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Calvo AE, Tristán Urrutia AG, Vargas-Zambrano JC, López Castillo H. Pertussis vaccine effectiveness following country-wide implementation of a hexavalent acellular pertussis immunization schedule in infants and children in Panama. Hum Vaccin Immunother 2024; 20:2389577. [PMID: 39164002 PMCID: PMC11340738 DOI: 10.1080/21645515.2024.2389577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 07/31/2024] [Accepted: 08/04/2024] [Indexed: 08/22/2024] Open
Abstract
Despite high pediatric vaccination coverage rates (VCRs), pertussis incidence has increased worldwide, including in several countries in Latin America in the last two decades. Given the few vaccine effectiveness (VE) studies in Latin American countries, this retrospective, observational, cohort study estimated the effectiveness of hexavalent acellular (aP) primary and booster vaccination (wP) against pertussis in infants (6.5-18.5 months) and children (18.5-48.5 and 48.5-72.5 months) in Panama. Age-specific incidence rates (IRs) were calculated for the vaccine's pre-initiation (2001-2013), initiation (2014), and post-initiation (2015-2019) periods. VCRs and trends were determined, and VE was analyzed using a case coverage or screening method to compare proportions of vaccinated cases and vaccinated individuals in the population. Between 2001-2019, 868 confirmed pertussis cases were reported in Panama; 712 (82.0%; 54.8 cases/year) during the pre-initiation period, 19 (2.2%; 19 cases/year) during the initiation period, and 137 (15.8%; 27.4 cases/year) during the post-initiation period. Panama underwent cyclical increases in IRs, which varied between age groups. VCRs increased for primary and booster doses. Between 2015 and 2019, third-dose yearly vaccine coverage increased, on average, 3.3%. Specifically, during the post-initiation period, 109/137 (79.6%) of cases were unvaccinated. Relative VE was estimated at 96.2% [95% CI: 86.5%, 98.9%] with three doses; 100% with 4 and 5 booster doses. Absolute VE was estimated at 99.3% with three doses only. These results show that vaccination played an important role in maintaining a low number of pertussis cases in Panama, affirming the need for sustained investment and commitment to vaccination programs.
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Affiliation(s)
- Arlene E. Calvo
- College of Public Health, University of South Florida, Panama Program at City of Knowledge, Tampa, FL, USA
- Gorgas Memorial Institute for Health Studies, Panama City, Panama
| | | | | | - Humberto López Castillo
- Department of Health Sciences, College of Health Professions and Sciences, Academic Health Sciences Center, University of Central Florida, Orlando, FL, USA
- Department of Population Health Sciences, College of Medicine, Academic Health Sciences Center, University of Central Florida, Orlando, FL, USA
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Melchinger H, Winters M, Christie S, Arias N, Lirman L, Abeyesekera S, Thomson A, Omer SB. Determinants of undervaccination of routine childhood immunization in Argentina: A cross-sectional study. Vaccine 2024; 42:126235. [PMID: 39182313 DOI: 10.1016/j.vaccine.2024.126235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/19/2024] [Accepted: 08/14/2024] [Indexed: 08/27/2024]
Abstract
Routine childhood immunization is one of the most effective methods of preventing infectious diseases in children. In Argentina, there has been a decline in routine immunization coverage since 2015, with very little evidence to date on underlying drivers of this steady decline. We administered an online nationwide behavioral insights survey in Argentina between July 1-25, 2022, targeting parents with at least one child under the age of 12 years. Our survey included 1504 parents, 7% (n = 111) of whom did not or only partially vaccinated their children. We found that, compared to the youngest parents (aged 18-24), older parents were less likely to under-vaccinate their children (e.g., 30-34 year-old parents: adjusted Odds Ratio (aOR): 0.31, 95% Confidence Interval (CI) 0.16-0.57). Parents who undervaccinated their children were more likely to take vaccination advice from parent and wellness social media influencers (parent influencers: aOR 2.51, 95% CI 1.46-4.31), and were less likely to trust the social media accounts of official health organizations (aOR 0.82, 95% CI 0.70-0.96). Furthermore, these parents had heightened concerns about routine immunizations, including the number of vaccines given to children and potential for adverse side effects. When asked whether they knew enough to make a vaccine decision for their children, parents who undervaccinated their children were more likely to report that they did not know enough about vaccines or the vaccination schedule to make a decision. These results offer important insights into parental concerns surrounding routine childhood immunization and suggest potential drivers of - and solutions to - the decline in routine immunization seen in Argentina since 2015.
