Floor stacker Alfred Lungu was smiling the day we met him, because he was just finished taking his daughter to the hospital. He knew that this was not the case for many women in his town.
In 2015, among the 4 million women with adolescent pregnancies, half of them live in Kamwenge, a large city in eastern Uganda. There are too few health facilities and transport means it can take as long as two days to reach the nearest one. The waits here, and in other towns in Uganda, are so long that many women do not get pregnant again until much later. More than a third of women in Kamwenge are infertile.
So for many people in Kamwenge, like Alfred Lungu, getting a chance to talk to a nurse is out of the question. Instead, he seeks treatment in a secondary clinic. In the ward, pregnant women make rounds, checking on one another and hoping that a nurse or doctor will see them.
Kamwenge is where scientists from the Albert Einstein College of Medicine and the KIROLOFS-HELMS Institute of Public Health in New York, along with experts from the private sector and government, are working to track and implement the global malaria vaccine initiative. (The two groups took The Lancet’s 2016 Vaccine Solutions challenge to track how women are faring in Kamwenge and the broader region.) Vaccine inequity means that those living in most urban areas, where transportation is relatively easy, get all the benefits of the program — while those who live on the more rural fringes are left behind.
The mothers we spoke with as part of the initiative heard the stories and reflected on the reality of the situation. “I live alone, and we lack transport,” said one mother. Another mother explained that the lack of safe water to wash before sex, as well as access to sanitary napkins and prolonged bathroom breaks deter the health of her second child: “Because [she’s] hungry, she doesn’t sleep.”
With the vaccine development program, nearly 70,000 local women were given the malaria vaccine in 2015 — and plans call for the number to grow in the years to come. In many places, the investment in the vaccine has been massive. For instance, KIROLOFS-HELMS and AECOM have built five rural clinics that will serve about 120,000 people. Over the coming months, medical staff and local health care practitioners will begin testing the vaccine in these facilities. Meanwhile, health ministry workers and local organizations continue building and renovating clinics in the community.