title: Influenza vaccine acceptance among pregnant women in urban slum areas, Karachi, Pakistan.
abstract: BACKGROUND
  Facilitators and barriers to influenza vaccination among pregnant women in the developing world are poorly understood, particularly in South Asia. We assessed intention to accept influenza vaccine among ethnically diverse low-income pregnant women in Pakistan.
  
  
  METHODS
  From May to August 2013, we conducted a cross-sectional survey of pregnant women who visited health centers in urban slums in Karachi city. We assessed intention to accept influenza vaccine against socio-demographic factors, vaccination history, vaccine recommendation sources, and other factors.
  
  
  RESULTS
  In an unvaccinated study population of 283 respondents, 87% were willing to accept the vaccine, if offered. All except two participants were aware of symptoms typically associated with influenza. Perceived vaccine safety, efficacy, and disease susceptibility were significantly associated with intention to accept influenza vaccine (p<0.05). Regardless of intention to accept influenza vaccine, 96% rated healthcare providers as highly reliable source of vaccine information. While a recommendation from a physician was critical for influenza vaccine acceptance, parents-in-law and husbands were often considered the primary decision-makers for pregnant women seeking healthcare including vaccination.
  
  
  CONCLUSIONS
  Maternal influenza vaccination initiatives in South Asia should strongly consider counseling of key familial decision-makers and inclusion of healthcare providers to help implement new vaccination programs.
authors: Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
authors: Afshin Alaf
authors: AA
authors: Khan
authors: Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
authors: Aiden Kennedy
authors: AK
authors: Varan
authors: National Center for Child and Adolescent Health, Ministry of Health, Francisco de P. Miranda 177, Lomas de Plateros, Álvaro Obregón, 01600 Mexico City, Mexico.
authors: Alejandra
authors: A
authors: Esteves-Jaramillo
authors: Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
authors: Mariam
authors: M
authors: Siddiqui
authors: Department of Pediatrics and Child Health, The Aga Khan University, Karachi 74800, Pakistan.
authors: Shazia
authors: S
authors: Sultana
authors: Department of Pediatrics and Child Health, The Aga Khan University, Karachi 74800, Pakistan.
authors: Asad S
authors: AS
authors: Ali
authors: Department of Pediatrics and Child Health, The Aga Khan University, Karachi 74800, Pakistan.
authors: Anita K M
authors: AK
authors: Zaidi
authors: Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA; Emory Vaccine Center, 201 Dowman Drive, Atlanta, GA 30322, USA; Emory University School of Medicine, 1648 Pierce Drive NE, Atlanta, GA 30322, USA. Electronic address: somer@emory.edu.
authors: Saad B
authors: SB
authors: Omer
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006761:Hospitals; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000517:prevention & control*; D008875:Middle Aged; D010154:Pakistan; D010342:Patient Acceptance of Health Care; D011204:Poverty Areas; D011247:Pregnancy; D012959:Socioeconomic Factors; D055815:Young Adult
chemical_list: D007252:Influenza Vaccines
keywords: Immunization; Influenza; Pakistan; Pregnant women; Vaccine acceptance