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Affiliation(s)
- Hannah Melchinger
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, TX 75390, United States
| | - Maike Winters
- Yale Institute for Global Health, Yale University, New Haven, CT 06511, United States
| | - Sarah Christie
- Yale School of Medicine, Yale University, New Haven, CT 06511, United States
| | | | | | | | | | - Saad B Omer
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, TX 75390, United States.
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Roberti J, Ini N, Belizan M, Alonso JP. Barriers and facilitators to vaccination in Latin America: a thematic synthesis of qualitative studies. CAD SAUDE PUBLICA 2024; 40:e00165023. [PMID: 38922226 PMCID: PMC11192573 DOI: 10.1590/0102-311xen165023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 04/01/2024] [Accepted: 04/09/2024] [Indexed: 06/27/2024] Open
Abstract
Vaccines are often undervalued or underused for a variety of reasons, and vaccine hesitancy is a global challenge that threatens vaccine acceptance and the goals of immunization programs. This review aimed to describe the barriers and facilitators to vaccination in Latin America. The study design was a systematic review and thematic synthesis of qualitative studies reporting on the knowledge or attitudes of adults, parents of children at vaccination age, adolescents and health professionals towards vaccination in Latin America. The databases searched were PubMed, CENTRAL, Scopus, LILACS, SciELO, and CINAHL. A total of 56 studies were included. Facilitators included vaccination being recognized as an effective strategy for preventing infectious diseases and as a requirement for access to social assistance programs, schooling or employment. Recommendations from health professionals and positive experiences with health services were also identified as facilitators. The main barriers were lack of information or counseling, structural problems such as shortages of vaccines and limited hours of operation, the inability to afford over-the-counter vaccines or transportation to health facilities, certain religious beliefs, misconceptions and safety concerns. Qualitative research can contribute to understanding perceptions and decision-making about vaccination and to designing policies and interventions to increase coverage.
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Affiliation(s)
- Javier Roberti
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Natalí Ini
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Maria Belizan
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Juan Pedro Alonso
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
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McDermid P, Blazek K, Mougin N, Thomson A, Seale H. Attitudes and behaviors of maternal Tdap vaccination in Panama, Peru, and Colombia: An international cross-sectional study. Vaccine 2024; 42:1698-1703. [PMID: 38355320 DOI: 10.1016/j.vaccine.2024.01.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/24/2024] [Accepted: 01/31/2024] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Despite a recommendation by PAHO for Tdap vaccination in pregnant women since 2019, uptake remains suboptimal across Latin America. This study evaluated the knowledge and attitudes of women towards maternal Tdap vaccination in Colombia, Peru, and Panama to identify the critical behavioral and social drivers of Tdap vaccine uptake during pregnancy. METHODS A cross-sectional online survey was undertaken between December 8, 2022, and January 11, 2023, targeting women in Colombia, Peru, or Panama with a child 12 months or under. We collected data on respondents' demographics, social and behavioral determinants of vaccine acceptance, determinants of vaccine uptake (using the validated 5As taxonomy), and previous vaccination experience. RESULTS In the 938 respondents who completed the survey (Panama, n = 325; Peru, n = 305; Colombia, n = 308), 73-80 % had received the influenza vaccine, whereas only 30-39 % had received a Tdap vaccine. Significant correlates of Tdap vaccine uptake common to all three countries included a health professional recommendation, knowledge of the vaccine and location of vaccination, perceived vulnerability to pertussis infection, perceived importance of immunization, and receipt of a reminder. In specific countries, nonvaccinated women were more likely to cite issues with ease of access (Panama, Colombia), affordability (opportunity costs; Peru, Colombia), and understanding the rationale for vaccination in pregnancy (Panama, Colombia). CONCLUSION To increase maternal Tdap vaccine uptake, health professionals should be encouraged to recommend vaccination consistently, and pregnant women should receive reminders explaining why and where to be vaccinated.
