Hopes and gaps: Turning point in malaria fight, not a finish line

 

Fredrick Gogo, A lab manager at Lumumba Sub-County Hospital, Kisumu, operating a microscope during the diagnosis of Malaria. [Rodgers Otiso, Standard]

In Kisumu, the malaria vaccine has changed the story, but it has not ended it. Health experts say that while its rollout since 2019 has significantly reduced severe illness among children, its success is closely linked to long-standing prevention strategies, community engagement and access to healthcare.

For Kisumu County Malaria Control Coordinator Lilyana Dayo, the impact is most visible in hospital wards that once struggled with large numbers of critically ill children. “The difference between now and before 2019 is clear,” she explains. “We are seeing far fewer children admitted with severe malaria. The vaccine has played a major role in reducing hospitalisations and saving lives.”

However, she stresses that the vaccine is not a cure-all. “It provides moderate protection,” she says. “It reduces severity, but it does not completely prevent infection. That is why we must continue using bed nets, indoor residual spraying, larviciding, and ensure early testing and treatment.”

Vaccine completion challenges

A key challenge remains the completion of the full vaccination schedule. The malaria vaccine requires four doses, given at six months, seven months, nine months and 24 months. However, many children do not complete all doses.

“We see a steady drop-off,” Dayo explains. “About 85 per cent receive the first dose, but by the fourth dose, that figure can fall to around 30 per cent.”

This decline is driven by mobility of families, access difficulties and caregiver concerns about side effects such as fever. Although usually mild and temporary, these reactions discourage some parents from returning.

At Kisumu County Referral Hospital, similar trends are evident. Lilian Otieno, who oversees maternal and child health services, says the vaccine has significantly reduced malaria cases and complications among children. 

“Less than 10 per cent of children we see test positive for malaria,” she says. “Even among those, complications are rare because the immune system is better prepared.”

However, she acknowledges concerns affecting uptake. “The most common side effect is fever, and that worries many mothers. Some do not return for the second or third dose because of that experience,” she explains.

She emphasises that such reactions are expected and indicate the body is building immunity.

Health workers have also observed changes in how malaria presents. Increasingly, children arrive with symptoms suggestive of malaria but test negative.

Despite progress, both experts stress that prevention remains the strongest defence. Insecticide-treated bed nets continue to be one of the most effective tools in reducing infection.

Indoor spraying and larval control also continue to play a key role in reducing mosquito populations.

Role of community health promoters

Community health promoters have been central to progress. With near-universal coverage in Kisumu, they educate families, track children who miss vaccinations and address myths surrounding immunisation.

“They help us reach households directly,” Dayo says.

“They follow up on defaulters and ensure children complete their doses.”

Their work has also eased pressure on hospitals by providing early testing and basic treatment within communities, allowing for earlier intervention.

Despite these gains, challenges remain. While vaccination is free in public facilities, treatment costs, especially for severe malaria requiring intravenous drugs, can be unaffordable for families without insurance.

There are also concerns about long-term sustainability. Much of the malaria response, including vaccine supply, relies on donor funding. Occasional stock-outs have raised questions about programme resilience without stronger domestic investment.

Experts say sustained progress will depend on improved vaccine completion, continued prevention measures, stronger health systems and reliable financing.