Country planning for health interventions under development: lessons from the malaria vaccine decision-making framework and implications for other new interventions

Traditionally it has taken years or decades for new public health interventions targeting diseases found in developing countries to be accessible to those most in need. One reason for the delay has been insufficient anticipation of the eventual processes and evidence required for decision making by countries. This paper describes research into the anticipated processes and data needed to inform decision making on malaria vaccines, the most advanced of which is still in phase 3 trials. From 2006 to 2008, a series of country consultations in Africa led to the development of a guide to assist countries in preparing their malaria vaccine decision-making frameworks. The guide builds upon the World Health Organization's Vaccine Introduction Guidelines. It identifies the processes and data for decisions, when they would be needed relative to the development timelines of the intervention, and where they will come from. Policy development will be supported by data (e.g. malaria disease burden; roles of other malaria interventions; malaria vaccine impact; economic and financial issues; malaria vaccine efficacy, quality and safety) as will implementation decisions (e.g. programmatic issues and socio-cultural environment). This generic guide can now be applied to any future malaria vaccine. The paper discusses the opportunities and challenges to early planning for country decision-making—from the potential for timely, evidence-informed decisions to the risks of over-promising around an intervention still under development. Careful and well-structured planning by countries is an important way to ensure that new interventions do not remain unused for years or decades after they become availabl

Community perceptions of malaria and vaccines in two districts of Mozambique

Abstract Background Malaria is a leading cause of mortality and morbidity in Mozambique, with nearly three-quarters of the country’s malaria-related deaths occurring in children younger than five years. A malaria vaccine is not yet available, but planning is underway for a possible introduction, as soon as one becomes available. In an effort to inform the planning process, this study explored sociocultural and health communications issues among individuals at the community level who are both responsible for decisions about vaccine use and who are likely to influence decisions about vaccine use. Methods Researchers conducted a qualitative study in two malaria-endemic districts in southern Mozambique. Using criterion-based sampling, they conducted 23 focus group discussions and 26 in-depth interviews. Implementation was guided by the engagement of community stakeholders. Results Community members recognize that malaria contributes to high death rates and affects the workforce, school attendance, and the economy. Vaccines are seen as a means to reduce the threat of childhood illnesses and to keep children and the rest of the community healthy. Perceived constraints to accessing vaccine services include long queues, staff shortages, and a lack of resources at health care facilities. Local leaders play a significant role in motivating caregivers to have their children vaccinated. Participants generally felt that a vaccine could help to prevent malaria, although some voiced concern that the focus was only on young children and not on older children, pregnant women, and the elderly. Probed on their understanding of vaccine efficacy, participants voiced various views, including the perception that while some vaccines did not fully prevent disease they still had important benefits. Overall, it would be essential for local leaders to be involved in the design of specific messages for a future malaria vaccine communications strategy, and for those messages to be translated into local languages. Conclusions Acceptance of routine childhood vaccines bodes well for a future malaria vaccine. Vaccinating children is a well-established routine that is viewed favourably in Mozambique. A communications strategy would need to build on existing immunization efforts and use trusted sources—including current government dissemination arrangements—to deliver health information

Full immunization coverage and its determinants among children aged 12-23 months in Wogera district, Northwest Ethiopia

