Assessing Community Acceptance of Maternal Immunisation in Rural KwaZulu-Natal, South Africa: A Qualitative Investigation.

Rujeko Chimukuche,Nothando Ngwenya,Nellie Myburgh,Nomasonto Radebe,Clare Cutland,Sunday Adedini,Motlatso Godongwana,Petronella Nxumalo,Zama Nxumalo,Janet Seeley

doi:10.3390/vaccines10030415

Abstract

Despite the significant benefits of maternal immunisation, uptake remains low in many parts of the world. In this qualitative study, we aimed to assess the factors that influence pregnant women’s decision to engage with maternal immunisation in rural KwaZulu-Natal, South Africa. We conducted in-depth interviews with a total of 28 purposively sampled pregnant women and key informants using semi-structured topic guides. Data analysis was conducted using a modified Health Belief Model framework that included constructs of barriers to action, modifying factors of cue to action and perceived social norms. The findings show that traditional customs and institutional barriers such as low-quality health service delivery, long queues, and distance to the health facilities, immunisation vaccine stockouts and low levels of maternal knowledge influence the choice and decision to engage with maternal immunisation. Understanding health-related behaviours and addressing barriers to care is important in facilitating vaccination uptake. This study contributes to the understanding of maternal immunisation uptake in low-resource settings.

Highlights

We describe the perceptions of maternal immunisation among pregnant women and other key informants in northern KwaZulu-Natal and the influence this has on maternal acceptance of the tetanus toxoid vaccine, and what might be done to increase vaccine confidence and improve uptake
This study was conducted in rural uMkhanyakude district of northern KwaZulu-Natal. This district is one of the poorest in South Africa, with 98% of the population living in rural homesteads; 22% have access to safe water; only 10% of households are within a short distance, approximately 4.72 km, of a health clinic [12,13]
The sub-study results on which this paper draws are part of a larger study, assessing community acceptance and health facility preparedness for the implementation of maternal immunisation programs in urban and rural South Africa funded through Immunizing Pregnant Women and Infants Network (IMPRINT)—Immunising Pregnant Women and Infants Network

Summary

Introduction

Maternal immunisation acceptance and uptake is influenced by several external factors including time, place and type of vaccine [1]. In low- to middle-income countries (LMICs), low levels of education, a lack of maternal immunisation vaccine knowledge and challenges in health service delivery hinder uptake [1]. Recommends maternal vaccination against tetanus, pertussis and influenza, as well as other diseases such as pneumococcus [2,3]. In many LMIC, including South Africa, tetanus toxoid immunisation is recommended for pregnant women to prevent neonatal tetanus [4,5]. According to the WHO, a gradual decline in the uptake of the third dose of diphtheria–

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