PDF(Pubmed)
Abstract：
BACKGROUND: Malaria remains a significant global health burden affecting millions of people, children under 5 years and pregnant women being most vulnerable. In 2019, the World Health Organization (WHO) endorsed the introduction of RTS,S/AS01 malaria vaccine as Phase IV implementation evaluation in three countries: Malawi, Kenya and Ghana. Acceptability and factors influencing vaccination coverage in implementing areas is relatively unknown. In Malawi, only 60% of children were fully immunized with malaria vaccine in Nsanje district in 2021, which is below 80% WHO target. This study aimed at exploring factors influencing uptake of malaria vaccine and identify approaches to increase vaccination.
METHODS: In a cross-sectional study conducted in April-May, 2023, 410 mothers/caregivers with children aged 24-36 months were selected by stratified random sampling and interviewed using a structured questionnaire. Vaccination data was collected from health passports, for those without health passports, data was collected using recall history. Regression analyses were used to test association between independent variables and full uptake of malaria vaccine.
RESULTS: Uptake of malaria vaccine was 90.5% for dose 1, but reduced to 87.6%, 69.5% and 41.2% for dose 2, 3, and 4 respectively. Children of caregivers with secondary or upper education and those who attended antenatal clinic four times or more had increased odds of full uptake of malaria vaccine [OR: 2.43, 95%CI 1.08-6.51 and OR: 1.89, 95%CI 1.18-3.02], respectively. Children who ever suffered side-effects following immunization and those who travelled long distances to reach the vaccination centre had reduced odds of full uptake of malaria vaccine [OR: 0.35, 95%CI 0.06-0.25 and OR: 0.30, 95%CI 0.03-0.39] respectively. Only 17% (n = 65) of mothers/caregivers knew the correct schedule for vaccination and 38.5% (n = 158) knew the correct number of doses a child was to receive.
CONCLUSIONS: Only RTS,S dose 1 and 2 uptake met WHO coverage targets. Mothers/caregivers had low level of information regarding malaria vaccine, especially on numbers of doses to be received and dosing schedule. The primary modifiable factor influencing vaccine uptake was mother/caregiver knowledge about the vaccine. Thus, to increase the uptake Nsanje District Health Directorate should strengthen communities\' education about malaria vaccine. Programmes to strengthen mother/caregiver knowledge should be included in scale-up of the vaccine in Malawi and across sub-Saharan Africa.
METHODS: In a cross-sectional study conducted in April-May, 2023, 410 mothers/caregivers with children aged 24-36 months were selected by stratified random sampling and interviewed using a structured questionnaire. Vaccination data was collected from health passports, for those without health passports, data was collected using recall history. Regression analyses were used to test association between independent variables and full uptake of malaria vaccine.
RESULTS: Uptake of malaria vaccine was 90.5% for dose 1, but reduced to 87.6%, 69.5% and 41.2% for dose 2, 3, and 4 respectively. Children of caregivers with secondary or upper education and those who attended antenatal clinic four times or more had increased odds of full uptake of malaria vaccine [OR: 2.43, 95%CI 1.08-6.51 and OR: 1.89, 95%CI 1.18-3.02], respectively. Children who ever suffered side-effects following immunization and those who travelled long distances to reach the vaccination centre had reduced odds of full uptake of malaria vaccine [OR: 0.35, 95%CI 0.06-0.25 and OR: 0.30, 95%CI 0.03-0.39] respectively. Only 17% (n = 65) of mothers/caregivers knew the correct schedule for vaccination and 38.5% (n = 158) knew the correct number of doses a child was to receive.
CONCLUSIONS: Only RTS,S dose 1 and 2 uptake met WHO coverage targets. Mothers/caregivers had low level of information regarding malaria vaccine, especially on numbers of doses to be received and dosing schedule. The primary modifiable factor influencing vaccine uptake was mother/caregiver knowledge about the vaccine. Thus, to increase the uptake Nsanje District Health Directorate should strengthen communities\' education about malaria vaccine. Programmes to strengthen mother/caregiver knowledge should be included in scale-up of the vaccine in Malawi and across sub-Saharan Africa.