AbstractBackground: Immunization is considered one of the most affordable health initiatives for children. Though there is good progress in Ethiopia, the amount of fully vaccinated children, is still below the target. Possible challenges include women having home visits and men’s’ involvement in vaccination uptake. Therefore, this study aimed to determine full immunization coverage and its determinants among children aged 12- 23 months in Wogera districts, Northwest Ethiopia.Aim: This study aimed to determine the full immunization coverage and its determinants among children aged 12-23 months, and to assess the level of immunization coverage and its determinants in Wogera districts, Northwest Ethiopia.Methods: A community-based cross-sectional study was conducted in Wogera district from May 28-June 25/2020. Cluster sampling method was used to recruit 598 study participants. Interviewer administered questionnaire was used to collect data. A bivariable and multivariable logistic regression analysis was done to identify factors associated with full immunization. Odds ratios with 95% Confidence intervals were used to determine significant variables.Results: A total of 584 mothers who had children aged 12-23 months participated in this study. The full immunization coverage was 76.5% (95%CI 73.2-79.8). Mother age >40 years (AOR=7.37, 95% CI: 1.65, 32); mothers who initiate vaccine uptake(woman empowerment) (AOR=1.57, 95% CI: 1.13-2.39); mothers who had 1-3 ANC visit (AOR=2.51, 95% CI:1.14, 5.52), and 4+ ANC follow up (AOR=2.73,95% CI: 1.26, 5.91); r health extension worker's home visit during the first weeks of postpartum period (AOR=1.76,95% CI:1.10, 2.84), and males involved in child immunization (AOR=3.27, 95% CI:1.84, 5.81) was positively associated with being fully vaccinated , however, birth order of 6 and above (AOR=0.35, 95% CI: 0.14, 0.86) was negatively associated with being fully vaccinated.Conclusion: In this study, the full immunization coverage is found to be suboptimal, and it is far from the expected national target coverage. Maternal health care uptake; women empowerment; home visits by HEW during the first week of the postpartum period and male involvement in child immunization were found to be predictors of being fully vaccinated. [Ethiop. J. Health Dev. 2021; 35(SI-3):16-27]Keywords: Full immunization, Children12-23 months, Northwest Ethiopia, Male involvemen

Strategies to revitalize immunization service provision in urban settings of Ethiopia

AbstractBackground: Improving routine immunization in the urban population is an essential element to address immunization coverage and equity. In rural areas, deliberate efforts are made to reach the populations using adapted strategies such as outreaches while specificities of urban populations are generally not considered in immunization programs of Ethiopia.Aim: To explore the barriers and alternative strategies for immunization service provision in urban settings of Ethiopia.Methods: A qualitative study with a phenomenological study design was conducted in selected cities of Addis Ababa, Dire Dawa and Mekele from June to August 2020. Data was collected at different levels of the health system and the community by using a piloted interview guide. Thirty-five key informants and nine in-depth interviews were conducted. Audio-records of interviews were transcribed verbatim, coded and thematic analysis was performed using Open code version 4.02. software.Results: Our finding revealed that the routine immunization service provision strategy in Addis Ababa, Dire Dawa and Mekele cities was a static approach. Service inaccessibility, poor defaulter tracking mechanisms, substandard service in private facilities, shortage of supplies, and lack of training were the main barriers. We explored alternative strategies to revitalize the Expanded Program on Immunization (EPI) including, expanding services to marginalized populations, outreach/home to home service provision, expanding services to private health facilities, and inter-facility linkage through digitalization.Conclusions: The existing immunization service provision strategies in urban settings are not adequate to reach all children. Immunization service inaccessibility and substandard services were the main barriers hindering service provision. Program managers should expand routine service access to marginalized populations through outreach services, by strengthening the public-private partnership, and integrating technological innovations (like digitalization of the EPI program and application of mHealth reminders) to facilitate inter-facility linkage. [Ethiop. J. Health Dev. 2021; 35(SI-3):98-110]Keywords: Immunization, Vaccination, Urban, Revitalize, Private Facility, Ethiopi

Community perceptions of malaria and vaccines in the South Coast and Busia regions of Kenya

<p>Abstract</p> <p>Background</p> <p>Malaria is a leading cause of morbidity and mortality in children younger than 5 years in Kenya. Within the context of planning for a vaccine to be used alongside existing malaria control methods, this study explores sociocultural and health communications issues among individuals who are responsible for or influence decisions on childhood vaccination at the community level.</p> <p>Methods</p> <p>This qualitative study was conducted in two malaria-endemic regions of Kenya--South Coast and Busia. Participant selection was purposive and criterion based. A total of 20 focus group discussions, 22 in-depth interviews, and 18 exit interviews were conducted.</p> <p>Results</p> <p>Participants understand that malaria is a serious problem that no single tool can defeat. Communities would welcome a malaria vaccine, although they would have questions and concerns about the intervention. While support for local child immunization programs exists, limited understanding about vaccines and what they do is evident among younger and older people, particularly men. Even as health care providers are frustrated when parents do not have their children vaccinated, some parents have concerns about access to and the quality of vaccination services. Some women, including older mothers and those less economically privileged, see themselves as the focus of health workers' negative comments associated with either their parenting choices or their children's appearance. In general, parents and caregivers weigh several factors--such as personal opportunity costs, resource constraints, and perceived benefits--when deciding whether or not to have their children vaccinated, and the decision often is influenced by a network of people, including community leaders and health workers.</p> <p>Conclusions</p> <p>The study raises issues that should inform a communications strategy and guide policy decisions within Kenya on eventual malaria vaccine introduction. Unlike the current practice, where health education on child welfare and immunization focuses on women, the communications strategy should equally target men and women in ways that are appropriate for each gender. It should involve influential community members and provide needed information and reassurances about immunization. Efforts also should be made to address concerns about the quality of immunization services--including health workers' interpersonal communication skills.</p

