Center for Vaccine Innovation and Access, PATH, 2201 Westlake Ave, Suite 200, Seattle, WA 98121, USA.
The Centre for Social Research, University of Malawi, PO Box 280, Zomba, Malawi.
Vaccine. 2019 Jul 26;37(32):4568-4575. doi: 10.1016/j.vaccine.2019.06.020.
Safe, effective vaccines are given to pregnant women to protect their infants and/or themselves against certain infectious agents; however, apart from tetanus vaccination, maternal immunization in low- and middle-income countries (LMICs) remains low. Tetanus toxoid vaccine is integrated into antenatal care services in Malawi with high coverage and provides an opportunity to identify factors that facilitate successful immunization delivery to pregnant women in LMICs.
PATH and the University of Malawi's Centre for Social Research conducted a mixed-methods study in 2015 to document community perceptions of maternal immunization, using tetanus vaccine as an example, and to identify factors perceived to be important to successfully introducing other maternal vaccines, such as influenza vaccine, in Malawi. We conducted 18 focus group discussions with pregnant and recently pregnant women and their family members and 76 semi-structured interviews with pregnant and recently pregnant women, community leaders, health workers, public health program managers, non-governmental partners, and policy makers.
We identified factors perceived to support the introduction of new maternal vaccines, including strong maternal vaccine acceptance in the community, an existing strategy for maternal tetanus vaccine delivery, and positive health workers' views about the introduction of additional maternal vaccines. Potential challenges to adoption and acceptance included identifying and tracking the target population and monitoring adverse events, and the need to ensure operational capacity of the health system to support the introduction and wide-scale use of an additional vaccine. For influenza vaccine specifically, additional challenges included limited awareness of influenza disease and its low prioritization among health needs.
Lessons from the successful delivery of maternal tetanus immunization in Malawi may be informative for similar countries considering new vaccines for pregnant women or striving to optimize the delivery of those currently provided.
为了保护孕妇及其婴儿免受某些传染病的侵害，会给孕妇接种安全有效的疫苗；然而，除破伤风类毒素疫苗外，中低收入国家（LMICs）的孕产妇免疫接种率仍然很低。在马拉维，破伤风类毒素疫苗已纳入产前护理服务，覆盖率很高，这为确定有利于在 LMICs 为孕妇成功接种疫苗的因素提供了机会。
PATH 和马拉维大学社会研究中心于 2015 年开展了一项混合方法研究，以记录社区对孕产妇免疫接种的看法，以破伤风疫苗为例，并确定被认为对成功引入其他孕产妇疫苗（如流感疫苗）至关重要的因素，在马拉维。我们对孕妇和最近怀孕的妇女及其家属进行了 18 次焦点小组讨论，对孕妇和最近怀孕的妇女、社区领导、卫生工作者、公共卫生项目管理人员、非政府合作伙伴和政策制定者进行了 76 次半结构化访谈。
我们确定了支持引入新的孕产妇疫苗的因素，包括社区对新的孕产妇疫苗的强烈接受度、现有的孕产妇破伤风疫苗接种策略，以及卫生工作者对引入额外孕产妇疫苗的积极看法。采用和接受的潜在挑战包括确定和跟踪目标人群以及监测不良事件，以及需要确保卫生系统的运营能力，以支持引入和广泛使用额外的疫苗。具体针对流感疫苗，额外的挑战包括对流感疾病的认识有限，以及对健康需求的低优先级。
从马拉维成功提供孕产妇破伤风免疫接种中吸取的经验教训，可能对考虑为孕妇提供新疫苗或努力优化目前提供的疫苗接种的类似国家具有借鉴意义。
