Determinants of maternal immunization in developing countries.
BACKGROUND
Maternal immunization is an effective intervention to protect newborns and young infants from infections when their immune response is immature. Tetanus toxoid vaccination of pregnant women is the most widely implemented maternal vaccine in developing countries where neonatal mortality is the highest. We identified barriers to maternal tetanus vaccination in developing African and Asian countries to identify means of improving maternal immunization platforms in these countries.


METHODS
We categorized barriers into health system, health care provider and patient barriers to maternal tetanus immunization and conducted a literature review on each category. Due to limited literature from Africa, we conducted a pilot survey of health care providers in Malawi on barriers they experience in immunizing pregnant women.


RESULTS
The major barriers of the health system are due to inadequate financial and human resources which translate to inadequate vaccination services delivery and logistics management. Health care providers are limited by poor attendance of Antenatal Care and inadequate knowledge on vaccinating pregnant women. Patient barriers are due to lack of education and knowledge on pregnancy immunization and socioeconomic factors such as low income and high parity.


CONCLUSIONS
There are several factors that affect maternal tetanus immunization. Increasing knowledge in health care providers and patients, increasing antenatal care attendance and outreach activities will aid the uptake of maternal immunization. Health system barriers are more difficult to address requiring an improvement of overall immunization services. Further analyses of maternal immunization specific barriers and the means of addressing them are required to strengthen the existing program and provide a more efficient delivery system for additional maternal vaccines.
P.O. Box 51590, Limbe, Malawi. Electronic address: jayani.c@hotmail.com.
Jayani
J
Pathirana
Kasungu District Hospital, Kasungu, Malawi.
Jerome
J
Nkambule
Center for Global Health, Cincinnati Children's Hospital, USA.
Steven
S
Black
D000349:Africa; D001208:Asia; D003906:Developing Countries; D005260:Female; D006282:Health Personnel / Q000193:education / Q000706:statistics & numerical data; D006280:Health Workforce / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D007114:Immunization / Q000191:economics / Q000706:statistics & numerical data*; D007223:Infant; D007231:Infant, Newborn; D008295:Malawi; D000068097:Maternal Health / Q000706:statistics & numerical data / Q000639:trends; D011247:Pregnancy; D011295:Prenatal Care / Q000191:economics; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013742:Tetanus / Q000517:prevention & control*; D013745:Tetanus Toxoid / Q000008:administration & dosage / Q000276:immunology
D013745:Tetanus Toxoid
Antenatal care; Barriers; Maternal immunization; Newborn; Tetanus