Immunization

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    Rapid assessment to evaluate the defaulter tracing program for under five children immunization services in Rumphi district
    (11-11-21) Tembo, Atupele Kapito
    EXECUTIVE SUMMARY Type of Study:Amixed methods study where retrospective data will be used and prospective data will be collected as well.Mixed quantitative and qualitative methods will be used.Secondary analysis of Ministry of Health(MOH)routineExpanded Programme on Immunisation (EPI)administrative datawill be conducted. Background:The MOHwith funding fromUNICEF has been implementing acommunity-based defaulter tracing program in Rumphi districtto improveequity and effectiveness of the immunization program.Thedefaulterprogramhas two approaches, one usingmother care group volunteers(MCGs)andthe other one usesreligious institutionsin the communities.It is anticipated that the defaulter program willincreaseproportionof fully immunized children and vaccination coverage in under-five childrenin the district. However,after implementing the program since August 2019,there is need to systematically evaluate theperformanceof the defaulter programin the districtregardingits impactand toinformtheimplementersand policy makerson areas requiring improvementsand strengthening. Main Objective:Evaluatethe performanceand impactof theMOH community-baseddefaulter programfor routine immunization in under-five childrenbeingimplemented byMCGs volunteers and religious institutionsinRumphidistrict. Methods:Wepropose toconductsecondary analysis of MOH routine EPIquantitative administrative data from 2018 to date toestablishthe immunization coverage trendsin the districtbefore and after the defaulter tracing program.We will also conductcross-sectional quantitative and qualitativeevaluation assessments.Theassessmentswill be conductedin4 randomly sampled health facilities, 2 from each of the implementation approaches(MCGs and religious institutions).Based on vaccination coverage performance,2 health facilities(one best EPI performing and one poor EPI performing health facility)will be randomly chosen from the listof facilitiesfor each approach.For the quantitative component, we willconduct exit interviews with child caregivers.We willenrol30 participants using simple randomsampling from each of the 4 selected facilities.For the qualitative component, we will conduct10focus group discussions (FGDs).The FGDs will be conducted as follows: a)Twowill be with child caregivers of under-immunised children attending therandomly sampled2low performing facilities, one from each approach b) Two will be with child caregivers of under-immunised children from communities of the 2low performing facilities, one from each approach c) One will be with MCGs who will be randomly sampled from a list of MCG volunteers d) One will be with religious volunteers who will be randomly sampled from a list of religious groups volunteersand e) Four will be with health workers from each of the 4 sampled health facilities.Each FGD will be comprised of 6-8participants.Wealso propose to conduct 8in-depth interviews (IDIs)with key informantsselectedpurposively.These will includedistrict EPI and community health coordinators,DEHO orAEHOs,health facility EPI focal personsor seniorHSAs. The exit interviews,FGDs and IDIs with key informants will be employed toobtain information ondefaulter program includingknowledge of the program,it’sstructure and systems, best practices,lessonslearnt, implementation strengths, challenges and recommendations.All qualitative interviews will be digitally-recorded and transcribed verbatim, coded and thematic analysis will beconducted.Quantitative data will be analysed using statistical software packages. Expectedfindings and dissemination: Weexpect thisevaluationtoprovide information on vaccinationcoveragetrends before and after the defaulter tracing program for immunization in Rumphi district to assess impact. In addition, the evaluation will document andprovide information on the currentimplementationstructuresand systems, best practices,lessons learnt, strengths and challenges of the defaulter tracing program. Theinformationwillguide implementers and policy makerson the areas requiringstrengthening andimprovementforthe program.It is planned that the findingswill be shared with College of Medicine Research and Ethics Committee, MOHand presented at college, national and/or international research dissemination conferences and will be publishedin peer-reviewed journals.
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    Factors associated with utilization of ITNs following immunization with RTS,S/AS01E malaria vaccine in underfive children in Nchalo-Chikwawa
    (Kamuzu University of Health Sciences, 19-01-22) Mangani, Milness
    Type of study The study will be an embedded mixed method cross-sectional study. Problem Malaria is the leading cause of mortality and morbidity in children below the age of five. The pandemic continues to increase morbidity in Africa. The use of RTS, S/AS01E RTS, S malaria vaccine helps to prevent 39% of malaria cases and 29% cases of severe malaria in young children. Since the vaccine is only partially effective, the Ministry of Health (MoH) recommends the use of additional preventive measures, such as indoor spraying, proper diagnosis and the use of ITNs. However, it is not known as to what extent caregivers adhere to these preventive measures after their children have received the malaria vaccine, and whether the use of RTSs will reduce demand for or utilization of ITNs under the assumption that the vaccine is highly protective. Broad objective To determine factors associated with utilization of ITNs in under-five children following RTS’S Malaria Vaccine in under-five children in Nchalo- Chikwawa. Specific objectives: 1. To determine prevalence of ITN use in under five children following malaria vaccination 2. To identify social and economic factors associated with ITN use among malaria vaccinated children. 3. To explore mother’s/guardian views regarding the use of ITNs after their children have received malaria vaccine. An embedded mixed method cross-sectional study. The study will be conducted in Nchalo –Chikwawa District. The study will run from August 2021 to May 2022. Data collection will be in October and December 2021. The plan is to enroll 280 children who have received three or four doses of malaria vaccine, and 24 women (3 FGDs, 8 participants in each group) of women coming to the under-five clinic. One research assistant trained in research ethics and good clinical practice will be recruited to help in data collection. Written informed consent will be sought from all eligible study participants. Data will be collected from perspective of caregivers of children who have received 3 or 4 doses of malaria vaccine on Qualitative data will be collected through FGD with the care givers, face to face while observing Covid -19 preventive measures. Data will be transcribed and imported into NVivo 12 for windows a qualitative data analysis software. Quantitative data will be collected through structured questionaries. STATA will be used for analysis.
