Factors Associated with RTS,S Malaria Vaccine Coverage in Northern Ghana from 2021 to 2022

Abstract

Introduction: Malaria still remains one of the top causes of under-five mortality in Ghana and many other sub-Saharan African countries despite several interventions to control it. In an attempt to prevent and control malaria, in 2019, approval for the use of the RTS,S/AS01E malaria vaccine (RTS,S) in Kenya, Ghana and Malawi on a pilot basis was granted by the WHO. The vaccine was subsequently piloted in 42 of Ghana’s 261 districts with plans to scale up to the entire country by incorporating it into the routine childhood immunization programme. The pilot introduction of the vaccine was done in the midst of scepticism regarding the side effects of the vaccine and vaccine hesitancy among the population. Aim: This study investigated the factors associated with RTS,S vaccination coverage among 12–38 months old children in Northern Ghana from 2021–2022. Methodology: The study used secondary data collected in two districts in the Upper East Region of Ghana: the Kassena Nankana Municipal and the Kassena Nankana West district. The study used vaccination data collected through biannual cross-sectional surveys of children under-five years by the Navrongo Health and Demographic Surveillance System (HDSS) in 2021 and 2022. Trained fieldworkers visited the households of caregivers every six months to document the RTS,S and other routine vaccines received from the health cards of the children. Data on the background characteristics of the children and their households were collected during the interviews. The RTS,S vaccination coverages for all the four doses were assessed. Factors associated with receiving three doses of RTS,S among children aged 12–23 months, and those associated with receiving four doses of RTS,S among children aged 27–38 months were examined using multivariable logistic regression models. Results: In all, 4770 children aged 12–23 months, and 2993 children aged 27–38 months were included in the analysis. Overall, 95%, 94%, and 89% of children aged 12 to 23 months received v the first, second and third doses of RTS,S vaccine respectively. Additionally, 94%, 93% and 85% of children aged 12 to 23 months received RTS,S1, RTS,S2 and RTS,S3 respectively in their first year of life. Coverage of the fourth RTS,S dose among children aged 27–38 months was 66%, and 64% were vaccinated by 27 months. Among children vaccinated with RTS,S, 89% received RTS,S1 by 6 months of age, 80% received RTS,S2 by 7 months and 81% received RTS,S3 by 9 months. In multivariable logistic regression analysis, children delivered at home or elsewhere had 53% reduced odds of receiving three RTS,S doses compared to those delivered in a health facility (aOR = 0.47, 95% CI:0.36–0.62). Children aged 12–23 months in high wealth index households had 31% increased odds of receiving three RTS,S doses compared to those in poor households (aOR = 1.31, 95% CI: 0.99–1.73). Among children aged 27–38 months, being Christian is associated with increased odds of receiving all four RTS,S doses compared to traditional religion (aOR = 1.25, 95% CI: 1.02–1.53). In addition, residing in rural areas is associated with 71% increased odds of receiving four RTS,S doses compared to residing in urban areas (aOR = 1.71, 95% CI: 1.31–2.22). Children aged 27–38 months delivered at home or elsewhere had 30% decreased odds of receiving four RTS,S doses compared to those delivered in a health facility (aOR = 0.70, 95% CI: 0.55–0.90). Conclusion: This study revealed high coverages of the first three RTS,S doses despite reported vaccine hesitancy in some studies in Ghana. However, coverage of RTS,S dose 4 of 66% is suboptimal. Being delivered in a health facility and living in a high wealth index household were significantly associated with increased odds of receiving three RTS,S vaccine doses among children aged 12–23 months. Among children aged 27–38 months, residing in a rural area, being a Christian and being born in a health facility were significantly associated with increased odds of receiving four RTS,S vaccine doses. To improve coverage, it is important for the Ministry of Health, Ghana Health Service and other partners to address the factors associated with RTS,S coverage, particularly dose 4, and to intensify health education campaigns on the RTS,S vaccine and its benefits.