对疫苗副作用的担忧减少，预期的疫苗接种益处强烈促使护理人员为他们的孩子接种疫苗。持久性卫生系统障碍(例如，医疗保健提供者罢工，疫苗库存，消极的提供者态度）意味着一些儿童因老化而错过了第一剂合格窗口。
结论：这项研究中的护理人员认为RTS，S/AS01是有效的，并有动力让他们的孩子接种疫苗。尽管人们对疟疾疫苗有积极的看法，持续的卫生系统限制大大阻碍了摄取。消极的提供者态度成为参加免疫接种服务的强大威慑力量，并阻碍了疫苗的使用。需要专注于改善医疗保健提供者之间人际沟通技巧的策略。
方法：在24个月的三个时间点对63名接受疟疾疫苗合格儿童照顾者进行了访谈。选择其合格儿童部分接种或未接种疫苗的11个照顾者的子集用于该子分析。疫苗接种不足的根本原因的5A分类法用于将感应编码的数据组织为类别（意识，接受,access,负担能力，和激活)，并确定影响护理人员摄取的因素。进行了轨迹分析，以了解每个照顾者经历中因素随时间的变化。照顾者的叙述用于说明影响摄取的因素如何相互关联并随时间变化。
结果：缺乏意识，以往儿童常规免疫接种的负面经验和前往医疗机构的负担导致护理人员最初延迟接种疫苗.随着时间的推移，对疫苗副作用的担忧减少，预期的疫苗接种益处强烈促使护理人员为他们的孩子接种疫苗。持久性卫生系统障碍(例如，医疗保健提供者罢工，疫苗库存，消极的提供者态度）意味着一些儿童因老化而错过了第一剂合格窗口。
结论：这项研究中的护理人员认为RTS，S/AS01是有效的，并有动力让他们的孩子接种疫苗。尽管人们对疟疾疫苗有积极的看法，持续的卫生系统限制大大阻碍了摄取。消极的提供者态度成为参加免疫接种服务的强大威慑力量，并阻碍了疫苗的使用。需要专注于改善医疗保健提供者之间人际沟通技巧的策略。
