The jab effect: How malaria vaccine is quietly saving Kisumu's children

For decades, paediatric wards across Kisumu’s public hospitals have carried a familiar weight, feverish children, anxious mothers and the relentless urgency associated with malaria, a disease that has shaped childhood illness along the Lake Victoria region for generations.

Hospital beds were once routinely filled with young patients battling high fevers, convulsions and severe infections, many requiring prolonged admissions. Malaria was not simply common; it defined the rhythm of clinical life.

Today, however, health workers and caregivers are beginning to notice something different. Malaria has not disappeared, but its presence feels altered — less severe, less overwhelming and increasingly manageable.

The shift coincides with the introduction of Kenya’s malaria vaccine.

On September 17, 2019, Kisumu County became one of the first regions in Kenya to introduce the RTS, S/AS01 malaria vaccine under the Malaria Vaccine Implementation Programme (MVIP). The pilot targeted children aged six months to two years across five sub-counties: Kisumu East, Kisumu West, Kisumu Central, Muhoroni and Seme.

The goal was ambitious: to reduce severe malaria cases in one of Kenya’s most affected regions.

Nearly six years later, families and health workers say the difference is becoming visible.

New generation of mothers

At Kisumu County Referral Hospital, 22-year-old Christine Agutu sits patiently in the outpatient queue, gently rocking her infant. A first-time mother from Manyatta, she represents a generation raising children in the era of malaria vaccination. “I started giving my child the malaria vaccine at seven months,” she says. “Before, it was not there. But now I can see the benefits.”

Christine gave birth in July last year and learned about the vaccine during routine clinic visits. Like many new mothers, she relied heavily on guidance from healthcare workers. “I was told at the hospital that my child would receive the malaria vaccine,” she explains.

“I trusted it because I knew it would protect my child from malaria.”

Her observations are simple but telling. “There are very few infections or signs of malaria,” she says. “No constant fever. The child is active.”

Despite the vaccine, Christine continues to use mosquito nets at home. “I still use the net to prevent mosquito bites,” she adds, recognising that vaccination complements, rather than replaces, existing prevention methods.

Her experience reflects a broader reality in Kisumu, where malaria remains endemic, but increasingly less severe.

Changing clinical patterns

For clinicians, such as John Omondi at Lumumba Sub-County Hospital, the transformation is evident in daily practice. “Before the malaria vaccine, we saw many severe malaria cases, especially among children under five,” he says. “These cases often came with complications and sometimes resulted in death.”

He recalls children arriving with extremely high parasite loads, severe anaemia, pneumonia and convulsions. “It was very serious,” he says. “You could examine 100 children and nearly half would be malaria cases, many of them severe.”

At the time, limited facility capacity meant frequent referrals to higher-level hospitals. “Severe malaria was the order of the day,” Omondi recounts.

Today, the picture looks markedly different. “With the vaccine, severe cases have reduced,” he explains.

In recent weeks, he notes, admissions for severe malaria have dropped significantly. “We have not admitted any severe malaria cases in the past few weeks,” he says. “Only one child with convulsions required referral earlier this year.”

Malaria has not been eliminated, but its intensity has declined. “We now see fewer cases within a week compared to before,” he adds.

“Deaths have also reduced, which is a major achievement.”

According to Kisumu County Malaria Control Coordinator Lilyana Dayo, the vaccine represents one of the most significant milestones in the fight against malaria, particularly for children under five, the group most vulnerable to severe disease. “The malaria vaccine is a major step forward,” she says. “We are already seeing reductions in severe illness and hospitalisation, which ultimately means lives saved.”

County data support these observations. Malaria prevalence in Kisumu stood at approximately 27 per cent in 2015–2016. By 2020, following vaccine introduction alongside continued interventions, such as mosquito nets and indoor spraying, prevalence had fallen to 15.6 per cent. “That is nearly an eight-percentage-point reduction,” Dayo explains. “The burden may have declined further, but we are awaiting updated survey data.”

Hospital statistics mirror this trend. Before 2019, severe malaria accounted for 10 to 15 per cent of hospital bed occupancy. Today, the figure is estimated at around five per cent or lower.

“These numbers show that integrated interventions are working,” she says.

Despite progress, malaria remains a significant public health threat.

Transmission continues to be higher in areas such as Seme, Nyando, Muhoroni, parts of Kisumu East and sections of the Kano Plains.

