Price Jessica, Gurley Nikki, Gyapong Margaret, Ansah Evelyn Korkor, Awusabo-Asare Kofi, Gyasi Samuel Fosu, Nkhoma Pearson, Nyondo-Mipando Alinane Linda, Okello George, Webster Jayne, Desmond Nicola, Hill Jenny, Gordon W Scott
PATH, 2201 Westlake Ave, Seattle, WA 98102, USA.
King County Department of Community and Human Services, 401 5th Ave #500, Seattle, WA 98104, USA.
Vaccines (Basel). 2023 Dec 1;11(12):1801. doi: 10.3390/vaccines11121801.
The WHO recommended the use of the RTS,S/AS01 malaria vaccine (RTS,S) based on a pilot evaluation in routine use in Ghana, Kenya, and Malawi. A longitudinal qualitative study was conducted to examine facilitators and barriers to uptake of a 4-dose RTS,S schedule.
A cohort of 198 caregivers of RTS,S-eligible children from communities where RTS,S was provided through the pilot were interviewed three times over a ≈22-month, 4-dose schedule. The interviews examined caregiver perceptions and behaviors. Children's vaccination history was obtained to determine dose uptake.
162 caregivers remained at round 3 (R3); vaccination history was available for 152/162 children. Despite early rumors/fears, the uptake of initial doses was high, driven by vaccine trust. Fears dissipated by R2, replaced with an enthusiasm for RTS,S as caregivers perceived its safety and less frequent and severe malaria. By R3, 98/152 children had received four doses; 34 three doses; 9 one or two doses; and 11 zero doses. The health system and information barriers were important across all under-dose cases. Fears about AEFIs/safety were important in zero-, one-, and two-dose cases. Competing life/livelihood demands and complacency were found in three-dose cases. Regardless of the doses received, caregivers had positive attitudes towards RTS,S by R3.
Findings from our study will help countries newly introducing the vaccine to anticipate and preempt reasons for delayed acceptance and missed RTS,S doses.
世界卫生组织（WHO）根据在加纳、肯尼亚和马拉维进行的常规使用试点评估，推荐使用RTS,S/AS01疟疾疫苗（RTS,S）。开展了一项纵向定性研究，以调查采用4剂次RTS,S接种程序的促进因素和障碍。
对198名符合RTS,S接种条件儿童的看护者组成的队列进行研究，这些儿童来自通过试点项目提供RTS,S疫苗的社区，在约22个月的4剂次接种程序中对他们进行了三次访谈。访谈考察了看护者的认知和行为。获取儿童的疫苗接种史以确定剂次接种情况。
第3轮访谈时仍有162名看护者参与；152/162名儿童有疫苗接种史。尽管早期存在谣言/恐惧，但在疫苗信任的推动下，首剂接种率很高。到第2轮时恐惧消散，看护者认为RTS,S安全且疟疾发作频率降低、症状减轻，从而对其产生了热情。到第3轮时，152名儿童中有98名接种了4剂；34名接种了3剂；9名接种了1剂或2剂；11名接种了0剂。在所有未足量接种的情况中，卫生系统和信息障碍都很重要。在接种0剂、1剂和2剂的情况中，对AEFI/安全性的恐惧很重要。在接种3剂的情况中发现了生活/生计需求竞争和自满情绪。无论接种剂次如何，到第3轮时看护者对RTS,S都持积极态度。
我们研究的结果将有助于新引入该疫苗的国家预测并预先排除延迟接受和错过RTS,S剂次的原因。
