Post introduction evaluation of the malaria vaccine implementation programme in Ghana, 2021

Adjei et al. BMC Public Health (2023) 23:586 https://doi.org/10.1186/s12889-023-15481-6 BMC Public Health Open Access RESEARCH Post introduction evaluation of the malaria vaccine implementation programme in Ghana, 2021 Michael Rockson Adjei1*, Kwame Amponsa-Achiano2, Rafiq Okine3, Peter Ofori Tweneboah3, Emmanuel Tettey Sally2, John Frederick Dadzie2, Fred Osei-Sarpong3, Michael Jeroen Adjabeng3, John Tanko Bawa4, George Bonsu4, Kwadwo Odei Antwi-Agyei4, Basil Benduri Kaburi2,5, Felicia Owusu-Antwi3, Elizabeth Juma3, Francis Chisaka Kasolo3, Franklin Asiedu-Bekoe2 and Patrick Kuma-Aboagye2 Abstract Background Malaria remains a public health challenge in Sub-Saharan Africa with the region contributing to more than 90% of global cases in 2020. In Ghana, the malaria vaccine was piloted to assess the feasibility, safety, and its impact in the context of routine use alongside the existing recommended malaria control measures. To obtain context-specific evidence that could inform future strategies of introducing new vaccines, a standardized postintroduction evaluation (PIE) of the successes and challenges of the malaria vaccine implementation programme (MVIP) was conducted. Methods From September to December 2021, the WHO Post-Introduction Evaluation (PIE) tool was used to conduct a mixed methods evaluation of the MVIP in Ghana. To ensure representativeness, study sites and participants from the national level, 18 vaccinating districts, and 54 facilities from six of the seven pilot regions were purposively selected. Quantitative and qualitative data were collected using data collection tools that were adapted based on the WHO PIE protocol. We performed summary descriptive statistics on quantitative data, thematic analysis on qualitative data, and triangulation of the results from both sets of analyses. Results About 90.7% (49/54) of health workers stated that the vaccine introduction process was smooth and contributed to an overall improvement of routine immunisation services. About 87.5% (47/54) of healthcare workers, and 95.8% (90/94) of caregivers accepted RTS,S malaria vaccine. Less than half [46.3%; (25/54)] of the healthcare workers participated in the pre-vaccine introduction training but almost all [94.4%; (51/54)] were able to constitute and administer the vaccine appropriately. About 92.5% (87/94) of caregivers were aware of the RTS,S introduction but only 44.0% (44/94) knew the number of doses needed for maximum protection. Health workers believed that the MVIP has had a positive impact on under five malaria morbidity. Conclusions The malaria vaccine has been piloted successfully in Ghana. Intensive advocacy; community engagement, and social mobilization; and regular onsite supportive supervision are critical enablers for successful *Correspondence: Michael Rockson Adjei Full list of author information is available at the end of the article © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Adjei et al. BMC Public Health (2023) 23:586 Page 2 of 8 introduction of new vaccines. Stakeholders are convinced of the feasibility of a nationwide scale up using a phased subnational approach taking into consideration malaria epidemiology and global availability of vaccines. Keywords Malaria, RTS, S vaccine, Pilot, Post introduction evaluation, Malaria vaccine implementation Programme, Mosquirix Background Malaria is a life-threatening disease caused by five species of mosquito-transmitted parasites in humans [1]. In 2020, an estimated 241 million cases of malaria were recorded globally with 627,000 deaths. Children under five years are the most vulnerable and accounted for 80% of the mortalities, of which Africa accounted for 95% of cases and 96% of deaths [2]. In Ghana, malaria accounts for approximately 30% of outpatient attendance and 23% inpatient admissions [3]. Plasmodium falciparum is the predominant malaria parasite in Ghana, accounting for approximately 80–90% of severe morbidity and mortality [4]. Generally, there is a stable transmission pattern. Studies conducted in 2014 and 2019 have shown endemicity ranging from intermittent transmission in the Greater Accra Region to intense seasonal transmission in the Upper West Region and seasonal transmission in the rest of the country [4, 5]. Ghana has made significant strides in malaria prevention and control with existing interventions, contributing substantially to a reduction in malaria-related mortalities [5]. However, the disease burden remains significant [4], and deployment of additional tools may facilitate achievement of elimination status. A well tolerated and effective vaccine with an acceptable safety profile could be a potentially important intervention for malaria control. In January 2016, Ghana (as well as Kenya and Malawi) responded to the World Health Organization (WHO) call for national Ministries of Health to express interest in collaborating in the RTS,S/AS01 malaria vaccine pilot implementation programme, and was reaffirmed in March 2016. Approval of the country’s request was announced by WHO (alongside with Malawi and Kenya) in April 2017 [6]. The pilots were designed to assess the feasibility of delivery, safety and impact on disease morbidity and mortality in the context of routine use alongside other currently recommended malaria control measures [7]. The malaria vaccine was introduced into the national childhood immunisation programme from May 2019 [8]. Based on the positive results from the pilots in Ghana, Kenya, and Malawi, in October 2021, the WHO advisory bodies for immunisation and malaria recommended the use of the RTS,S/AS01 malaria vaccine for the prevention of P. falciparum malaria in children living in areas of moderate to high transmission as defined by the WHO. There is also strong evidence of high efficacy of the vaccine using seasonally timed vaccinations in areas where malaria transmission is highly seasonal [7]. Although the Ghana Health Service (GHS) (...truncated)