Jessica A Fleming1, Rafael Baltrons2, Elizabeth Rowley3, Isabel Quintanilla4, Elner Crespin4, Alba-Maria Ropero5, Justin R Ortiz6, Philipp Lambach7, Kathleen M Neuzil6, Maria Stepanchak8, Joachim Hombach7, Niranjan Bhat9. 1. Center for Vaccine Innovation and Access, PATH, Seattle, WA, USA. Electronic address: jfleming@path.org. 2. Instituto Salvadoreño del Seguro Social, San Salvador, El Salvador. 3. HIV/AIDS and Tuberculosis Global Program, PATH, Washington, DC, USA. 4. Universidad Francisco Gavidia, San Salvador, El Salvador. 5. Immunization Unit, Pan American Health Organization, Washington, DC, USA. 6. Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, USA. 7. Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland. 8. Global Alliance to Prevent Prematurity and Stillbirth, Seattle, WA, USA. 9. Center for Vaccine Innovation and Access, PATH, Seattle, WA, USA.
Abstract
INTRODUCTION: The World Health Organization (WHO) recommends that countries prioritize pregnant women for influenza vaccination, yet few low- or middle-income countries (LMICs) have implemented maternal influenza immunization programs. To inform vaccine decision-making and operational planning in LMICs, there is a need to document and share experiences from countries that provide seasonal influenza vaccine to pregnant women, particularly those with high coverage, like El Salvador. METHODS: In 2015 and 2016, PATH and country researchers conducted a mixed-methods study to document the experience and lessons learned from maternal influenza immunization delivery and acceptance in El Salvador as part of a collaborative effort between WHO and PATH. Researchers conducted focus group discussions, semi-structured interviews, antenatal clinic exit interviews, and key informant interviews with 326 participants from two municipalities in each of the country's three regions. Respondents included pregnant and recently pregnant women, family members, community leaders, health personnel, public health managers and partners, and policymakers. RESULTS: Factors perceived as positively influencing maternal influenza immunization delivery and acceptance in El Salvador include the use of multiple vaccine delivery strategies, targeted education and community engagement efforts, and a high degree of trust between the community and health care providers. Influenza vaccine acceptance by pregnant women is high and has improved over time, largely attributed to education targeting health care advisors. Perceived challenges to pregnant women receiving health care and vaccination include the need for permission to attend services and limited access to health services in insecure areas related to the presence of criminal gang activity. CONCLUSIONS: We identified approaches and barriers perceived to affect maternal influenza vaccine delivery in El Salvador. This information will be useful to public health decision-makers and implementers in El Salvador and other countries considering introduction of new maternal vaccines or striving to increase coverage of vaccines currently provided.
INTRODUCTION: The World Health Organization (WHO) recommends that countries prioritize pregnant women for influenza vaccination, yet few low- or middle-income countries (LMICs) have implemented maternal influenza immunization programs. To inform vaccine decision-making and operational planning in LMICs, there is a need to document and share experiences from countries that provide seasonal influenza vaccine to pregnant women, particularly those with high coverage, like El Salvador. METHODS: In 2015 and 2016, PATH and country researchers conducted a mixed-methods study to document the experience and lessons learned from maternal influenza immunization delivery and acceptance in El Salvador as part of a collaborative effort between WHO and PATH. Researchers conducted focus group discussions, semi-structured interviews, antenatal clinic exit interviews, and key informant interviews with 326 participants from two municipalities in each of the country's three regions. Respondents included pregnant and recently pregnant women, family members, community leaders, health personnel, public health managers and partners, and policymakers. RESULTS: Factors perceived as positively influencing maternal influenza immunization delivery and acceptance in El Salvador include the use of multiple vaccine delivery strategies, targeted education and community engagement efforts, and a high degree of trust between the community and health care providers. Influenza vaccine acceptance by pregnant women is high and has improved over time, largely attributed to education targeting health care advisors. Perceived challenges to pregnant women receiving health care and vaccination include the need for permission to attend services and limited access to health services in insecure areas related to the presence of criminal gang activity. CONCLUSIONS: We identified approaches and barriers perceived to affect maternal influenza vaccine delivery in El Salvador. This information will be useful to public health decision-makers and implementers in El Salvador and other countries considering introduction of new maternal vaccines or striving to increase coverage of vaccines currently provided.
Authors: Jessica A Fleming; Alister Munthali; Bagrey Ngwira; John Kadzandira; Monica Jamili-Phiri; Justin R Ortiz; Philipp Lambach; Joachim Hombach; Kathleen M Neuzil; Maria Stepanchak; Niranjan Bhat Journal: Vaccine Date: 2019-07-26 Impact factor: 3.641