Malawi: Closing in On Malaria With Vaccination

Lilongwe — Fainesi Maida (not real name) of Bereu Village in Traditional Authority (TA) Maseya's area in Chikhwawa District never saw two of her three babies grow through to 11 months.

She lost both to malaria; the first at six and the other at 10.

Maida has since then been a desperate regular client of Bereu Health Centre with her third who is now seven months old.

"I can dare you, no one knows the pain and emptiness of losing a baby like a mother does. I have been through it twice," she explains while visibly forcing a smile to hide the pain in her tear-filled eyes.

Maida's predicament is only a snapshot of how ruthlessly Plasmodium falciparum, the most deadly malaria parasite, is sending many infants to their early graves countrywide.

Edrifa Kayira of Tayawaka Village in Nkhata Bay District also recounts a similar ordeal.

"I lost one of my four babies when he was only four months old and my other three have been continuously struggling with malaria," she explains.

It is this sorry state, worse across Sub-Saharan Africa including Malawi that prompted World Health Organisation (WHO) to partner with government and introduce a malaria vaccine.

The RTS,S/AS01, also known as Mosquirix, is a first generation vaccine that directly acts against Plasmodium falciparam in children.

Under the Malaria Vaccine Implementation Programme (MVIP), RTS,S was rolled out late April in 11 hardest hit districts across the country with evidently positive results four months down the line.

As Senior Health Surveillance Assistant (HSA) at Chikhwawa's Bereu Health Centre Denis Nkuna explains, there has been a 93 percent progressive stride at the clinic since the vaccine implementation in April.

"Due to intensified awareness campaigns, we had vaccinated five in April, 40 in May, 76 in June, 150 in July, against a monthly target of 80 babies," he explains.

The vaccine is administered in four intermascular doses; the first at the child's five months old, the second at six, third at seven and the last one at 22 months.

Nkuna says one of the challenges of the programme is the cut-off point; the period between the third and last dose, which, he says, is long and could give room to babies defaulting their vaccination dose.

To address the fear, however, government has incorporated MVIP in the upgraded Under-2 Vaccination Register which contains all of the child's details including his village.

National Coordinator of Malaria Vaccine at National Malaria Control Programme John Sande, explains that through the register, children's progress is monitored and defaulters tracked down and put back on the dose.

"The vaccination has also been allocated a column in children's health passports where a health practitioner attending to the child will easily monitor the child's vaccination progress," Sande explains.

He says Community Health Volunteers also play a crucial role in following up on defaulters.

In spite of the registered progress, Senior HSA for Mamba Health Centre in Nkhata Bay District Godfrey Phiri says work burden due to under staffing is a challenge.

"The vaccine comes as an addition to other vaccines already being administered to children. This, sometimes, results in one HSA handling several vaccines to several babies at the same time," he explains.

He, however, says there has been recorded progress through reduced infant malaria cases at the health centre.

Even Maida testifies that after putting her only surviving child on the vaccination she has never witnessed any malaria signs and symptoms on her child.

"There are at least no malaria signs in my baby now after he had his first vaccine and I plan to take him through all the four doses," Maida says.

The vaccine is a complementary malaria control tool being added to the core package of WHO's recommended control measures of insecticide-treated bed nets, indoor insecticide sprays and timely malaria testing and treatment.

If all of the four doses are correctly administered, the vaccine is tested and proven to be capable of reducing malaria-related infant deaths by four percent.

The WHO, along with partners like PATH, is jointly implementing the programme with governments of Malawi, Ghana and Kenya.

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