Demographic characteristics of study participants
Of a total of 55 participants, 49 participated in the FGDs and six participated in IDIs; all were male. Most participants resided in rural areas. Among respondents, small-scale farming and small businesses were common occupations. Those with formal employment included MDs and VEOs. Respondents’ ages ranged from 21 to 71 years.
Participants had an overall positive view towards the secondary health benefits established by MVTs. The main themes that emerged from this study were: i) improvement of health care services; ii) transport; iii) infrastructure and iv) human resources. Misconceptions were also reported by a minority of participants
Improvement of health care services
All participants agreed that the phase 2 and phase 3 RTS,S MVTs improved the quality of health care to the study participants, as well as the community as a whole, by providing reliable, full-time and quick medical care. The participants claimed that the project had improved health care services at the hospital level where a modern laboratory and radiology unit had been built in the compound of Korogwe District Hospital. The presence of these facilities offered better health care to study participants, as well as to the whole community. One 36-year-old male health worker explained that:
“We have a big laboratory which has been built by the malaria project through donors’ fund, for this laboratory to be in the District Hospital compound, it has given us (the District Hospital) the opportunity to utilize the structure, human resources as well as the services and because of the poor quality of most of the government laboratories, the presence of this laboratory which is also monitored and overseen by the laboratory professionals and experts from abroad, it has helped us so much to have the quality laboratory services in the District” (Participant number B55)
Participants who did not get an opportunity to participate in the MVT expressed their willingness to participate in the project because of the quality health care services offered by the project. A 42-year-old female who did not participate in the trials explained that:
“Those who have been enrolled in the malaria vaccine project are really praising the project; I want also to join the project because of the good health services which are being offered by the project such as free medical care…” (Participant number A3)
Some participants who participated in the FGDs but who did not participate in the trials were not aware of the health care services being offered by the project.
The majority of respondents, including those who participated in the MVT and those who did not, stated that the project has been able to reduce the number of deaths for children under five in the study area due to the effective and fast treatment offered to trial participants as well as non-participants. A 36-year-old male health worker explained:
“The death of children has been massively reduced in the paediatric ward” (Participant number B5)
Some respondents who participated in the FGDs but who did not participate in the MVTs, were quiet about this subtheme, likely because they were not knowledgeable about the topic.
The majority of the participants, especially women in the FGDs, reported that the malaria vaccine project provided treated mosquito nets to all participants. However, there were concerns about the number of nets provided by the project, which was perceived to be limited. A minority of the participants did not comment on this subtheme. One 59-year-old female commented that:
“…If possible we request that each participant in the malaria vaccine project should get more than one bed net in order to prevent other children in the family…” (Participant number A09)
In addition to distribution of bed nets, most participants mentioned close follow up and monitoring of participants by the project health workers as an important component of the project. A 53-year-old male participant stated:
“…Participants in the malaria vaccine project are being followed by the project field workers to monitor their health status…” (Participant number A19)
Nearly all respondents expressed that the malaria vaccine project provided very good care to trial participants. Project staff use polite language and provide good care to participants and non-participants. However there are some malaria vaccine staff who are rude. A 43-year-old female stated:
“…Majority of malaria vaccine staff are very polite and caring. However there are some staff who are rude. One day my children were sick, I went to Magunga Hospital (Magunga is the name of Korogwe District Hospital) I was so embarrassed by one doctor. I am not sure whether he is the project employee or the government employee but I thank God some malaria vaccine staff assisted me…” (Participant number A06)
The majority of respondents, especially in the FGDs, expressed that in case of death of any of the study participants the malaria vaccine project does participate in the funeral. Participants commented that the project always provides condolences and transport for caretakers of the study participants in case of any death. A 59-year-old male respondent commented that:
“…Malaria vaccine project do provide transport and condolences to the caretakers in case of any death of the study participants…” (Participant number A13)
All participants in both FGDs and IDIs explained that the malaria vaccine project provides free treatment to the community and especially to those trial participants. Free treatment is perceived by respondents as one of the primary benefits established by MVTs. One 48-year-old female commented:
“…Even if the parents or guardians do not have money they still get quality health service, this project does not segregate between rich people and poor people…” (Participant number A45)
The majority of the respondents in both FGDs and IDIs explained that the malaria vaccine project has established a referral system for participants who cannot be treated at the project dispensary or at Korogwe District Hospital. This particular theme was discussed by respondents in both FGDs and IDIs. Respondents expressed that once the study participant is seriously sick and he/she cannot be treated at the health facility across the study area, the patient is referred immediately to a referral hospital for further check up and treatment. The community perceived this as a vital secondary health benefit brought by the malaria vaccine project. A 43-year-old female explained:
