Ojakaa David, Yamo Emmanuel, Collymore Yvette, Ba-Nguz Antoinette, Bingham Allison
Focal Person Health Systems Research, Nairobi, Kenya.
Hum Vaccin. 2011 Oct;7(10):1096-9. doi: 10.4161/hv.7.10.17496. Epub 2011 Oct 1.
Malaria is a leading cause of morbidity and mortality in Kenya. To confront malaria, the Government of Kenya has been implementing and coordinating three approaches - vector control by distributing insecticide-treated bed nets and indoor residual spraying, case management, and the management of malaria during pregnancy. Immunization is recognized as one of the most cost-effective public health interventions. Efforts are underway to develop a malaria vaccine. The most advanced (RTS,S), is currently going through phase 3 trials. Although recent studies show the overwhelming support in the community for the introduction of a malaria vaccine, two issues - culture and the delivery of child immunization services - need to be considered. Alongside the modern methods of malaria control described above, traditional methods coexist and act as barriers to attainment of universal immunization. The gender dimension of the immunization programme (where women are the main child caretakers) will also need to be addressed. There is an age dimension to child immunization programmes. Two age cohorts of parents, caregivers, or family members deserve particular attention. These are the youth who are about to initiate childbearing, and the elderly (particularly mother-in-laws who often play a role in child-rearing). Mothers who are less privileged and socially disadvantaged need particular attention when it comes to child immunization. Access to immunization services is often characterized in some Kenyan rural communities in terms of living near the main road, or in the remote inaccessible areas. Should a malaria vaccine become available in the future, a strategy to integrate it into the immunization programme in Kenya should take into account at least two issues. First, it must address the fact that alongside the formal approach in malaria control, there exist the informal traditional practices among communities. Secondly, it must address particular issues in the delivery of immunization services.
疟疾是肯尼亚发病和死亡的主要原因之一。为应对疟疾，肯尼亚政府一直在实施和协调三种方法——通过分发经杀虫剂处理的蚊帐和进行室内滞留喷洒来控制病媒、病例管理以及孕期疟疾管理。免疫接种被认为是最具成本效益的公共卫生干预措施之一。目前正在努力研发疟疾疫苗。最先进的（RTS,S）疫苗目前正在进行3期试验。尽管最近的研究表明社区对引入疟疾疫苗给予了压倒性支持，但有两个问题——文化和儿童免疫服务的提供——需要加以考虑。除了上述现代疟疾控制方法外，传统方法也并存，并且成为实现普遍免疫的障碍。免疫计划的性别层面（女性是儿童的主要照料者）也需要得到解决。儿童免疫计划存在年龄层面的问题。两类父母、照料者或家庭成员群体值得特别关注。一类是即将开始生育的年轻人，另一类是老年人（特别是经常在育儿中发挥作用的岳母）。在儿童免疫方面，特权较少且社会处境不利的母亲需要特别关注。在肯尼亚的一些农村社区，获得免疫服务的情况往往取决于居住在主干道附近还是偏远难以到达的地区。如果未来有疟疾疫苗可用，将其纳入肯尼亚免疫计划的战略应至少考虑两个问题。首先，它必须解决这样一个事实，即除了疟疾控制的正规方法外，社区中还存在非正规的传统做法。其次，它必须解决免疫服务提供方面的特殊问题。
