Abstract
ObjectivesTo 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. DesignA 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. SettingLMICs. ResultsThe 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. ConclusionsRecommendations 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.
Highlights
Introduction of other maternal vaccinesAim to ensure that the service delivery of new vaccines is integrated with existing delivery channels for tetanus toxoid-containing vaccine (TTCV), where these achieve high coverage
The findings from the Maternal Immunization and Antenatal Care Situational Analysis (MIACSA) project shed light on how existing health services in countries currently deliver TTCV to pregnant women and on attributes associated with effective maternal vaccine service delivery in low- and middle-income countries (LMICs)
Successful approaches identified in this project include target setting, integrated programme coordination between Expanded Programme on Immunization (EPI) and MNCH and operational approaches that maximise a woman’s access to maternal immunization at the time of Antenatal care (ANC)
Summary
Introduction of other maternal vaccinesAim to ensure that the service delivery of new vaccines is integrated with existing delivery channels for TTCV, where these achieve high coverage. It is hoped that the findings from the MIACSA project and the implementation of these evidence-based recommendations will contribute to the achievement of global MNTE and contribute to a robust platform for the introduction of new maternal vaccines in the future. In 2017, the global mortality rate for children under five years of age was 39 per 1,000 live births, half the worldwide rate in 1990 [5]. The Sustainable Development Goals (SDGs), launched in 2015, [6] set the target 3.2 to end preventable deaths of newborns and children under five years of age by 2030 and to reduce neonatal mortality to a maximum of 12 per 1,000 live births [7]. Numerous countries from these regions risk being among the 60 countries projected to miss the SDGs in 2030 [8]
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