Community perceptions of malaria and vaccines in two districts of Mozambique

Abstract Background Malaria is a leading cause of mortality and morbidity in Mozambique, with nearly three-quarters of the country’s malaria-related deaths occurring in children younger than five years. A malaria vaccine is not yet available, but planning is underway for a possible introduction, as soon as one becomes available. In an effort to inform the planning process, this study explored sociocultural and health communications issues among individuals at the community level who are both responsible for decisions about vaccine use and who are likely to influence decisions about vaccine use. Methods Researchers conducted a qualitative study in two malaria-endemic districts in southern Mozambique. Using criterion-based sampling, they conducted 23 focus group discussions and 26 in-depth interviews. Implementation was guided by the engagement of community stakeholders. Results Community members recognize that malaria contributes to high death rates and affects the workforce, school attendance, and the economy. Vaccines are seen as a means to reduce the threat of childhood illnesses and to keep children and the rest of the community healthy. Perceived constraints to accessing vaccine services include long queues, staff shortages, and a lack of resources at health care facilities. Local leaders play a significant role in motivating caregivers to have their children vaccinated. Participants generally felt that a vaccine could help to prevent malaria, although some voiced concern that the focus was only on young children and not on older children, pregnant women, and the elderly. Probed on their understanding of vaccine efficacy, participants voiced various views, including the perception that while some vaccines did not fully prevent disease they still had important benefits. Overall, it would be essential for local leaders to be involved in the design of specific messages for a future malaria vaccine communications strategy, and for those messages to be translated into local languages. Conclusions Acceptance of routine childhood vaccines bodes well for a future malaria vaccine. Vaccinating children is a well-established routine that is viewed favourably in Mozambique. A communications strategy would need to build on existing immunization efforts and use trusted sources—including current government dissemination arrangements—to deliver health information.</p

Policy analysis for deciding on a malaria vaccine RTS,S in Tanzania

Traditionally, it has taken decades to introduce new interventions in low-income countries. Several factors account for these delays, one of which is the absence of a framework to facilitate comprehensive understanding of policy process to inform policy makers and stimulate the decision-making process. In the case of the proposed introduction of malaria vaccines in Tanzania, a specific framework for decision-making will speed up the administrative process and shorten the time until the vaccine is made available to the target population.; Qualitative research was used as a basis for developing the Policy Framework. Interviews were conducted with government officials, bilateral and multilateral partners and other stakeholders in Tanzania to assess malaria treatment policy changes and to draw lessons for malaria vaccine adoption.; The decision-making process for adopting malaria interventions and new vaccines in general takes years, involving several processes: meetings and presentations of scientific data from different studies with consistent results, packaging and disseminating evidence and getting approval for use by the Ministry of Health and Social Welfare (MOHSW). It is influenced by contextual factors; Promoting factors include; epidemiological and intervention characteristics, country experiences of malaria treatment policy change, presentation and dissemination of evidence, coordination and harmonization of the process, use of international scientific evidence. Barriers factors includes; financial sustainability, competing health and other priorities, political will and bureaucratic procedures, costs related to the adoption and implementations of interventions, supply and distribution and professional compliance with anti-malarial drugs.; The framework facilitates the synthesis of information in a coherent way, enabling a clearer understanding of the policy process, thereby speeding up the policy decision-making process and shortening the time for a malaria vaccine to become available