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Affiliation(s)
- Pippa McDermid
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, New South Wales, Australia
| | - Katrina Blazek
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, New South Wales, Australia
| | | | - Angus Thomson
- Irimi Company, Lyon, France; Department of Communication Studies & Global Health Communication Center, Indiana University School of Liberal Arts at IUPUI, USA
| | - Holly Seale
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, New South Wales, Australia.
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Houghton N, Bascolo E, Coitiño A, Koller TS, Fitzgerald J. Using mixed methods to understand and tackle barriers to accessing health services. Rev Panam Salud Publica 2023; 47:e117. [PMID: 37609528 PMCID: PMC10441553 DOI: 10.26633/rpsp.2023.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 06/05/2023] [Indexed: 08/24/2023] Open
Abstract
This report describes the experience and lessons learnt from designing and implementing a combined quantitative and qualitative method to assess barriers to accessing health services. This approach was developed to study barriers to access in five dimensions: availability; geographical, financial, and organizational accessibility; acceptability; contact; and effective coverage. The study design was used in six countries in the World Health Organization Region of the Americas. The findings highlight the importance of having a well defined analysis framework and the benefits of adopting a mixed-methods approach. Using existing data and contextualizing findings according to specific population groups and geographical areas were essential for relevance and utilization of the study outcomes. The findings demonstrate the feasibility of using mixed methods to understand the complexity of access problems faced by different subpopulations. By involving decision-makers from the beginning and allowing flexibility for sustained discussions, the analysis and findings had an impact. The engagement of health authorities and key stakeholders facilitated the use of the findings for collaborative identification of policy options to eliminate access barriers. Lessons learnt from the study emphasized the need for active participation of decision-makers, flexibility in the process, and sustained opportunities for discussion to ensure impact. Giving consideration to local priorities and adapting the methods accordingly were important for the relevance and use of the findings. Future efforts could consider incorporating mixed methods into national and local monitoring and evaluation systems.
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Affiliation(s)
- Natalia Houghton
- Pan American Health OrganizationWashington D.C.United States of AmericaPan American Health Organization, Washington D.C., United States of America.
| | - Ernesto Bascolo
- Pan American Health OrganizationWashington D.C.United States of AmericaPan American Health Organization, Washington D.C., United States of America.
| | - Andrés Coitiño
- Pan American Health OrganizationWashington D.C.United States of AmericaPan American Health Organization, Washington D.C., United States of America.
| | - Theadora S. Koller
- World Health OrganizationGenevaSwitzerlandWorld Health Organization, Geneva, Switzerland.
| | - James Fitzgerald
- Pan American Health OrganizationWashington D.C.United States of AmericaPan American Health Organization, Washington D.C., United States of America.
