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Screams echoed between the dilapidated walls of the pediatric ward at Yala Hospital in western Kenya. The bite of the malaria vaccine makes children cry. A lesser evil to fight against this disease, resulting from parasites transmitted by mosquitoes, which kills 409,000 per year in the world, including 260,000 children under 5 in Africa. “I once was really scared of losing one of my boys. He was 3 years old and his symptoms were very strong ”, says Maureen Atieno, sitting at the back of the consultation room.
On this December day, this mother of eight went to the hospital to have her two youngest babies, nine-month-old twins, vaccinated. In this region near Lake Victoria, where mosquitoes find numerous breeding grounds, malaria is endemic. For younger people, it can be fatal in twenty-four hours.
This is the reason why they are the target of the first vaccine recommended against the disease by the World Health Organization (WHO). Since 2019, RTS, S (marketed by the GlaxoSmithKline laboratory under the name Mosquirix) has been the subject of a large-scale trial in three countries – Malawi, Ghana and Kenya – where 800,000 children have already received a first dose. On October 6, the WHO recommended it for large-scale use in all heavily affected areas.
“Malaria is one of the three leading causes of childhood death in Kenya, along with pneumonia and diarrhea”says Dr Simon Kariuki, who heads malaria research at the Center for Global Health Research (CRHG) in Kisumu, one of the eight counties where the assessment is being conducted. This pilot program, which is supposed to end in 2023, aims to estimate the ease of administration of the four required doses, the potential for reducing infant mortality and the benign nature of its use on a large sample of the population.
Vincent Omwenga, the nurse in charge of the maternal and child health center at Yala hospital, collects the doses in a cooler, mixes the active ingredient and the adjuvant, shakes everything and injects it with a needle. The vaccination takes place in the morning when the mercury is already approaching 30 ° C. Dorcas Anyango Juma, 26, waits his turn in the lobby of the establishment. It was by chance that she was offered RTS, S, she came to the clinic to check the growth progress of her 6 month old baby. She accepted without hesitation: “I’m confident because I studied molecular biology at university, I know how vaccines are prepared and how they work. “
“Parents’ consent is closely linked to their level of knowledge on health issues, but since the vaccine is administered at the same time as those needed by the child, there is little refusal”, specifies Hassan Odhiembo, community health volunteer (CHV) for the village of Nyamninia, neighboring the town of Yala. These community referees organized the awareness campaign among families, making it possible to achieve 80% adhesion to the vaccine at the national level. Only a few reservations appeared, particularly in connection with the new character of the product. But the most important thing, according to Joan Akimyi who works for the local administration and heads several CHVs, is that“There has been a general drop in the death rate from malaria and the vaccine has something to do with it”.
This improvement is felt at Yala hospital where, in the pediatric hospitalization department, not a single child is admitted for malaria at this time. “Before, this room would have been filled with children with malaria, notes nurse Vincent Omwenga. Today, it is very rare to see children hospitalized for severe forms once they have been immunized. “ The number of children under 5 who died from malaria at this rural facility has halved over the past two years; they were three in 2021.
Speed of diagnostics
However, according to clinical trials, the results of which were published in 2015, this new vaccine is far from constituting a miraculous protection since it would prevent only 40% of cases of malaria and 30% of severe forms. Thereby, “We strongly encourage the population to continue using other prevention tools”, says Doctor Simon Kariuki. Betty Kinya, a 34-year-old mother who came to give her 7-month-old son the second dose of the vaccine, recalls: “The first effective government action was to introduce mosquito nets, but that has not prevented all cases. “ She uses the conversation to find out about the upcoming free distribution of insecticide-treated bednets at the hospital.
In addition to this protective measure, improved diagnostics and their greater timeliness have helped reduce the incidence of the disease. In 2018, health workers in the villages received malaria detection and treatment kits allowing them to treat mild cases on site and refer children to hospitals in the event of a complication. According to the National Malaria Indicators Survey in 2020, the prevalence of the disease in endemic areas of Kenya increased from 27% in 2015 to 19%.
Despite the decline in infant mortality, malaria remains a scourge for families, including from a financial point of view. One of Maureen Atieno’s children is particularly touched, “He can get sick up to three times a month”, emphasizes the mother, forced to spend a lot of money on drugs. According to Bernard Ochieng, study coordinator in the area, taking a sick child for diagnosis and purchasing treatment costs on average 200 Kenyan shillings (1.57 euros), which is the average daily wage. in Kenya.
“If it is a case of severe malaria and the child is admitted to the hospital, he adds, the mother has to stop all his activities to stay with him. Some refuse because they have no one to take care of the other children at home. “ This complex equation adds additional value to the vaccine which, even with limited efficacy, saves crucial time and money in rural Kenya.
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In Kenya, the malaria vaccine begins to prove its worth