Maternal immunization in Malawi: A mixed methods study of community perceptions, programmatic considerations, and recommendations for future planning.
Adolescent
Adult
Female
Health Personnel
/ statistics & numerical data
Humans
Immunization
/ statistics & numerical data
Malawi
Middle Aged
Patient Acceptance of Health Care
/ statistics & numerical data
Pregnancy
Pregnancy Complications, Infectious
/ prevention & control
Pregnant Women
Vaccination
/ statistics & numerical data
Vaccines
/ administration & dosage
Young Adult
Malawi
Maternal immunization
Maternal tetanus toxoid and maternal influenza vaccine
Operational research
Journal
Vaccine
ISSN: 1873-2518
Titre abrégé: Vaccine
Pays: Netherlands
ID NLM: 8406899
Informations de publication
Date de publication:
26 07 2019
26 07 2019
Historique:
received:
25
10
2018
revised:
20
05
2019
accepted:
24
05
2019
entrez:
20
7
2019
pubmed:
20
7
2019
medline:
17
9
2020
Statut:
ppublish
Résumé
Safe, effective vaccines are given to pregnant women to protect their infants and/or themselves against certain infectious agents; however, apart from tetanus vaccination, maternal immunization in low- and middle-income countries (LMICs) remains low. Tetanus toxoid vaccine is integrated into antenatal care services in Malawi with high coverage and provides an opportunity to identify factors that facilitate successful immunization delivery to pregnant women in LMICs. PATH and the University of Malawi's Centre for Social Research conducted a mixed-methods study in 2015 to document community perceptions of maternal immunization, using tetanus vaccine as an example, and to identify factors perceived to be important to successfully introducing other maternal vaccines, such as influenza vaccine, in Malawi. We conducted 18 focus group discussions with pregnant and recently pregnant women and their family members and 76 semi-structured interviews with pregnant and recently pregnant women, community leaders, health workers, public health program managers, non-governmental partners, and policy makers. We identified factors perceived to support the introduction of new maternal vaccines, including strong maternal vaccine acceptance in the community, an existing strategy for maternal tetanus vaccine delivery, and positive health workers' views about the introduction of additional maternal vaccines. Potential challenges to adoption and acceptance included identifying and tracking the target population and monitoring adverse events, and the need to ensure operational capacity of the health system to support the introduction and wide-scale use of an additional vaccine. For influenza vaccine specifically, additional challenges included limited awareness of influenza disease and its low prioritization among health needs. Lessons from the successful delivery of maternal tetanus immunization in Malawi may be informative for similar countries considering new vaccines for pregnant women or striving to optimize the delivery of those currently provided.
Sections du résumé
BACKGROUND
Safe, effective vaccines are given to pregnant women to protect their infants and/or themselves against certain infectious agents; however, apart from tetanus vaccination, maternal immunization in low- and middle-income countries (LMICs) remains low. Tetanus toxoid vaccine is integrated into antenatal care services in Malawi with high coverage and provides an opportunity to identify factors that facilitate successful immunization delivery to pregnant women in LMICs.
METHODS
PATH and the University of Malawi's Centre for Social Research conducted a mixed-methods study in 2015 to document community perceptions of maternal immunization, using tetanus vaccine as an example, and to identify factors perceived to be important to successfully introducing other maternal vaccines, such as influenza vaccine, in Malawi. We conducted 18 focus group discussions with pregnant and recently pregnant women and their family members and 76 semi-structured interviews with pregnant and recently pregnant women, community leaders, health workers, public health program managers, non-governmental partners, and policy makers.
RESULTS
We identified factors perceived to support the introduction of new maternal vaccines, including strong maternal vaccine acceptance in the community, an existing strategy for maternal tetanus vaccine delivery, and positive health workers' views about the introduction of additional maternal vaccines. Potential challenges to adoption and acceptance included identifying and tracking the target population and monitoring adverse events, and the need to ensure operational capacity of the health system to support the introduction and wide-scale use of an additional vaccine. For influenza vaccine specifically, additional challenges included limited awareness of influenza disease and its low prioritization among health needs.
CONCLUSIONS
Lessons from the successful delivery of maternal tetanus immunization in Malawi may be informative for similar countries considering new vaccines for pregnant women or striving to optimize the delivery of those currently provided.
Identifiants
pubmed: 31319932
pii: S0264-410X(19)30781-9
doi: 10.1016/j.vaccine.2019.06.020
pmc: PMC6642336
pii:
doi:
Substances chimiques
Vaccines
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
4568-4575Subventions
Organisme : World Health Organization
ID : 001
Pays : International
Informations de copyright
Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.
Références
Vaccine. 2003 Jul 28;21(24):3442-5
pubmed: 12850356
Vaccine. 2018 Jun 14;36(25):3573-3575
pubmed: 28427847
Clin Exp Vaccine Res. 2018 Jan;7(1):76-81
pubmed: 29399583
Disaster Med Public Health Prep. 2015 Apr;9(2):120
pubmed: 25882117
Vaccine. 2015 Aug 14;33(34):4191-203
pubmed: 25896385
Vaccine. 2012 Sep 7;30 Suppl 3:C35-7
pubmed: 22939019
Vaccine. 2016 Oct 26;34(45):5400-5405
pubmed: 27646030
Vaccine. 2012 Sep 7;30 Suppl 3:C66-71
pubmed: 22939025
Vaccine. 2016 Jan 2;34(1):20-32
pubmed: 26602267
Clin Vaccine Immunol. 2016 Jan 27;23(3):186-8
pubmed: 26818954
Wkly Epidemiol Rec. 2012 Nov 23;87(47):461-76
pubmed: 23210147
Wkly Epidemiol Rec. 2015 May 29;90(22):261-78
pubmed: 26027016
Clin Infect Dis. 2018 Mar 5;66(6):865-876
pubmed: 29045699
Vaccine. 2018 Jun 27;36(28):4054-4061
pubmed: 29859803
Pharmacoepidemiol Drug Saf. 2015 Apr;24(4):361-7
pubmed: 25683692
Arch Dis Child Fetal Neonatal Ed. 2017 Sep;102(5):F456-F463
pubmed: 28468899
J Infect Dis. 2016 Dec 1;214(11):1700-1711
pubmed: 27630199
Am J Trop Med Hyg. 2016 Oct 5;95(4):915-917
pubmed: 27527633
Vaccine. 2014 Dec 12;32(52):7057-64
pubmed: 25285883
Science. 2017 Oct 27;358(6362):452-453
pubmed: 29074757
Vaccine. 2015 Nov 25;33(47):6420-9
pubmed: 26320417
Arch Sex Behav. 2012 Dec;41(6):1319-20
pubmed: 22968493
Vaccine. 2018 May 11;36(20):2751-2759
pubmed: 29661584
Vaccine. 2016 Jul 25;34(34):3942-9
pubmed: 27317458