The importance of involving midwives before and during the implementation of an antenatal pertussis vaccination program in New South Wales, Australia

Coverage and predictors of influenza and pertussis vaccination during pregnancy: a whole of population-based study

BACKGROUND

Respiratory infections including influenza and pertussis are associated with significant morbidity and mortality in mothers and newborns. Vaccination during pregnancy against influenza and pertussis is recommended for all women but data on uptake in Australia is limited.

METHODS

We conducted a retrospective population-based cohort study in Australia's largest state, New South Wales (NSW), using a Perinatal Data Collection (PDC). Data included demographic, pregnancy, and birth details including pertussis and influenza vaccination during pregnancy for all women giving birth between 01 January 2016 and 31 December 2020. We used descriptive statistics to assess uptake of influenza and pertussis vaccination during pregnancy and Poisson loglinear regression to estimate associations between maternal characteristics and vaccine receipt.

RESULTS

During 2016-2020, there were 477,776 births (mean maternal age 32.25 years). In 176,255 (36.9%) births the mother received both vaccines; 202,922 (42.5%) influenza and 315,620 (66.1%) pertussis vaccine. From 2016 to 2020, reported coverage increased from 26.7% to 58.7% for influenza and 43.1% to 78.8% for pertussis, respectively. After adjustment, characteristics associated with lower likelihood of receiving influenza and pertussis vaccination included: younger age (<30 years), being born in Australia/New Zealand, from lower socio-economic strata, having previous pregnancies, being later to first antenatal care, utilising the public hospital care model, smoking, having chronic hypertension and BMI > 25 kg/m2.

CONCLUSIONS

While reported coverage of both influenza and pertussis vaccine in birthing women in NSW has increased over time, disparities in coverage exist and they highlight areas where evidence-based interventions to improve maternal vaccination could be targeted.

Vaccination in pregnancy: The role of the midwife

Midwives are the front-line workers providing maternity care for women in many countries. The role of the midwife includes providing information about, and recommendations for, maternal vaccination in pregnancy and for the baby in the postnatal period. Vaccinations recommended in pregnancy include those to prevent influenza, pertussis, tetanus and now COVID-19. Vaccinations for the newborn baby include hepatitis B. Healthcare professionals play an important role in influencing decision-making around vaccination and midwives are key in supporting vaccination uptake. Midwives are strong influencer in women's decisions around vaccination for themselves and their babies. The COVID-19 vaccination programs have shone a light on vaccination in pregnancy especially as SARS-COV-2 infection has significant adverse effects in pregnancy. COVID-19 vaccination has been shown to be safe and effective in pregnancy. Despite this, there is vaccine hesitancy from pregnant women in many countries. Midwives play a unique role in the provision of care to women and families but they need specific support and information regarding vaccination in pregnancy. Targeted education, supportive mentoring and supervision and opportunities to lead innovative ways of ensuring vaccine access is logistically easy and possible are all needed. This Commentary outlines the key vaccinations recommended in pregnancy including COVID-19 vaccination and highlights some strategies to scale-up vaccination programs in pregnancy with a particular focus on the role of midwives.

Patient satisfaction with non-clinical nursing care provided by the nursing assistant under different management models in Chinese public tertiary hospital

BACKGROUND

There are disparities of in-hospital non-clinical nursing care delivered by the nursing assistant under different management models in China. This study aimed to identify the best management model of the nursing assistant from the patient perspective.

METHODS

This is a cross-sectional study. The inpatient satisfaction with in-hospital non-clinical nursing care delivered by the nursing assistant under different management models was measured and analyzed based on a national inpatient survey Likert the 5-point scale questionnaire conducted in 144 public tertiary hospitals across 31 provinces of China. The study conducted univariate analysis and binary Logistic regression analysis to examine which management model of the nursing assistant and any other key determinants would lead to a positive satisfaction rating by the inpatient who experienced non-clinical nursing care.

FINDINGS

The overall satisfaction rating of 6211 inpatients received non-clinical nursing care was 4.73 out of 5, among which 96.09% of the responded inpatients had a positive satisfaction rating. By controlling of the other variables, the likelihood of having a positive inpatient satisfaction rating of non-clinical nursing care delivered by the nursing assistant under the direct commercial company management model, the self-employed model, the commercial company and hospital joint management model accounted for only 14.8%, 20.3% and 35.7% of the nursing assistant under the direct hospital management model.