“…One day my child had a foreign body ingestion (chicken bone) he couldn’t be treated at Korogwe District Hospital. The project referred my child to KCMC Referral Hospital and he was well treated and is doing very fine now” (Participant number A06)
Overall, the majority of participants in all FGDs and IDIs stated that the availability of transport is one of the major secondary health benefits brought by the project. Most participants explained that project vehicles provide free transport to study participants, as well as non-study participants. As one 59-year-old male stated:
“…Malaria vaccine project provide free transport to the people…” (Participant number A26)
A few respondents were quiet on the above topic, maybe because they were not involved directly in the research or because they stayed closer to the project dispensary. Fewer participants, especially in the IDIs, expressed that the project collaborated well with the District Hospital in case of emergencies. A 36-year-old male health worker explained:
“…For example last year during the national vaccination campaign malaria project has given us the vehicle and driver. They really assisted the Hospital. We are very grateful for the collaboration which exists between the project and the Hospital…” (Participant number B55)
The majority of respondents, especially in the FGDs, were not conversant with the collaboration between the project and the District Hospital because they were not involved directly in the day-to-day activities of the project as well as the District Hospital.
A few participants, especially in the IDIs, explained that the project has massively increased the number of health professionals across the study area. Respondents claimed that the project employed qualified staff from different parts of the country as well as from outside the country. A 36-year-old male health worker commented:
“…There are project staff who are working in the paediatric ward and radiology unit; they really assist to bridge the gap of the shortage of human resources which we are facing in this hospital…” (Participant number B55)
Another 36-year-old male health worker explained:
“…If I can recall correctly we came here in 2006, in Korogwe District Hospital there was no medical doctor but MVT has been able to employ three qualified medical doctors and 12 nursing officers who are working in the paediatric ward” (Participant number B54)
A few respondents, especially in the IDIs, expressed that the project had been able to provide employment chances to people in the community across the study area. Respondents explained that the community appreciates the contribution of the project for employing people from the community and they perceive this contribution as one of the major secondary health benefits that has been established by the malaria project. A 36-year-old male health worker claimed:
“…The presence of malaria vaccine project has assisted the community members to get some auxiliary employment, I have seen some young people employed by the project, although they don’t have good education but these young people could have been bad people in the community but due to the presence of the malaria vaccine project these young people have managed to get employment…” (Participant number B55)
The majority of respondents, especially in the FGDs, were not conversant with the two subthemes above, perhaps because they were not closely involved in the health systems. Key informants had sufficient information about the topics.
A few participants, especially in the IDIs, explained that the project had built nine vaccination centres in the study area and the modern laboratory, which is fully equipped with both modern equipment and qualified staff. Respondents elaborated that the presence of health care facilities across the study area has brought health care services close to the community, which is perceived by the community as one of the most important secondary health benefits established by the malaria vaccine project. A 36-year-old male health worker explained:
“…The community has been able to get health care services closer to the areas in which they live. In our community it is normal to find the distance between one household and the health facility is too far but the project has managed to build dispensaries closer to the communities which facilitate easier provision of health services…” (Participant number B55 in the IDI number 06)
The same respondent continued:
“…Also malaria vaccine project has been able to renovate our dispensaries and they have built some new structures for vaccination of their study subjects. Our dispensaries were in bad condition and old but the project has assisted to renovate. At Korogwe District Hospital the malaria project has built a big modern laboratory…” (Participant number B55)
The majority of respondents, especially in the FGDs, were not familiar with the above subtheme. They were not sure whether the infrastructure had been built by the government or by the project.
A few respondents raised some questions with regard to the trial activities, especially on blood sampling; for example, some respondents claimed that there were reports that the blood collected from participants was sold by the research institute; and others stated that the blood is used for satanic purposes (Mumiani- Kiswahili word which means blood-suckers). Those respondents claimed that people with less experience of research, such as the elderly and residents of remote villages, were believed to have spread such rumours.
“…The amount of blood which is taken is high, so people are scared; they need to be educated. They said the project is selling the blood…” (Participant number A33)
After further exploration, the majority of the respondents reported that the blood is used for diagnostic purposes especially for malaria disease.