The Malaria Vaccine Implementation Programme study area in Ghana: results of a household survey prior to the introduction of the RTS,S/AS01 vaccine

Abstract Background In 2019, the RTS,S/AS01E malaria vaccine (RTS,S) was introduced into Ghana’s routine health system as part of the Malaria Vaccine Implementation Programme (MVIP). Household surveys were conducted prior to vaccine introduction and approximately 18 and 30 months post-introduction. We present a description of the area in Ghana based on the baseline household survey including malaria prevalence, malnutrition, wealth, insecticide-treated net (ITN) coverage, other health interventions (deworming, Vitamin A supplementation (VAS)), coverage of Expanded Programme on Immunization (EPI) vaccines, and health-seeking behaviour for febrile children. Methods The baseline household survey was conducted between 25 February and 18 March 2019 in a representative sample of 6778 households across 66 districts (33 in each of the implementing and comparator areas) in Ghana. Caregivers of children aged 5–48 months were interviewed. For each child, vaccination details were transcribed from the maternal and child health record book, and we measured the mid-upper arm circumference and obtained a malaria Rapid Diagnostic Test (RDT). Survey-weighted coverage estimates were obtained using standard survey methods. Survey Poisson regression was used to estimate prevalence ratios. Results Overall, 7768 children were included in the study, and 21% (95% CI 18–23) tested positive for malaria parasitemia by RDT. About 87%, 95%CI (85–89) of all households owned at least one ITN, and 62%, 95%CI (59–64) of children aged 5–48 months slept under an insecticide-treated net (ITN) the night before the survey. Additionally, 22%, 95%CI (21–24) of children reported having fever in the two weeks preceding the survey; among those with reported fever, 72%, 95%CI (69–74) sought advice or treatment, 40%, 95%CI (37–44) were tested for malaria, and 42%, 95%CI (39–46) of those with fever took an antimalarial drug. Additionally, 17%, 95%CI (16–19) had a mid-upper arm circumference (MUAC) ≤ 13.5 cm, and 1%, 95%CI (0–1) had a (MUAC) ≤ 11.5 cm. The uptake of vitamin A VAS in the 6 months prior to the survey was 36%, based on routine delivery through EPI, and deworming coverage was 29%. Coverage of EPI vaccines was > 90%. Indicators in comparison and implementation areas were comparable. Conclusions The pilot implementation and evaluation of the RTS,S malaria vaccine in Ghana was conducted in an area with substantial malaria transmission and illness, modest health-seeking behaviour and ITN use, and good EPI vaccine coverage. This study has established the baseline comparability between implementation and comparator areas, which serves as the foundation for future feasibility assessments.