Assessing the Fidelity of the Malaria Vaccine Implementation in Malawi

Abstract Background: Remarkable progress has been made in the fight against malaria over the last two decades. Despite the mounted response using preventive and treatment measures, the rate of malaria case incidence and mortality stalled from 2015 onwards. Mosquirix (RTS, S/AS01), a 4 dose malaria vaccine with an effectiveness of 39%, was piloted by the WHO in three countries including Malawi where the vaccine is integrated in the EPI as a regular schedule dose. The vaccine portrays a chance to enhance the globally stalled progress against the malaria epidemic. Fidelity, therefore should be assessed in order to correctly identify the adherence to the planned protocol for the rollout of the program and evaluate whether it is being undertaken as planned. Methods: This is a descriptive qualitative cross-sectional study that used the implementation fidelity framework (2007). 12 Healthcare workers were interviewed while 47 parents or guardians attended 2 focused group discussions, in two separate health centers serving as immunization clinics. A non-participatory checklist was also used to predetermine the status of the vaccine storage and the system of administration of the malaria vaccine. Data was analyzed using the framework analysis approach. Results: 59 participants were interviewed in this study, 12 were HCWs and 47 were guardians. Out of the 12 health workers that were interviewed, 2 (17%) were female and 10 (83%) were male. While for the clients, all 47 (100%) were female. The average age of HCWs was 38 while for the guardians it was 29. The study observed that there was adherence to the protocols but to a lesser extent. Conclusion: It is evident that the Malaria vaccine programme has to some extent been implemented with fidelity and there is demonstrable adherence to the vaccine protocol. Nevertheless, gaps still exist and it is the role of the Ministry of Health through the respective departments to learn from such experiences and employ strategies that will even increase adherence to the vaccine protocol by health workers which ultimately will reduce the malaria burden in the country since adherence to the protocols may also lead to improved efficacy of the vaccine.