Social sciences

Objectives

To examine the social dimensions of, and community responses to, diverse strategies for malaria vaccine deployment and their influence on malaria vaccine uptake in seasonal transmission areas of Mali and Guinea.

1. To analyse local understandings on malaria prevention strategies, including SMV, Seasonal Malaria Chemoprevention (SMC) and Insecticide-Treated Nets (ITNs), and the combined use of these interventions.
2. To describe the influence of malaria seasonality on vaccine acceptance and adherence, including community-level understanding of malaria transmission and its relationship with vaccine deployment.
3. To understand the social, cultural, and community-level factors influencing vaccine acceptance, hesitancy, and utilisation from both the healthcare provider and community perspectives.
4. To explore and describe community perceptions and attitudes towards the different malaria vaccine delivery strategies employed, particularly the delivery platforms (i.e. EPI program vs. community-based mass campaigns) and the timing of vaccine administration (season-based vs. age-based), and understand how these systems influence vaccine uptake and adherence.
5. To identify barriers and facilitators to the successful implementation of seasonal malaria vaccination programmes, both from the healthcare system and community perspectives.

Study design

Exploratory longitudinal study employing qualitative methods, and an iterative approach with three cross-sectional data collection points

1. In-depth semi-structured interviews
2. Focus group discussions
3. Non-participant/Direct observations:
4. Exit In-Depth Interview

The target groups include caregivers, community members, healthcare providers (especially those involved in R21M administration at the EPI clinics and mass vaccination campaigns), and community health workers.

Objectives

1. To assess the acceptability, accessibility, implementation feasibility and scalability of the two delivery strategies for seasonal malaria vaccination.
2. To identify barriers and facilitators to the successful implementation of the seasonal malaria vaccination strategies, both from the health system and community perspectives.
3. To understand the implementation process and implementation fidelity of the two malaria vaccine delivery strategies.

Study design

Embedded process evaluation, and mixed-methods combining data from the qualitative social study, implementation trial and additional data collection including:

1. Cross-sectional health facility audits 
2. Health worker surveys
3. Document review and engagement with implementers
4. In-depth interviews

Objectives

To assess the incremental cost-effectiveness of administration of the annual malaria vaccine booster doses a) through community-based mass vaccination campaigns versus through EPI clinics in Mali, and b) prior to malaria transmission season versus under an age-based vaccination schedule in Guinea

1. To estimate the economic cost (including financial and opportunity costs) of the two strategies
2. To assess and compare the unit economic costs (per child) of receiving one or two booster doses under the two different scenarios
3. To estimate the cost associated to the management of uncomplicated and complicated malaria in the study sites from different perspectives (provider and private)
4. To assess the robustness of the generated cost-effectiveness estimates by testing the impact of uncertain parameters in the results
5. To identify and understand the specific contextual factors driving the cost-effectiveness results 
6. To assess the economic feasibility of expanding community-based distribution of booster doses to other areas (sub-national or national level) → Only in Mali

Study design

The following tools will be used to gather data:

1. Caregiver exit survey
2. Health workers survey
3. Cost menu