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Open Access Highly Accessed Research

Community perceptions of malaria and vaccines in the South Coast and Busia regions of Kenya

David I Ojakaa1*, Peter Ofware1, Yvonne W Machira2, Emmanuel Yamo1, Yvette Collymore3, Antoinette Ba-Nguz4, Preeti Vansadia4 and Allison Bingham5

Author Affiliations

1 African Medical and Research Foundation, Wilson Airport, Langata Road, PO Box 30125, Nairobi, Kenya

2 Previous address: African Medical and Research Foundation, Wilson Airport, Langata Road, PO Box 30125, Nairobi, Kenya

3 PATH Malaria Vaccine Initiative, 455 Massachusetts Avenue NW, Washington, DC 20001-2621, USA

4 PATH Malaria Vaccine Initiative, ACS Plaza, 4th floor, Lenana and Galana Road, PO Box 76634, Nairobi 00508, Kenya

5 PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA 98121, USA

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Malaria Journal 2011, 10:147  doi:10.1186/1475-2875-10-147

Published: 30 May 2011

Abstract

Background

Malaria is a leading cause of morbidity and mortality in children younger than 5 years in Kenya. Within the context of planning for a vaccine to be used alongside existing malaria control methods, this study explores sociocultural and health communications issues among individuals who are responsible for or influence decisions on childhood vaccination at the community level.

Methods

This qualitative study was conducted in two malaria-endemic regions of Kenya--South Coast and Busia. Participant selection was purposive and criterion based. A total of 20 focus group discussions, 22 in-depth interviews, and 18 exit interviews were conducted.

Results

Participants understand that malaria is a serious problem that no single tool can defeat. Communities would welcome a malaria vaccine, although they would have questions and concerns about the intervention. While support for local child immunization programs exists, limited understanding about vaccines and what they do is evident among younger and older people, particularly men. Even as health care providers are frustrated when parents do not have their children vaccinated, some parents have concerns about access to and the quality of vaccination services. Some women, including older mothers and those less economically privileged, see themselves as the focus of health workers' negative comments associated with either their parenting choices or their children's appearance. In general, parents and caregivers weigh several factors--such as personal opportunity costs, resource constraints, and perceived benefits--when deciding whether or not to have their children vaccinated, and the decision often is influenced by a network of people, including community leaders and health workers.

Conclusions

The study raises issues that should inform a communications strategy and guide policy decisions within Kenya on eventual malaria vaccine introduction. Unlike the current practice, where health education on child welfare and immunization focuses on women, the communications strategy should equally target men and women in ways that are appropriate for each gender. It should involve influential community members and provide needed information and reassurances about immunization. Efforts also should be made to address concerns about the quality of immunization services--including health workers' interpersonal communication skills.