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Davies B, Olivier J, Amponsah-Dacosta E. Health Systems Determinants of Delivery and Uptake of Maternal Vaccines in Low- and Middle-Income Countries: A Qualitative Systematic Review. Vaccines (Basel) 2023; 11:vaccines11040869. [PMID: 37112781 PMCID: PMC10144938 DOI: 10.3390/vaccines11040869] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/11/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
Maternal vaccination is considered a key component of the antenatal care package for improving maternal and child health. Low- and middle-income countries (LMICs) fall short of global targets to prevent maternal and neonatal deaths, with a disproportionate burden of vaccine-preventable diseases. Strategies towards ending preventable maternal mortality necessitate a health systems approach to adequately respond to this burden. This review explores the health systems determinants of delivery and uptake of essential maternal vaccines in LMICs. We conducted a qualitative systematic review of articles on maternal vaccination in LMICs, published between 2009 and 2023 in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Thematic analysis was conducted to identify key themes in the literature, interpreted within a conceptual framing that explores the systems determinants influencing maternal vaccines. Our search yielded 1309 records, of which 54 were included, covering 34 LMICs. Most of the included studies were from South America (28/54) and included pregnant women as the primary study population (34/54). The studies explored influenza (25/54) and tetanus toxoid (20/54) vaccines predominantly. The findings suggest that systems hardware (lack of clear policy guidelines, ineffective cold-chain management, limited reporting and monitoring systems) are barriers to vaccine delivery. Systems software (healthcare provider recommendations, increased trust, higher levels of maternal education) are enablers to maternal vaccine uptake. Findings show that formulation, dissemination and communication of context-specific policies and guidelines on maternal vaccines should be a priority for decision-makers in LMICs.
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Affiliation(s)
- Bronte Davies
- Health Policy and Systems Division, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town 7925, South Africa
- Vaccines for Africa Initiative, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town 7925, South Africa
| | - Jill Olivier
- Health Policy and Systems Division, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town 7925, South Africa
| | - Edina Amponsah-Dacosta
- Vaccines for Africa Initiative, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town 7925, South Africa
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Di Lello FA, Martínez AP, Flichman DM. Insights into induction of the immune response by the hepatitis B vaccine. World J Gastroenterol 2022; 28:4249-4262. [PMID: 36159002 PMCID: PMC9453777 DOI: 10.3748/wjg.v28.i31.4249] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 05/21/2022] [Accepted: 07/25/2022] [Indexed: 02/06/2023] Open
Abstract
After more than four decades of hepatitis B virus (HBV) vaccine implementation, its safety and efficacy in preventing HBV infection have been proven and several milestones have been achieved. Most countries have included HBV immunization schedules in their health policies and progress has been made regarding universalization of the first HBV vaccine dose at birth. All of these actions have significantly contributed to reducing both the incidence of HBV infection and its related complications. However, there are still many drawbacks to overcome. The main concerns are the deficient coverage rate of the dose at birth and the large adult population that has not been reached timely by universal immunization. Additionally, the current most widely used second-generation vaccines do not induce protective immunity in 5% to 10% of the population, particularly in people over 40-years-old, obese (body mass index > 25 kg/m2), heavy smokers, and patients undergoing dialysis or infection with human immunodeficiency virus. Recently developed and approved novel vaccine formulations using more potent adjuvants or multiple antigens have shown better performance, particularly in difficult settings. These advances re-launch the expectations of achieving the World Health Organization’s objective of completing hepatitis control by 2030.
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Affiliation(s)
- Federico Alejandro Di Lello
- Microbiology, Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Instituto de Investigaciones en Bacteriología y Virología Molecular, Buenos Aires C1113AAD, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires C1425FQB, Argentina
| | - Alfredo Pedro Martínez
- Virology Section, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno “CEMIC”, Buenos Aires C1431FWO, Argentina
| | - Diego Martín Flichman
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires C1425FQB, Argentina
- Microbiology, Universidad de Buenos Aires, Instituto de Investigaciones Biomédicas en Retrovirus y Síndrome de Inmunodeficiencia Adquirida, Buenos Aires C1121ABG, Argentina
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Samuel O, Zewotir T, North D. Decomposing the urban-rural inequalities in the utilisation of maternal health care services: evidence from 27 selected countries in Sub-Saharan Africa. Reprod Health 2021; 18:216. [PMID: 34717668 PMCID: PMC8557532 DOI: 10.1186/s12978-021-01268-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/19/2021] [Indexed: 11/25/2022] Open