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    Understanding the epidemiology of iNTS disease in Africa in preparation for future iNTS
    (Kamuzu University of Health Sciences, 2020-10-08) Gordon, Melita
    Type of study Clinical research study involving collecting samples from human participants. Prospective serological studies will be carried out across 4 sub-Saharan African sites (Malawi, Kenya, Burkina Faso, Ghana), for which Malawi will be the leading site. A core protocol has been written for all 4 sites in a separate document. This protocol focuses on the Malawi site. Methods to measure age-stratified acquisition of antibody and bactericidal activity to NTS. Data will be collected on the key risk factors for invasive disease: malaria, anaemia and malnutrition and stool samples to measure enteric NTS exposure. Children 0 to 5 years selected from mapped and censused randomly selected households Chikwawa, Malawi; an area with substantial malaria burden - a key risk factor for iNTS. Paired immunology and stool samples for NTS taken 3 months apart for 2000 children; distributed over each age stratum of 1 year, from the age of 0 to 5 years (4000 samples in total). A small number of confirmed invasive NTS cases identified at Queen Elizabeth Hospital (QECH), Blantyre, Malawi, will also have samples for investigated for antibody and bactericidal activity at presentation and 1 month follow-up. Other sites (Kenya, Burkina Faso, Ghana): Prospective serological community study with unpaired/ single samples taken from children aged 0-5 years. No data collected on risk factors. Expected findings and dissemination We will describe the pattern of immunological susceptibility to NTS and enteric exposure in relation to risk factors and geographical settings to facilitate early iNTS vaccine licensure. The final study report will be submitted to the College of Medicine Research Ethics Committee (COMREC) University of Malawi, University of Liverpool IRB and the funders (Wellcome Trust and VacciNTS project). The results will be presented locally, nationally and internationally including other partner sites in the seroepidemiology work package of the VacciNTS consortium contributing to key knowledge for vaccine development and deployment. This will have relevance for policy decisions regarding iNTS control in Malawi and other sub-Saharan African countries. Results will be submitted for publication in a peer reviewed academic journal.
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    Determinants of vaccine coverage and acceptability of malaria RTSS vaccine in children aged 12-23 months in Malawi: a healthcare provider perspective, version 1.0
    (Kamuzu University of Health Sciences, 2022-07-18) Nkosi, Dumisile
    Type of research study: The study will use systematic literature review and a qualitative study design using purposive sampling of 20 healthcare workers at Zomba District Health Office. Problem statement: Developing appropriate interventions on immunization in young children requires a detailed understanding of immunisation levels and factors affecting coverage among children. Although there has been an increase in overall coverage of DPT3 from 84% to 94% between 2016 and 2020, only 78% of the 28 districts in Malawi had achieved the targeted coverage of > 80% in 2020. This indicates that there is still a gap in childhood vaccine coverage within the country. Additionally, understanding the acceptability of a vaccine before roll out helps in generating appropriate interventions to improve vaccine coverage. Therefore, this study seeks to understand the healthcare providers’ perceptions on the factors that will affect coverage and acceptability of the malaria RTSS vaccine before it is rolled out countrywide in Malawi. Objectives: The main objective of this research project is to evaluate the determinants of vaccination coverage and acceptability of the RTSS malaria vaccine in children aged 12-23 months in Malawi. The specific objectives are: to assess the determinants of vaccine coverage in children aged 12-23 months using systematic review of previously conducted studies on vaccine coverage and acceptability in Malawi, to determine the perceptions of healthcare workers on factors that will affect provision of the RTSS malaria vaccine in children between 12-23 months of age in Zomba, Malawi, and to determine the healthcare workers’ perception on factors that will affect uptake and acceptability of the 4-dose RTSS malaria vaccine in addition to routine vaccines for children aged 12-23 months in Zomba, Malawi. Methodology: Firstly, a systematic review will be conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework to identify research articles that address acceptability and coverage of vaccines in young children in Malawi. Secondly, a qualitative study design using purposive sampling of 20 healthcare workers at Zomba District Health Office will be conducted. Data will be collected using in depth telephonic interviews. Descriptive baseline statistics will be summarised using proportions. Qualitative data will be analysed using thematic content analysis to establish themes related to factors that affect coverage and acceptability of malaria RTSS vaccine. Expected findings and dissemination: The expected findings for this study are that the healthcare providers will describe the determinants of coverage and acceptance of the malaria RTSS vaccine to be similar to the other previously reported determinants of coverage and acceptance for vaccines in children aged 12 to 23 months in other studies conducted in Malawi. Study findings will be disseminated during the researcher’s Master of Vaccinology and Drug Development thesis defense at the University of Siena. Additionally, findings will be disseminated to COMREC and Zomba DHO. Finally, a manuscript will be developed which will be submitted for peer review journals for publication.