Malaria vaccine brings hope, fears to mothers in Western

Before Kenya launched the malaria vaccine, Maureen Owiti had three young children that often fell sick with the disease.

"They could always get infected and I had to buy drugs for their treatment," she explains.

The vaccine, known as RTS,S, was launched on September 13, 2019, for children up to two years of age.

Maureen's fourth child was born in 2022, three years after the launch of the vaccine.

“For my fourth child, who is now one year old, he was given the malaria vaccine and he has not gotten ill or been infected with malaria,” she said in an interview.

Maureen, a resident of Miwani Village in Rongo, Migori county, says her fourth child was given the vaccine at the Rongo Subcounty Hospital in 2022.

She is required to use other protective measures to ensure her child has extra protection from mosquitoes in addition to the malaria vaccine.

“I always use the nets. With the high temperatures of this region, I just do that to give my child protection,” Maureen says.

“I also make sure that I have reduced any possible hiding place and breeding place for the mosquitoes, like mostly stagnant water that always stays outside our house during the rainy season.”

For her first, second and third children, she used a lot of money on treatment for malaria, but now she is relaxed.

“It has also reduced the cost of treatment of my fourth child compared to the previous three children," she says. 

CHILD MORTALITY

Childhood mortality remains part of the pressing problems in rural Kenya, with malaria being the major cause of death in children under the age of five years, according to a study in the Plos Journal.

A survey conducted in Rongo subcounty by the Lwala Community Alliance between 2007 and 2017 and published in the Plos Journal says the common causes of death among children under five years were malaria (19 per cent), respiratory infections (13 per cent) and anaemia (11 per cent).

The study is titled, "Under-five mortality in the Rongo Subcounty of Migori County, Kenya: Experience of the Lwala Community Alliance 2007-17 with evidence from a cross-sectional survey."

The World Health Organisation says malaria takes away the life of one child every two minutes, and in 2020, there were 241 million reported cases of malaria throughout the world, with 627,000 deaths.

At the end of February, Kenya had given more than 1.1 million doses of the vaccine to children under the age of five, of whom 386,000 had received the first of the four-dose vaccine. 

The WHO said the target is to reach more than 134,093 children annually in eight counties around Lake Victoria, in Nyanza and Western Kenya, where malaria is endemic. 

At the beginning of March, Kenya distributed the vaccine to another 25 subcounties in addition to the initial 26, reaching at least 133,185 more children.

Dennis Solomon is a clinical officer at Rongo Subcounty Hospital. He admits that there are reduced chances of admission for any vaccinated child with the malaria vaccine.

“There is a 30 per cent chance that there will be no admission on the children given the malaria vaccine," he says.

He advises that mothers should take the initiative to take their children for the complete four doses of the vaccine.

“The side effect is just the local reaction at the site of injection, which has pain and inflammation. Otherwise, there are no other side effects, such as headache or vomiting.”

Education of mothers on the importance of the vaccine during clinical visits, he says, has improved the reception of the vaccine to the whole community.

“The community has accepted the vaccine as mothers who come to the hospital for clinical care during this time, we advise them on the importance of taking this vaccine and its positive impact on their child as this area is prone to malaria,” Solomon adds.

PREVALENCE SHRINKING

The Kenya Malaria Indicator Survey 2020 shows malaria prevalence has reduced from eight per cent in 2015 to six per cent in 2020.

The mortality rate declined by 2.2 per cent in 2018 to two per cent per 100,000 population in 2020.

The survey is conducted every after three years by the Ministry of Health.

Dr Walter Otieno, a paediatrician at Migori County Hospital, said some parents fear their children are getting too many injections at a tender age.

“We noticed some parents are uncomfortable with the four doses and sometimes they will skip the clinics to not have their children given the injections,” he said.

“Thus, we need to do more mobilisation of the community so that we as a community can eradicate the malaria issues at once.”

He called for the vaccine to be expanded to other areas that have not received it so that more children can be inoculated.

“Just like any other vaccine, the more vaccinated people, the greater the protection we as a community will be building at large.”

He expressed confidence that there will better reception of the vaccine and the ending of malaria in this region in the coming years.

No patients would suffer a severe manifestation of the disease, he said.

Last week, the Nigerian government approved a new malaria vaccine from Oxford University, becoming the second country after Ghana in the world to grant such approval.

The vaccine, R21/Matrix-M, is developed by the University of Oxford and manufactured by the Serum Institute of India.

The R21/Matrix-M vaccine is awaiting WHO approval.

However, it is the first to exceed the WHO threshold of 75 per cent efficacy over 12 months of follow-up.

The vaccine showed a 77 per cent protective efficacy over 12 months in a phase 2b trial involving young West African children, following an initial three-dose course of injections.

Last week, WHO Kenyan representative Dr Diallo Abdourahmane said it is being considered for approval. 

"WHO is aware of the new innovation, the new R21 malaria vaccine, as a potential vaccine of public health importance, and awaits the expert review processes before a WHO recommendation can be made," he said.