Abstract
Background There has been a substantial improvement in reducing maternal mortality in the Sub-Saharan African region. The vast rural-urban gap in maternal health outcomes, however, is obscured by this average achievement. This study attempts to measure the contribution of identified risk factors to describe the average rural-urban difference in the use of antenatal care, health facilities for delivery, and health professional assistance at delivery. Method To achieve this objective, we used descriptive analysis and Fairlie non-linear decomposition method to quantify covariates’ contribution in explaining the urban–rural difference in maternal healthcare services utilisation. Result The study’s finding shows much difference between urban and rural areas in the use of maternal healthcare services. Socio-economic factors such as household wealth index, exposure to media, and educational level of women and their husbands/partners contributed the most in explaining the gap between urban and rural areas in healthcare services utilisation. Conclusions Interventions to bridge the gap between urban and rural areas in maternal healthcare services utilisation in Sub-Saharan Africa should be centred towards socio-economic empowerment. Government can enforce targeted awareness campaigns to encourage women in rural communities in Sub-Sharan Africa to take the opportunity and use the available maternal health care services to be at par with their counterparts in urban areas. Maternal health refers to the health of women throughout pregnancy, delivery, and the postnatal period. Each step should be a good experience that ensures mothers, and their infants realize their maximum health and well-being potential. In this study, we used individual, demographic, and socio-economic characteristics to measure the urban–rural discrepancies in maternal health care services in Sub-Saharan Africa. We used Information of 220 164 women of child-bearing age (15–49) gathered from National Demographic Health Surveys from 27 countries in the Sub-Sahara African region. We found 46.1% of women in rural areas had no education, 39.7% of the women in rural areas have husbands/partners with no education, and 60.1% of the women in rural areas are from households with poor wealth indexes. The use of maternal health care services found to be predominant in the urban areas than rural areas, and the measure of this difference can inform policymakers on the level of effort that needed to be put in place to balance the discrepancies and improve maternal health in general.
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Affiliation(s)
- Oduse Samuel
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, 4001, South Africa.
| | - Temesgen Zewotir
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, 4001, South Africa
| | - Delia North
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, 4001, South Africa
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Maternal and neonatal immunization in the Americas: The benefits, the hurdles, and the way forward. Vaccine 2021; 39 Suppl 2:B1-B2. [PMID: 34130884 PMCID: PMC8196310 DOI: 10.1016/j.vaccine.2021.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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10
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Vicari AS, Olson D, Vilajeliu A, Andrus JK, Ropero AM, Morens DM, Santos IJ, Azziz-Baumgartner E, Berman S. Seasonal Influenza Prevention and Control Progress in Latin America and the Caribbean in the Context of the Global Influenza Strategy and the COVID-19 Pandemic. Am J Trop Med Hyg 2021; 105:93-101. [PMID: 33970888 PMCID: PMC8274756 DOI: 10.4269/ajtmh.21-0339] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/16/2021] [Indexed: 12/12/2022] Open
Abstract
Each year in Latin America and the Caribbean, seasonal influenza is associated with an estimated 36,500 respiratory deaths and 400,000 hospitalizations. Since the 2009 influenza A(H1N1) pandemic, the Region has made significant advances in the prevention and control of seasonal influenza, including improved surveillance systems, burden estimates, and vaccination of at-risk groups. The Global Influenza Strategy 2019–2030 provides a framework to strengthen these advances. Against the backdrop of this new framework, the University of Colorado convened in October 2020 its Immunization Advisory Group of Experts to review and discuss current surveillance, prevention, and control strategies for seasonal influenza in Latin America and the Caribbean, also in the context of the COVID-19 pandemic. This review identified five areas for action and made recommendations specific to each area. The Region should continue its efforts to strengthen surveillance and impact evaluations. Existing data on disease burden, seasonality patterns, and vaccination effectiveness should be used to inform decision-making at the country level as well as advocacy efforts for programmatic resources. Regional and country strategic plans should be prepared and include specific targets for 2030. Existing investments in influenza prevention and control, including for immunization programs, should be optimized. Finally, regional partnerships, such as the regional networks for syndromic surveillance and vaccine effectiveness evaluation (SARInet and REVELAC-i), should continue to play a critical role in continuous learning and standardization by sharing experiences and best practices among countries.