CONCLUSIONS

The direct hospital management model of the nursing assistant might be the best one to deliver the non-clinical nursing care that mostly satisfied the inpatient of Chinese public hospitals.

Midwifery care of non-vaccinating families - Insights from the Byron Shire

PROBLEM

Midwives may feel ill-equipped to manage clinical encounters with non-vaccinating parents.

BACKGROUND

Pregnancy is a peak time in the formation of parents' vaccination views and intention. Midwives are central to maternity care in Australia. While most midwives will have infrequent contact with families who intend not to vaccinate, when they do, they must feel equipped to communicate with them in a manner which fulfils their professional responsibilities, acknowledges parental autonomy and facilitates continued engagement.

AIM

To understand how midwives can most effectively communicate with non-vaccinating parents.

METHODS

We conducted in-depth interviews with 32 non-vaccinating parents and six key informant health professionals, and a focus group of six midwives. Data collection occurred in the Byron Shire of New South Wales, where childhood vaccination rates are persistently lower than national averages.

FINDINGS

This study explores four central codes. The first, 'hold on…I'm not sure about this' providing insights into moments of doubt preceding parents' decisions not to vaccinate. The second 'Pregnancy: a decision-making focal point' reinforces the importance of effective vaccination recommendations in the antenatal period. 'Manipulation and ambivalence' examines why overzealous or unclear recommendations about vaccination are unhelpful, and the fourth central code 'engage, inform and encourage' summarise recommendations from health professionals who are experienced in communicating, apparently effectively, with non-vaccinating families.

DISCUSSION

Insights from this study are used to recommend practical strategies which may be employed by midwives and maternity units to successfully and professionally manage clinical encounters with non-vaccinating parents.

CONCLUSION

Midwives are well positioned to provide clear recommendations to parents regarding childhood vaccination whilst maintaining engagement and meeting the goals of woman-centred care.

Influenza and pertussis vaccination during pregnancy - attitudes, practices and barriers in gynaecological practices in Germany

Background

In Germany, antenatal influenza vaccination is recommended since 2010, but uptake remains low. Several countries recently introduced antenatal pertussis vaccination, which is currently under consideration in Germany. We conducted a survey among gynaecologists on attitudes, practices and barriers regarding influenza and pertussis vaccination during pregnancy.

Methods

Gynaecologists were invited to complete a pre-tested, 24-item questionnaire published in the German Professional Association of Gynaecologists’ journal in September 2017 within 2 months. Associations between variables were examined using Chi-Squared, Fischer’s Exact or t-tests. Variables associated with gynaecologists’ self-reported implementation of vaccination in pregnant women were identified using univariate and multivariate logistic regression analyses.

Results

Of 867 participants (response 11%), 91.4 and 59.4% reported currently vaccinating pregnant women against influenza and pertussis, respectively. Gynaecologists who reported obtaining annual influenza vaccination and actively informing their patients about these vaccinations were significantly more likely to vaccinate pregnant women against influenza (96.5% vs. 65.7 and 95.1% vs. 62.2%) and pertussis (63.1% vs. 44.3 and 82.4% vs. 12.9%). Performing influenza vaccination was least likely among gynaecologists who perceived logistical difficulties as a vaccination barrier (35.9%), while pertussis vaccination was least likely if the lacking official recommendation (32.0%), logistical difficulties (27.1%), safety concerns (17.5%) and limited vaccine effectiveness (11.1%) were perceived as barriers. Of participants not yet vaccinating pregnant women against pertussis, 86.5% reported they would follow an official recommendation. Including vaccination recommendations in the maternity record (95.2%) and informing the public (88.7%) and health care professionals (86.6%) were considered the most suitable measures to achieve high pertussis vaccination coverage.

Conclusions

The large proportion reporting performance of influenza vaccination during pregnancy and high acceptance of a potential recommendation for pertussis vaccination reflected positive attitudes towards vaccination among participants. However, factors associated with failure to vaccinate may be more prevalent among non-participants. Results suggest that gynaecologists’ confidence in vaccination is crucial for implementing vaccination in pregnancy. Thus, doubts on vaccine effectiveness and safety should be allayed among gynaecologists and pregnant women via various communication channels, and solutions for logistical barriers sought. Including antenatal vaccination recommendations in the maternity record would serve as an important reminder for both groups.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-4437-y) contains supplementary material, which is available to authorized users.