Journal article
Vaccine implementation factors affecting maternal tetanus immunization in low- and middle-income countries: Results of the Maternal Immunization and Antenatal Care Situational Analysis (MIACSA) project.
- Giles ML Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia. Electronic address: michelle.giles@monash.edu.
- Mantel C MMGH Consulting, Zurich, Switzerland.
- Muñoz FM Departments of Pediatrics, Section of Infectious Diseases, and Molecular Virology and Microbiology, Baylor College of Medicine, Houston TX, USA.
- Moran A Department of Maternal, Newborn, Child, Adolescent Health and Ageing, Geneva, Switzerland.
- Roos N Department of Maternal, Newborn, Child, Adolescent Health and Ageing, Geneva, Switzerland.
- Yusuf N Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland.
- Diaz T Department of Maternal, Newborn, Child, Adolescent Health and Ageing, Geneva, Switzerland.
- Ahun M Independent Consultant, McKing Consulting, Geneva, Switzerland.
- Nic Lochlainn LM Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland.
- Wootton E Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland.
- Pathirana J Medical Research Council: Respiratory and Meningeal Pathogens Research Unit and Department of Science and Technology/ National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
- Rendell S Department of Anthropology University of Pennsylvania, Philadelphia, USA.
- Tuncalp O Department of Sexual and Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, WHO, Geneva, Switzerland.
- Perut M Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland.
- Hombach J Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland.
- Merten S Swiss Tropical and Public Health Institute and University of Basel, Basel, Switzerland.
- Lambach P Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland.
- 2020-06-27
Published in:
- Vaccine. - 2020
English
OBJECTIVES
To examine the characteristics of existing maternal tetanus immunization programmes for pregnant women in low- and middle-income countries (LMICs) and to identify and understand the challenges, barriers and facilitators associated with maternal vaccine service delivery that may impact the introduction and implementation of new maternal vaccines in the future.
DESIGN
A mixed methods, cross sectional study with four data collection phases including a desk review, online survey, telephone and face-to-face interviews and in country visits.
SETTING
LMICs.
RESULTS
The majority of countries (84/95; 88%) had a maternal tetanus immunization policy. Countries with high protection at birth (PAB) were more likely to report tetanus toxoid-containing vaccine (TTCV) coverage targets > 90%. Less than half the countries included in this study had a TTCV coverage target of > 90%. Procurement and distribution of TTCV was nearly always the responsibility of the Expanded Programme on Immunization (EPI), however planning and management of maternal immunization was often shared between EPI and Maternal, Newborn and Child Health (MNCH) programmes. Receipt of TTCV at the same time as the antenatal care visit correlated with high PAB. Most countries (81/95; 85%) had an immunization safety surveillance system in place although only 11% could differentiate an adverse event following immunization (AEFI) in pregnant and non-pregnant women.
CONCLUSIONS
Recommendations arising from the MIACSA project to strengthen existing services currently delivering maternal tetanus immunization in LMICs include establishing and maintaining vaccination targets, clearly defining responsibilities and fostering collaborations between EPI and MNCH, investing in strengthening the health workforce, improving the design and use of existing record keeping for immunization, adjusting current AEFI reporting to differentiate pregnant women and endeavoring to integrate the provision of TTCV within ANC services where appropriate.
To examine the characteristics of existing maternal tetanus immunization programmes for pregnant women in low- and middle-income countries (LMICs) and to identify and understand the challenges, barriers and facilitators associated with maternal vaccine service delivery that may impact the introduction and implementation of new maternal vaccines in the future.
DESIGN
A mixed methods, cross sectional study with four data collection phases including a desk review, online survey, telephone and face-to-face interviews and in country visits.
SETTING
LMICs.
RESULTS
The majority of countries (84/95; 88%) had a maternal tetanus immunization policy. Countries with high protection at birth (PAB) were more likely to report tetanus toxoid-containing vaccine (TTCV) coverage targets > 90%. Less than half the countries included in this study had a TTCV coverage target of > 90%. Procurement and distribution of TTCV was nearly always the responsibility of the Expanded Programme on Immunization (EPI), however planning and management of maternal immunization was often shared between EPI and Maternal, Newborn and Child Health (MNCH) programmes. Receipt of TTCV at the same time as the antenatal care visit correlated with high PAB. Most countries (81/95; 85%) had an immunization safety surveillance system in place although only 11% could differentiate an adverse event following immunization (AEFI) in pregnant and non-pregnant women.
CONCLUSIONS
Recommendations arising from the MIACSA project to strengthen existing services currently delivering maternal tetanus immunization in LMICs include establishing and maintaining vaccination targets, clearly defining responsibilities and fostering collaborations between EPI and MNCH, investing in strengthening the health workforce, improving the design and use of existing record keeping for immunization, adjusting current AEFI reporting to differentiate pregnant women and endeavoring to integrate the provision of TTCV within ANC services where appropriate.
- Language
-
- English
- Open access status
- hybrid
- Identifiers
-
- DOI 10.1016/j.vaccine.2020.05.084
- PMID 32586763
- Persistent URL
- https://sonar.ch/global/documents/232570
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