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Affiliation(s)
- Andrea S Vicari
- 1Health Emergencies Department, Pan American Health Organization, Washington, District of Columbia
| | - Daniel Olson
- 2Division of Pediatric Infectious Disease, University of Colorado School of Medicine, Aurora, Colorado.,3Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado.,4Center for Global Health, Colorado School of Public Health, Aurora, Colorado
| | - Alba Vilajeliu
- 5Comprehensive Family Immunization, Pan American Health Organization, Washington, District of Columbia
| | - Jon K Andrus
- 6Department of Global Health, George Washington University Milken Institute of Public Health, Washington, District of Columbia.,7Division of Vaccines and Immunization, Center for Global Health, University of Colorado, Aurora, Colorado
| | - Alba Maria Ropero
- 5Comprehensive Family Immunization, Pan American Health Organization, Washington, District of Columbia
| | - David M Morens
- 8Office of the Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | | | | | - Stephen Berman
- 4Center for Global Health, Colorado School of Public Health, Aurora, Colorado
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Erazo CE, Erazo CV, Grijalva MJ, Moncayo AL. Knowledge, attitudes and practices on influenza vaccination during pregnancy in Quito, Ecuador. BMC Public Health 2021; 21:72. [PMID: 33413252 PMCID: PMC7791889 DOI: 10.1186/s12889-020-10061-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 12/13/2020] [Indexed: 02/07/2023] Open
Abstract
Background Vaccination is the most effective way to prevent infection and severe outcomes caused by influenza viruses in pregnant women and their children. In Ecuador, the coverage of seasonal influenza vaccination in pregnant women is low. The aim of this study was to assess the knowledge, attitudes, and practices (KAP) of pregnant women toward influenza vaccination in Quito-Ecuador. Methods A cross-sectional study enrolled 842 women who delivered at three main public gynecological-obstetric units of the Metropolitan District of Quito. A questionnaire regarding demographics, antenatal care, risk conditions and knowledge, attitudes and practices related to influenza vaccination was administered. We examined factors associated with vaccination using log-binomial regression models. Results A low vaccination rate (36.6%) against influenza was observed among pregnant women. The factors associated with vaccination included the recommendations from health providers (adjusted PR: 15.84; CI 95% 9.62–26.10), belief in the safety of the influenza vaccine (adjusted PR: 1.53; CI 95% 1.03–2.37) and antenatal care (adjusted PR: 1.21; CI 95% 1.01–1.47). The most common reasons for not vaccinating included the lack of recommendation from health care providers (73.9%) and lack of access to vaccine (9.0%). Conclusions Health educational programs aimed at pregnant women and antenatal care providers have the most potential to increase influenza vaccination rates. Further studies are needed to understand the barriers of health care providers regarding influenza vaccination in Ecuador. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-10061-4.
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Affiliation(s)
- Carlos E Erazo
- Centro de Investigación para la Salud en América Latina (CISeAL), Escuela de Ciencias Biológicas, Facultad de Ciencias Exactas y Naturales, Pontificia Universidad Católica del Ecuador, Apartado, 1701-2184, Quito, Ecuador
| | - Carlos V Erazo
- Facultad de Medicina, Pontificia Universidad Católica del Ecuador, Apartado, 1701-2184, Quito, Ecuador
| | - Mario J Grijalva
- Centro de Investigación para la Salud en América Latina (CISeAL), Escuela de Ciencias Biológicas, Facultad de Ciencias Exactas y Naturales, Pontificia Universidad Católica del Ecuador, Apartado, 1701-2184, Quito, Ecuador.,Department of Biomedical Sciences, Infectious and Tropical Disease Institute, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, 45701, USA
| | - Ana L Moncayo
- Centro de Investigación para la Salud en América Latina (CISeAL), Escuela de Ciencias Biológicas, Facultad de Ciencias Exactas y Naturales, Pontificia Universidad Católica del Ecuador, Apartado, 1701-2184, Quito, Ecuador.
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