Strategies to improve caregiver awareness and completion of the 2nd and 3rd doses of the malaria vaccine in Mukono district, Uganda

Summary

Mukono district in Uganda has experienced significant challenges in the uptake of the 2nd and 3rd doses of the newly introduced R21/Matrix-M malaria vaccine, which is administered at 6, 7, 8, and 18 months of age. While the first dose achieved a high coverage of 110% due to a mass health campaign, coverage for the 2nd and 3rd doses dropped sharply to 24%, largely because these doses are not aligned with routine immunization visits. This misalignment results in caregivers needing to make additional visits, contributing to low follow-up and partial immunization, which reduces protection against severe malaria. The District Health Team sought evidence on strategies to improve uptake of these doses. Key findings indicate that caregiver awareness, recall, and motivation are critical factors. Effective strategies include enhanced visual cues on home-based immunization records, structured caregiver education with visual aids, community-led follow-up by health workers, voice-based digital reminders, and incentivized reminders. Implementing these strategies in combination can significantly improve completion rates. The brief recommends adopting an active follow-up model integrating communication, reminders, and follow-up within routine immunization and community health systems to address the low uptake of the 2nd and 3rd malaria vaccine doses.

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