In the fight against malaria, a new vaccine has been a breakthrough in saving lives, especially for children, who are most vulnerable to the disease. Kenya's successful pilot of the RTS,S vaccine, coordinated by the World Health Organization (WHO), marked a turning point in the country’s long-running battle to eradicate one of the deadliest illnesses in the world. This year, Kenya began expanding vaccine delivery to high-risk areas.
Lwala is partnering with Migori County’s Ministry of Health to actualize the dream of a malaria-free future. Migori is located near Lake Victoria in a malaria-endemic zone, where prevalence rates are more than two times higher than the national average. In recent years, the rise in malaria transmission due to changes in the climate has led to a surge in cases. Studies indicate that there is a higher prevalence of malaria in poor and rural areas, where living conditions often favor mosquito breeding—including poor-quality housing structures, stagnant water, and limited availability of malaria prevention measures.
The world’s first approved malaria vaccine offers hope. RTS,S can reduce malaria cases by more than 50% in the first year after vaccination in regions of moderate to high transmission. Upon the launch of the vaccine, Lwala helped Migori County to develop a distribution plan to ensure that eligible children receive the immunization as quickly as possible. We supported the county to sensitize healthcare workers across the 6 subcounties where the vaccine is being distributed, thereby bridging the knowledge gap in administering this new vaccine. We also worked with the county to sensitize community health workers (CHWs) and their supervisors to educate their communities and generate demand for the vaccine. Additionally, we are supporting mass outreaches across the target subcounties, as well as door-to-door campaigns to reach children who may have been missed. By ensuring that all eligible children are reached quickly and that no child is left behind in accessing this critical vaccine, we are bringing the vision of a malaria-free future closer to reality.
CHWs bridging the gap in the fight against malaria
CHWs are trusted caregivers in rural communities all over the world, and they are important agents in the fight to eradicate malaria. In Migori County, Lwala trains and equips CHWs to manage cases of malaria during routine household visits. They identify sick children, test for and treat malaria, and make referrals when needed. CHWs also educate their communities about malaria prevention and management, and they encourage use of insecticide-treated bed nets and indoor residual spraying. Following implementation of this malaria intervention, our research found that the percentage of children with a fever being tested for malaria increased from 24% to 88%, and fever prevalence decreased.
As Migori County rolls out the malaria vaccine, CHWs are playing a crucial role in spreading the word. Lwala is supporting 1,325 CHWs across Rongo, Awendo, and Nyatike subcounties to provide information and connect children with health workers who can administer the vaccine, either at a health facility or at a community outreach event. They also follow-up with families to ensure children stay on the 4-dose schedule.
“In my ten years as a CHW, I've seen many cases of malaria, some of which have resulted in death. Now we can raise awareness within the community about the new malaria vaccine. This has made a huge difference in the fight against malaria.”
– Christine Auma, CHW, Central Kamagambo, Rongo Subcounty
Lwala is also equipping all CHWs in Migori with digital tools to support malaria vaccination. As we work with Migori County to rollout the electronic Community Health Information System (eCHIS), we have added indicators and prompts on the malaria vaccine. For example, CHWs can now collect information on a child’s vaccination status and help caregivers make a plan for seeking out subsequent doses. The data also helps CHWs identify and follow-up with children who may be behind on their vaccination schedule.
Community-facility linkages to increase uptake and coverage of malaria vaccine
In addition to training CHWs, Lwala is working with Migori County to ensure facility-based providers have the information they need to administer the new vaccine–we have supported sensitization for health workers across facilities in Rongo, Awendo, and Nyatike. Additionally, we are supporting health facilities across all of Migori County to incorporate the malaria vaccine into health outreach events, whereby health care workers bring services to hard-to-reach communities, or communities with a high number of vaccine defaulters. CHWs then help mobilize households to attend these events.
Over the past 3 months, Lwala supported 262 integrated outreach events across Rongo, Awendo, and Nyatike. CHWs and facility-based providers also conducted door-to-door visits to boost malaria vaccination in hard-to-reach areas. These visits gave us an opportunity to screen children who might not otherwise visit health facilities and provide any other missing immunizations. As a result of this work, more than 17,000 children have received their first dose of the vaccine across Rongo, Awendo, and Nyatike, and more than 2,000 are already fully immunized.
In some of our implementation areas, we have seen malaria vaccine hesitancy due to religious beliefs, misinformation about side effects, or prior negative experiences with other vaccines. Some caregivers were unable to adhere to the 4-dose schedule, which resulted in lost vaccination opportunities for their children. As a result, we are using targeted messaging and proactively engaging caregivers to overcome barriers to uptake. We are doing this by conducting targeted dialogues, health talks, and counseling sessions with caregivers. In partnership with Dimagi and Digital Medic, we are conducting a study that aims to investigate vaccine hesitancy in Kenya and develop digital tools to help CHWs address the issue.
“Some caregivers after receiving one or two malaria vaccine doses for their children, do not return for additional doses. So we share a list of defaulters with CHWs, who follow up with clients during home visits and address the reasons for defaulting and any concerns.”
– Mackline Auko Awuor, Nurse at Lwala Community Hospital
Looking toward a malaria-free future
This is a historic moment in the fight against malaria in Kenya. Most malaria prevention approaches in prior decades have centered on insecticide-treated bed nets and indoor residual spraying, which are effective but have long-term constraints. And while malaria testing and medicines are essential, children can live healthier lives if they never fall ill with malaria in the first place. The malaria vaccine is a critical tool for prevention that will increase chances of survival for children, and hasten the journey to Universal Health Coverage.
“In the future, I no longer see malaria being a primary concern for our clients in the community. My inspiration is seeing my clients healthy. Seeing more and more caregivers bringing their children for vaccination promises a healthy future for our communities.”
– Mackline Auko Awuor, Nurse at Lwala Community Hospital