1. Sarah Karanja 1,David Ojakaa 2, Jordan Jarvis 3, Mary Matilu 4 and Sylla Thiam 5 1.AMREF Kenya 2.Formerly with AMREF Kenya 3.AMREF Canada 4.KEMRI 5.Amref Health in Africa Headquarters Amref Health in Africa International Conference 24 th – 26 th October, Nairobi, Kenya Acceptance of a Malaria Vaccine by Caregivers of Sick Children in Kenya

2. Overview of Presentation Introduction Background Study objectives Methods Variables captured Results Conclusion and recommendations

3. Introduction Malaria a life threatening parasitic disease About 70% of Kenyan population at risk (NMCP) Kenyan response is broad - four pronged Nevertheless KMIS 2010 shows gaps persist: –ITN coverage is one net for five people –25% of expectant women received IPT at ANC Malaria vaccine – close gap left by these interventions

4. Background Several malaria vaccines are currently in clinical trials. GSK’s RTS,S is currently in Phase 3 clinical development Consider sociocultural environment of region for widespread approval. In 2010 AMREF conducted this study on behalf of PATH Malaria Vaccine Initiative

5. Study Objectives General:  To analyse and share complimentary information on attitudes of individuals in Kenya towards a possible malaria vaccine Specific:  Determine attitudes of caregivers towards a malaria vaccine  Identify key factors influencing attitudes of caregivers

6. Methods Exit interviews with 2003 caregivers in 695 health facilities across Kenya during the 2010 KSPA Descriptive statistics (cross-tabulation) and multinomial regression were used to analyze the determinants of accepting a child to be immunized with the malaria vaccine.

7. List of Variables for Analysis Facility /Community– level factors: –Facility type; Operating authority; Fees for services?; Opinion on services Sick child – characteristics –Type of visit; Diagnosis for malaria; Taking malaria drug; Problems causing visit Caregiver – characteristics –Opinion of services received; Relationship to the sick child; Socio-demographic characteristics Malaria vaccine questions –Whether would accept young child in community or own child getting the malaria vaccine.

8. Characteristics of Caregivers Characteristics of respondents Per cent Sex Female93.5 Male6.5 Age <208.2 20-3476.6 35-4913.6 50+1.6 Relationship to child Mother90.3 Father5.9 Other3.8

9. Characteristics of Sick Children CharacteristicPercentage Sex Female53 Male47 Age (years) <133.7 1-230 2-317.2 3-411.6 4-57.5 Malaria diagnosis (clinical) Yes38.1 No61.9 Malaria test (blood smear or rapid test) Positive16.1 Negative83.9

10. Acceptance of Child Vaccination Child in community Own child % Yes88.788.0 No4.6 Don’t know6.77.4

11. Caregivers educational factor and acceptance of vaccine FactorsVaccination in community Vaccination of own child Yes NoDon't know YesNoDon't know % Ever attended school Yes (85.9%) 94339343 No (14.1%)56133155738 Literacy Read and write (64%) 96229532 Read only (4.08%) 7462071821 None (32%) 6992269526

12. Approval of Vaccine by Region RegionApproval of Vaccine (%) Nyanza98.9 Coast98.7 Eastern97.8 Central96.7 Western95.4 Rift Valley91 Nairobi87 North Eastern23

13. Factors associated with acceptance of malaria vaccine VariableRRRP-value Region: Central4.0** Coast13.1*** Eastern8.7*** North Eastern0.3* Nyanza12.0*** Rift Valley3.2** Western3.7** Satisfaction with health services: Somewhat0.5** Age of Caretaker: 35-490.3* 50+0.1* Ever Attended school No0.4* *** p<0.001 **p<0.01 *p<0.05

14. Conclusion and recommendations The results show high endorsement and expectations of the vaccine, except for North Eastern Province. This calls for the need to carefully manage the expectations as the vaccine is released Target specific segments of child caregivers with relevant messages and education on the malaria vaccine Target audiences include residents where acceptance is low; older caregivers and those with low literacy levels; service providers

15. Acknowledgements PATH MVI: for funding National Council for Population and Development (NCPD) for coordination of KSPA Division of Vaccines and Immunization: Advice on priority research questions Division of Malaria Control: Support ICF Macro: Providing the datasets AMREF: Technical/Administrative Support

16. THANK YOU