Omondi emphasises the importance of managing expectations. “The vaccine does not completely stop malaria,” he says. “Like many vaccines, it reduces severity. A child may still be infected, but the illness is less dangerous.”

Preventive measures, therefore, remain essential. “Sleeping under mosquito nets still protects children from mosquito bites,” he adds.

One challenge facing the programme is incomplete vaccination. “Some parents stop bringing children after the first year,” Omondi notes. “They miss important doses needed for full protection.”

In communities across Kisumu, older caregivers remember malaria very differently.

In Obunga, Roselyn Opiyo, 46, recalls the fear that once accompanied every fever. “Malaria was a monster,” she says. “If not treated quickly, it could kill.”

Her firstborn suffered repeated infections, but her youngest child, born in 2016 before the vaccine rollout, experienced the most severe illness. “She became very sick,” Roselyn remembers. “Malaria hit hard and she almost collapsed.”

The child was admitted for four weeks, placing enormous emotional and financial strain on the family. “I spent a lot of money in the hospital,” she says. “I could not work because I had to stay with the child.”

Without health insurance, treatment costs were overwhelming.

When the vaccine was introduced in 2019, Roselyn initially hesitated.

“We were happy, but unsure whether it would work,” she admits.

Information from radio programmes, newspapers and community health promoters eventually convinced her. “I learned it was important, so I took my children for vaccination.”

The results were noticeable. “My children no longer get frequent malaria attacks,” she says. “Even when they fall sick, it is not severe.”

She credits community health promoters for building trust and awareness. “They helped us understand why vaccination matters.”

Financial relief for families

Colleta Atieno, 33, also draws a clear contrast between life before and after vaccination.

Her firstborn frequently battled illness. “He used to sweat a lot,” she recalls. 

Eventually, her child was admitted to Jaramogi Oginga Odinga Teaching and Referral Hospital with severe malaria and stayed for three weeks.

The hospital bill reached Sh154,000. “I did not have health insurance,” she says. 

After learning about the malaria vaccine in 2020 through community health promoters, she ensured her younger children received it. “Since then, things have changed,” she says.

“They may get malaria, but it is mild.”

Although myths surrounding vaccines persist, she chose to trust medical advice. “I believed it would help my children,” she says.

A spot check across several facilities, including Lumumba Sub-County Hospital, Kisumu County Referral Hospital and Jaramogi Oginga Odinga Teaching and Referral Hospital, indicates a consistent decline in severe malaria admissions among children.

Health workers describe quieter paediatric wards compared with previous years, even during peak transmission seasons.

However, Kisumu’s geographical realities continue to sustain malaria transmission. Proximity to Lake Victoria and favourable climatic conditions create an environment where mosquitoes thrive.

Current estimates place malaria prevalence among children in the region at around 19 per cent, with Plasmodium falciparum remaining the dominant parasite.

Nationally, malaria remains a major health challenge. Approximately 75 per cent of Kenya’s population lives at risk of infection, with an estimated 3.3 million cases reported in 2023.

The 2020 Kenya Malaria Indicator Survey showed about 70 per cent of the population at risk, including 13 million people in endemic regions and 19 million in epidemic-prone areas.

Between 2022 and 2023, malaria incidence declined slightly from 62 to 59 cases per 1,000 people, while mortality remained at 0.21 deaths per 1,000.

Globally, the disease continues to exact a heavy toll. In 2024, an estimated 282 million malaria cases and 610,000 deaths were recorded worldwide. Sub-Saharan Africa accounted for 94 per cent of infections and 95 per cent of deaths.

Children under five remain the most vulnerable, representing nearly three-quarters of malaria deaths in the region.

Earlier global estimates from 2019 reported 229 million cases and more than 409,000 deaths, again with Africa carrying the greatest burden.

In Kenya, malaria still accounts for over 18 per cent of outpatient visits and roughly 20 per cent of hospital admissions.

Global health authorities formally recommended wider use of the malaria vaccine in 2021 following encouraging results from pilot countries, including Kenya.

Experts emphasise that the vaccine is not a standalone solution but part of an integrated strategy combining mosquito nets, prompt treatment, surveillance and community education.

Years after its introduction, the vaccine’s impact in Kisumu is emerging not as the elimination of malaria, but as a transformation.

Severe illness is declining. Hospital admissions are falling. Families are spending less time at bedsides and fewer resources on treatment.