Pathirana Jayani, Nkambule Jerome, Black Steven
P.O. Box 51590, Limbe, Malawi.
Kasungu District Hospital, Kasungu, Malawi.
Vaccine. 2015 Jun 12;33(26):2971-7. doi: 10.1016/j.vaccine.2015.04.070. Epub 2015 Apr 30.
Maternal 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.
We 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.
The 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.
There 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.
孕产妇免疫接种是一种有效的干预措施，可在新生儿和幼儿免疫反应不成熟时保护他们免受感染。在新生儿死亡率最高的发展中国家，孕妇接种破伤风类毒素疫苗是实施最广泛的孕产妇疫苗。我们确定了非洲和亚洲发展中国家孕产妇破伤风疫苗接种的障碍，以找出改善这些国家孕产妇免疫接种平台的方法。
我们将障碍分为孕产妇破伤风免疫接种的卫生系统、医疗保健提供者和患者障碍，并对每个类别进行了文献综述。由于来自非洲的文献有限，我们对马拉维的医疗保健提供者进行了一项关于他们在为孕妇接种疫苗时遇到的障碍的试点调查。
卫生系统的主要障碍是由于财政和人力资源不足，这导致疫苗接种服务提供和后勤管理不足。医疗保健提供者受到产前保健就诊率低和对孕妇接种疫苗知识不足的限制。患者障碍是由于缺乏关于孕期免疫接种的教育和知识以及低收入和高生育次数等社会经济因素。
有几个因素影响孕产妇破伤风免疫接种。提高医疗保健提供者和患者的知识水平、增加产前保健就诊率和外展活动将有助于孕产妇免疫接种的推广。卫生系统障碍更难解决，需要改善整体免疫接种服务。需要进一步分析孕产妇免疫接种的具体障碍及其解决方法，以加强现有计划并提供更有效的额外孕产妇疫苗接种服务系统。
