Determinants of maternal immunization in developing countries |
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| Institution: | 1. P.O. Box 51590, Limbe, Malawi;2. Kasungu District Hospital, Kasungu, Malawi;3. Center for Global Health, Cincinnati Children''s Hospital, USA;1. Departments of Clinical Virology (RJT, GJF, ST, PA), Gastrointestinal Sciences (CEE, GC), Staff and Students Health Services (HK), Immunohematololgy and Transfusion Medicine (MPC), Christian Medical College Hospital, Vellore, Tamil Nadu, India;1. Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Decatur, GA, United States;2. Emory University, Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Atlanta, GA, United States;3. Emory University, Rollins School of Public Health, Hubert Department of Global Health, Atlanta, GA, United States;4. Emory University, Rollins School of Public Health, Department of Epidemiology, Atlanta, GA, United States;1. Duke Global Health Institute, Duke University, Durham, NC, USA;2. Health Section, UNICEF, New York, USA;3. Immunization Coverage and Equity, UNICEF, New York, USA;4. Enterprise Analytics and Data Sciences, University of North Carolina Health Care, Chapel Hill, NC, USA;5. Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA;6. Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA;1. Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada;2. Centre de recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, Canada;3. Département de gestion, d’évaluation et de politique de santé, École de santé publique de l’Université de Montréal (ESPUM), Montreal, Canada;4. Institute for Health and Social Policy, McGill University, Montreal, Canada;5. Statistics Canada, Ottawa, Canada;6. Gavi, the Vaccine Alliance, Geneva, Switzerland;1. Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam;2. Liverpool School of Tropical Medicine, and Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, UK;3. Kenya Medical Research Institute – Wellcome Trust Collaborative Programme, Kilifi, Kenya;4. Department of Psychiatry, University of Oxford, Oxford, UK;1. Department of Pediatrics, Infectious Diseases Section, Baylor College of Medicine, Houston, TX 77030, USA;2. Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030, USA;3. Center for Vaccine Awareness and Research, Texas Children''s Hospital, Houston, TX 77030, USA |
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| Abstract: | BackgroundMaternal immunization is an effective intervention to protect newborns and young infants from infections when their immune response is immature. Tetanus toxoid vaccination of pregnant women is the most widely implemented maternal vaccine in developing countries where neonatal mortality is the highest. We identified barriers to maternal tetanus vaccination in developing African and Asian countries to identify means of improving maternal immunization platforms in these countries.MethodWe categorized barriers into health system, health care provider and patient barriers to maternal tetanus immunization and conducted a literature review on each category. Due to limited literature from Africa, we conducted a pilot survey of health care providers in Malawi on barriers they experience in immunizing pregnant women.ResultsThe major barriers of the health system are due to inadequate financial and human resources which translate to inadequate vaccination services delivery and logistics management. Health care providers are limited by poor attendance of Antenatal Care and inadequate knowledge on vaccinating pregnant women. Patient barriers are due to lack of education and knowledge on pregnancy immunization and socioeconomic factors such as low income and high parity.ConclusionThere are several factors that affect maternal tetanus immunization. Increasing knowledge in health care providers and patients, increasing antenatal care attendance and outreach activities will aid the uptake of maternal immunization. Health system barriers are more difficult to address requiring an improvement of overall immunization services. Further analyses of maternal immunization specific barriers and the means of addressing them are required to strengthen the existing program and provide a more efficient delivery system for additional maternal vaccines. |
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| Keywords: | Maternal immunization Tetanus Barriers Newborn Antenatal care |
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