摘要：
背景：疟疾仍然是影响数百万人的重大全球健康负担，5岁以下儿童和孕妇最容易受到伤害。2019年，世界卫生组织（WHO）批准引入RTS，S/AS01疟疾疫苗作为第四阶段实施评估在三个国家:马拉维,肯尼亚和加纳。实施地区的可接受性和影响疫苗接种覆盖率的因素相对未知。在马拉维,2021年，在Nsanje地区，只有60%的儿童获得了疟疾疫苗的全面免疫，低于80%的世卫组织目标。本研究旨在探索影响疟疾疫苗接种的因素，并确定增加疫苗接种的方法。
方法：在4月至5月进行的一项横断面研究中，2023年，通过分层随机抽样选择410名24-36个月儿童的母亲/照顾者，并使用结构化问卷进行访谈。疫苗接种数据是从健康护照上收集的，对于那些没有健康护照的人来说，使用召回历史记录收集数据.回归分析用于测试独立变量与疟疾疫苗完全摄取之间的关联。
结果：剂量1的疟疾疫苗的摄取率为90.5%，但减少到87.6%，剂量2、3和4分别为69.5%和41.2%。具有中等或高学历的看护者的儿童以及在产前诊所就诊四次或更多次的儿童完全接种疟疾疫苗的可能性增加[OR：2.43，95CI1.08-6.51和OR：1.89，95CI1.18-3.02]，分别。免疫接种后曾遭受副作用的儿童和长途跋涉到达疫苗接种中心的儿童完全接种疟疾疫苗的几率降低[分别为:0.35,95CI0.06-0.25和OR:0.30,95CI0.03-0.39]。只有17％（n=65）的母亲/护理人员知道正确的疫苗接种时间表，而38.5％（n=158）知道儿童应接受的正确剂量。
结论：只有RTS，S剂量1和2的摄取达到了世卫组织的覆盖目标。母亲/照顾者对疟疾疫苗的信息水平很低，特别是要接受的剂量数量和给药时间表。影响疫苗摄取的主要可改变因素是母亲/护理人员对疫苗的了解。因此，为了提高Nsanje地区卫生局的使用率，应该加强社区对疟疾疫苗的教育。马拉维和整个撒哈拉以南非洲的疫苗推广中应包括加强母亲/照顾者知识的方案。
方法：在4月至5月进行的一项横断面研究中，2023年，通过分层随机抽样选择410名24-36个月儿童的母亲/照顾者，并使用结构化问卷进行访谈。疫苗接种数据是从健康护照上收集的，对于那些没有健康护照的人来说，使用召回历史记录收集数据.回归分析用于测试独立变量与疟疾疫苗完全摄取之间的关联。
结果：剂量1的疟疾疫苗的摄取率为90.5%，但减少到87.6%，剂量2、3和4分别为69.5%和41.2%。具有中等或高学历的看护者的儿童以及在产前诊所就诊四次或更多次的儿童完全接种疟疾疫苗的可能性增加[OR：2.43，95CI1.08-6.51和OR：1.89，95CI1.18-3.02]，分别。免疫接种后曾遭受副作用的儿童和长途跋涉到达疫苗接种中心的儿童完全接种疟疾疫苗的几率降低[分别为:0.35,95CI0.06-0.25和OR:0.30,95CI0.03-0.39]。只有17％（n=65）的母亲/护理人员知道正确的疫苗接种时间表，而38.5％（n=158）知道儿童应接受的正确剂量。
结论：只有RTS，S剂量1和2的摄取达到了世卫组织的覆盖目标。母亲/照顾者对疟疾疫苗的信息水平很低，特别是要接受的剂量数量和给药时间表。影响疫苗摄取的主要可改变因素是母亲/护理人员对疫苗的了解。因此，为了提高Nsanje地区卫生局的使用率，应该加强社区对疟疾疫苗的教育。马拉维和整个撒哈拉以南非洲的疫苗推广中应包括加强母亲/照顾者知识的方案。
