Abstract
Background . Expansion of maternal immunization, which offers some of the most effective protection against morbidity and mortality in pregnant women and neonates, requires broad acceptance by healthcare providers and their patients. We aimed to describe issues surrounding acceptance and demand creation for maternal vaccines in Kenya from a provider perspective. Methods . Nurses and clinical officers were recruited for semi-structured interviews covering resources for vaccine delivery, patient education, knowledge and attitudes surrounding maternal vaccines, and opportunities for demand creation for new vaccines. Interviews were conducted in English and Swahili, transcribed verbatim from audio recordings, and analyzed using codes developed from interview guide questions and emergent themes. Results . Providers expressed favorable attitudes about currently available maternal immunizations and introduction of additional vaccines, viewing themselves as primarily responsible for vaccine promotion and patient education. The importance of educational resources for both patients and providers to maintain high levels of maternal immunization coverage was a common theme. Most identified barriers to vaccine acceptance and delivery were cultural and systematic in nature. Suggestions for improvement included improved patient and provider education, including material resources, and community engagement through religious and cultural leaders. Conclusions . The distribution of standardized, evidence-based print materials for patient education may reduce provider overwork and facilitate in-clinic efforts to inform women about maternal vaccines. Continuing education for providers should address communication surrounding current vaccines and those under consideration for introduction into routine schedules. Engagement of religious and community leaders, as well as male decision-makers in the household, will enhance future acceptance of maternal vaccines.
Highlights
Reductions in neonatal mortality have not kept pace with overall declines in childhood mortality, partly because neonates are too young to be vaccinated, and have not benefitted from the progressive introduction of childhood vaccines globally[1]
Six major themes emerged from interviews: (1) the centrality of the patient-provider relationship in vaccine promotion; (2) cultural, religious, and social factors influencing vaccine acceptance among patients; (3) resources needed for improved vaccine delivery; (4) differences in provider knowledge about maternal vaccines; (5) favorable attitudes toward maternal vaccines; (6) patient access issues
Healthcare providers expressed favorable attitudes about currently available maternal immunizations, and the majority were open to providing new vaccines that may be in the pipeline, e.g. respiratory syncytial virus (RSV)
Summary
Reductions in neonatal mortality have not kept pace with overall declines in childhood mortality, partly because neonates are too young to be vaccinated, and have not benefitted from the progressive introduction of childhood vaccines globally[1]. Maternal immunizations offer some of the most effective protection against morbidity and mortality in both pregnant women and young infants[2]. Expansion of maternal immunization coverage, requires broad acceptance by both pregnant women and their healthcare providers (HCPs)[3,4]. One effective approach to maintain high coverage rates involves enabling providers to use effective messaging during patient interactions. Such a strategy builds upon patient knowledge, aids in countering misinformation, and provides a trusted source for women to confide in on maternal and child health visits[6]. Expansion of maternal immunization, which offers some of the most effective protection against morbidity and mortality in pregnant women and neonates, requires broad acceptance by healthcare providers and their patients.
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