Impact of Malaria Vaccination Coverage on Uncomplicated and Severe Malaria Cases Among Children Under Five Years in Central Region, Ghana

Background: Malaria remains a leading cause of morbidity and mortality among children under five in sub-Saharan Africa, including Ghana. Despite significant efforts to control the disease through interventions such as insecticide-treated nets (ITNs) and indoor residual spraying (IRS), malaria continues to pose a public health challenge. The introduction of the RTS,S/AS01 malaria vaccine in 2019 aimed to complement existing interventions. However, its impact on uncomplicated and severe malaria cases among children under five in Ghana's Central Region remains poorly understood. This study assesses the impact of malaria vaccination coverage on malaria cases and explores implementation challenges associated with the Malaria Vaccine Implementation Program (MVIP).  Methods: A retrospective longitudinal study design was employed, analyzing routine health data from the District Health Information Management System 2 (DHIMS-II) from January 2016 to December 2022. Interrupted Time Series (ITS) analysis was used to evaluate the impact of the RTS,S vaccine on uncomplicated and severe malaria cases. Qualitative interviews with healthcare workers and caregivers provided insights into implementation challenges.  Results: The study found a complex relationship between vaccination coverage and malaria cases, with significant declines in uncomplicated malaria in some districts (e.g., Agona East, Assin Fosu, Cape Coast) but increases in others (e.g., Asikuma- Odoben-Brakwa). Qualitative data highlighted challenges such as cold chain deficiencies, financial constraints, cultural barriers, and logistical issues.  Conclusion: The effectiveness of malaria vaccination varied across districts, underscoring the need for localized strategies to address context-specific barriers. Strengthening cold chain infrastructure, improving community engagement, and addressing logistical challenges are essential to optimize vaccine impact.