Conceptualizing the COVID-19 Pandemic: Perspectives of Pregnant and Lactating Women, Male Community Members, and Health Workers in Kenya

Maternal Immunization Decision-Making Among Pregnant and Lactating People in Kenya: A Qualitative Exploration of Peer Influences on Vaccine Decision-Making for a Future RSV Vaccine

INTRODUCTION

Respiratory syncytial virus (RSV) is a leading cause of respiratory illness in infants globally, with new maternal RSV vaccines on the horizon. Vaccine decision-making during pregnancy is shaped by individual, interpersonal, community, and societal factors. This study explored key interpersonal influences on maternal vaccine decision-making among pregnant and lactating people (PLP) and community members in Kenya.

METHODS

This qualitative study conducted in-depth interviews with six pregnant people, 18 lactating people, and 10 community members in one rural and one urban county in Kenya. Data were analyzed using a grounded theory approach.

RESULTS

Participants identified the pregnant person themself, male partners, other family members, peers, and healthcare providers (HCPs) as key influences on the maternal immunization decision-making process. The majority of interviewed PLP believed that decision-making during pregnancy should be left to themselves due to autonomy and their role as the primary caregiver. Community members, including male partners, also identified pregnant people as the key decision-maker. While some PLP said they deferred to male partners to make vaccine decisions, more felt that men were not as informed on maternal and child issues as themselves or other female peers and relatives. HCPs emerged as important influences and information sources for PLP during decision-making.

DISCUSSION

Understanding who influences vaccine-decision making during pregnancy will help inform demand generation strategies, and in turn, uptake of future maternal vaccines, including RSV vaccines. Given the strong role HCPs and peers have in the decision-making process, targeting key potential influences is essential to improve vaccine acceptance.

Effect of psychological care on the prenatal mental state and vaginal delivery in pregnant women during the early stages of the COVID-19 epidemic

The COVID-19 pandemic has had a profound impact on the lives of people globally, including pregnant women. We aimed to explore the influence of a psychological care intervention based on behavioral change theory on the prenatal mental state and mode of delivery in pregnant women from June 2020 to June 2022 during the early stage of the COVID-19 epidemic in China. A retrospective analysis was conducted of the records of pregnant women who delivered in our hospital from June 2020 to June 2022. They were assigned to an observation and a control group according to the care that they received. The Symptom Checklist-90 (SCL-90) was used to evaluate their negative emotions. The duration of each labor stage and the mode of delivery (cesarean section, spontaneous vaginal delivery, or assisted vaginal delivery) were recorded. A total of 216 women were included in the analysis. Before care, there were no significant differences in the SCL-90 scores between the 2 groups. After delivery, the SCL-90 scores in the observation group were significantly lower than those in the control group. The vaginal delivery rate in the observation group was 92.59%, which was significantly higher than that in the control group (70.39%). The duration of the first stage of labor and the total duration of labor in the observation group were 447.95 ± 53.45 minutes and 498.15 ± 35.14 minutes, respectively, which were significantly lower than those in the control group. The implementation of psychological care based on behavioral change theory in pregnant women during the early stage of the COVID-19 epidemic significantly improved their prenatal psychological state, promoted vaginal delivery, and help shorten the labor process, and reduce the risk of adverse pregnancy outcomes. This intervention is thus worth promoting.

Challenges Faced by Mothers Practicing Kangaroo Mother Care (KMC) in a Resource-Limited Setting During the COVID-19 Pandemic: Insights From the Voices of Mothers of Preterm Babies and Their Suggested Solutions

Objectives. We investigated the challenges faced by mothers of preterm babies practicing KMC during the Covid-19 pandemic and documented the mothers' suggestions of possible interventions. Methods. We conducted a cross-sectional descriptive study at the New Born Unit of Kenyatta National Hospital(KNH). We interviewed 82 mothers using a researcher-administered questionnaire with closed and open-ended questions. Qualitative data generated from open-ended questions was analyzed thematically. Results. KMC was majorly affected by; fear of the baby contracting COVID-19, fear of contracting COVID-19, and social distancing restrictions. The mothers' suggested interventions included; the need for more KMC rooms, provision of appropriate clothing, strict application of COVID-19 prevention guidelines, and greater support of practice by the family. Conclusion. The mother's pivotal role as a partner in decision-making in regard to the improvement of KMC during pandemics and possibly other settings was demonstrated. Targeted interventions should incorporate the suggestions from the mothers.

"I was having an internal conflict with myself." COVID-19 vaccination decision-making processes among pregnant women

BACKGROUND

Vaccination serves as an efficient primary means of control for infectious diseases. However, in the case of the COVID-19 pandemic, pregnant women within the United States had the lowest rates of COVID-19 vaccination and reported the lowest intent to vaccinate.

OBJECTIVES

To explore the decision-making process for COVID-19 vaccination for people pregnant during the pandemic.

DESIGN

A secondary analysis of data from a mixed-methods study that examined the impact of COVID-19 on experiences of prenatal care, birth support, and delivery in the Southern United States.

METHODS

This study used a descriptive phenomenological approach to thematically analyze in-depth interviews (n = 20) with adult women who were pregnant by January 2020 and had their prenatal care and delivery during the pandemic beginning in March 2020. The transcripts were de-identified, coded, and thematically analyzed to saturation to identify drivers of COVID-19 vaccine decision-making based on COVID-19 vaccination status and timing. Comparative analyses were conducted to assess differences in decision-making processes based on race/ethnicity and parity. Participants also completed a sociodemographic survey that included their COVID-19 vaccination status.

RESULTS

Two themes emerged, the weighing of parallel risks and priorities from different sources resulting in vaccine decisional conflict and the need to reconcile that conflict via multiple strategies. All participants weighed priorities and risks from multiple areas of their lives and described internal conflict around vaccination. Participants described tailoring decisions to household dynamics, reconciling public and private values around vaccination, and the impact of their identities on the decision-making process. While many described concerns over vaccine safety and fetal health, uniquely, many highlighted weighing the impact of prior pregnancy loss history, with some choosing other preventive measures like social distancing or mask-wearing, which they deemed less risky.

CONCLUSION

Pregnant people make complex COVID-19 vaccination decisions, which must be considered in future vaccine messaging and advocacy for this group.