“Grace has never suffered from malaria. But her older siblings do often suffer from malaria. After her first dosage she got sick but when we came here at the Health Centre (Chileka) we were told it was just a cough and not malaria. As I am speaking, she has just received her fourth and final dosage.” Said Clara.
For Clara this is a very good development for her family because she is able to attend to other things which is a contrast experience with her other older children who used to have severe malaria attack in their first two to three years.
“I do a small-scale business to support my family. My experience with Clara is way different from the other children who have not been vaccinated. I have ample time to grow my business because with the vaccine we spend less time at the hospital since there is no malaria attack.” She said.
Clara’s testimony is echoed by Stelia Lawrence, 29 a mother of three as well whose youngest daughter Liviness has also received the vaccine.
“My youngest daughter is receiving the malaria vaccine and my child has not had a malaria attack. I just want to encourage fellow mothers to bring their children for vaccine.” She said.
Both Grace and Liviness receive their vaccination at Chileka Health Centre in Lilongwe rural. Victor Chisamba a Disease Control Surviellance Assistant at the facility disclosed that the number of malaria cases among children under 2 years of age have significantly decreased at the health centre.
“Since we started administering the Malaria vaccine in 2019 I can safely say that the progress is overwhelming. Mothers are forthcoming when it comes to bringing their children for vaccination. We had a problem of adherence during the first year but now the women know when to bring their children to be vaccinated against malaria. A look into our register books shows we have recorded significant decrease in malaria cases among those receiving vaccination in comparison to a time there was no malaria vaccine.” Said Chisamba.
The malaria vaccine is being given in selected areas in 11 selected districts of Karonga and Nkhata Bay in the Northern Region, Mchinji, Ntchisi, and Lilongwe rural in the Central Region, Mangochi, Machinga, Balaka, Phalombe, Chikwawa, and Nsanje in the Southern Region.
Just like in Lilongwe rural, in Nkhata-bay district the vaccine was unwelcome when it was first implemented amid fears that it could make children impotent. This is according to Toffam Ngulube a senior health surveillance assistant at Nkhata-bay district hospital who described the first year of implementation as challenging.
Said he; “There were a lot myths when the vaccine was first introduced here. Communities here feared the vaccine was introduced to make people infertile and others thought it could bring in deformities.
But with increased sensitization, eventually people’s perception has changed on the vaccine. At the moment a lot mothers are bringing their children to be vaccinated unlike in the first days of implementation. And because of this, we have seen that the number of malaria cases among children under two years of age has gone down. When we move around the health centers and village clinics and see the registers, we see a drop in malaria cases. One of the contributing factors is that the vaccine is working. Even here at the (Nkhata-bay) district hospital before the vaccine -out of a hundred Out Patient
Department OPD visits over forty percent were of malaria cases but now this has decreased”
However, Ngulube said the major challenge in the second year of implementing the malaria vaccine is the long interval between the third and fourth(final) dosage as mothers tend to forget.
“We give the first dosage at 5 months, second dosage at 6 months and third dosage at 7 months. However, there is a long interval between the third and fourth dosage because it comes after 22 months. Some women tend to forget to bring their children for the final dosage. But then we are using every available chance like every time they come to the hospital for other services, to remind them of the dates for the final dosage.” Said Ngulube.
Within the eleven districts, the vaccine is being provided in a phased approach according to John Sande National coordinator for Malaria vaccine Implementation Program at Malaria Control Program. He said the program which was launched in April 2019 is under the Expanded program Immunization EPI, with support from the World Health Organization WHO. Sande described the program as a gamechanger in as far as the landscape in fighting malaria in the country is concerned. He said though the program faced hurdles there is a lay of hope that the vaccine is the right way in as far as ending malaria in the country is concerned.
“We consider the malaria vaccine as one of the potential strategies that is very essential in the control of malaria. In 2018 we had an increase of malaria cases by 16 percent, but when we introduced the malaria vaccine in April 2019 by December the same year, we had registered a reduction by 25 percent. That was a huge achievement in as far as malaria control is concerned.” Sande said.
But he said the covid 19 pandemic impacted the program negatively because the Out Patient Department (OPD) attendance had reduced countrywide, which saw an increase in the malaria cases in 2020 by 38 percent.
“As you know there is a similarity in presentation of malaria and COVID 19. People who had malaria symptoms feared they could be diagnosed of Covid 19 so they chose not to come to hospital. So, when a household has a malaria case that is not treated urgently it becomes a source of infection within the area where the mosquitos would transmit the malaria parasite to others.” Said Sande.
He however said that despite the covid 19 there has been a reduction in admission in severe malaria cases by 15 percent in 2020 against an 18 percent in 2018-2019.
Sande said the positive strides registered in malaria control through the malaria vaccine is a good development in the provision of quality health service and universal health care.
“We know that malaria is a number one cause of morbidity in Malawi, we know that over 30 percent of cases in our hospitals are because of malaria. If we reduce that it means government is spending less money in terms of buying malaria drugs. And for our own information malaria medicine LA is very expensive and government cannot afford that as it depends so much on donors and other partners who are supporting us. So, if we are reducing malaria cases it means not so many people will be coming to hospitals for malaria just as it will also lessen the burden on health workers and they will be concentrating on other conditions other than malaria. And also on the part of government, we will not spend much money as such those resources will be channeled to other important areas and that will mean we are bringing development to the country.” He said.
Despite these achievements, malaria remains a public health threat, with the whole population at risk. The 2016 Health Management Information System report shows that malaria accounts for more than 30 percent of outpatient visits and 40 percent of inpatient visits.
The introduction of the malaria vaccine, according to Mphatso Mtenje focal point person for malaria vaccine implementation project under the Expanded Programme on Immunization (EPI) has offered an additional way to protect young children from malaria. He said the vaccine is part of the package of recommended malaria prevention measures that is why parents and caregivers are encouraged to continue using the already existing prevention and control measures along with the vaccine.
Said he; “The vaccine has the potential to save tens of thousands of young lives in Malawi when used with other proven preventive interventions. Already statistics are showing that cases of severe malaria cases among under-five children have gone down since the introduction of the vaccine.
One area we need to consider as government is availability of the vaccine. Much as we have rolled out the vaccine in heavily burdened districts, we need to ensure that we introduce the same in all districts.”
Malawi is one of three African countries (alongside Ghana and Kenya) that is carrying out the Malaria Vaccine Implementation Programme with support from the World Health Organization (WHO) and in collaboration with partners, including PATH, a nonprofit organization, and GSK, the vaccine manufacturer.
In Malawi the aim is to vaccinate at least 120,000 children per year for three years in the selected areas. Development of the RTS,S malaria vaccine began more than 30 years ago.