PMID- 32586763 OWN - NLM STAT- MEDLINE DCOM- 20210427 LR - 20210427 IS - 1873-2518 (Electronic) IS - 0264-410X (Print) IS - 0264-410X (Linking) VI - 38 IP - 33 DP - 2020 Jul 14 TI - Vaccine implementation factors affecting maternal tetanus immunization in low- and middle-income countries: Results of the Maternal Immunization and Antenatal Care Situational Analysis (MIACSA) project. PG - 5268-5277 LID - S0264-410X(20)30739-8 [pii] LID - 10.1016/j.vaccine.2020.05.084 [doi] AB - OBJECTIVES: To examine the characteristics of existing maternal tetanus immunization programmes for pregnant women in low- and middle-income countries (LMICs) and to identify and understand the challenges, barriers and facilitators associated with maternal vaccine service delivery that may impact the introduction and implementation of new maternal vaccines in the future. DESIGN: A mixed methods, cross sectional study with four data collection phases including a desk review, online survey, telephone and face-to-face interviews and in country visits. SETTING: LMICs. RESULTS: The majority of countries (84/95; 88%) had a maternal tetanus immunization policy. Countries with high protection at birth (PAB) were more likely to report tetanus toxoid-containing vaccine (TTCV) coverage targets > 90%. Less than half the countries included in this study had a TTCV coverage target of > 90%. Procurement and distribution of TTCV was nearly always the responsibility of the Expanded Programme on Immunization (EPI), however planning and management of maternal immunization was often shared between EPI and Maternal, Newborn and Child Health (MNCH) programmes. Receipt of TTCV at the same time as the antenatal care visit correlated with high PAB. Most countries (81/95; 85%) had an immunization safety surveillance system in place although only 11% could differentiate an adverse event following immunization (AEFI) in pregnant and non-pregnant women. CONCLUSIONS: Recommendations arising from the MIACSA project to strengthen existing services currently delivering maternal tetanus immunization in LMICs include establishing and maintaining vaccination targets, clearly defining responsibilities and fostering collaborations between EPI and MNCH, investing in strengthening the health workforce, improving the design and use of existing record keeping for immunization, adjusting current AEFI reporting to differentiate pregnant women and endeavoring to integrate the provision of TTCV within ANC services where appropriate. CI - Copyright (c) 2020 The Authors. Published by Elsevier Ltd.. All rights reserved. FAU - Giles, M L AU - Giles ML AD - Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia. Electronic address: michelle.giles@monash.edu. FAU - Mantel, C AU - Mantel C AD - MMGH Consulting, Zurich, Switzerland. FAU - Munoz, F M AU - Munoz FM AD - Departments of Pediatrics, Section of Infectious Diseases, and Molecular Virology and Microbiology, Baylor College of Medicine, Houston TX, USA. FAU - Moran, A AU - Moran A AD - Department of Maternal, Newborn, Child, Adolescent Health and Ageing, Geneva, Switzerland. FAU - Roos, N AU - Roos N AD - Department of Maternal, Newborn, Child, Adolescent Health and Ageing, Geneva, Switzerland. FAU - Yusuf, N AU - Yusuf N AD - Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland. FAU - Diaz, T AU - Diaz T AD - Department of Maternal, Newborn, Child, Adolescent Health and Ageing, Geneva, Switzerland. FAU - Ahun, M AU - Ahun M AD - Independent Consultant, McKing Consulting, Geneva, Switzerland. FAU - Nic Lochlainn, L M AU - Nic Lochlainn LM AD - Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland. FAU - Wootton, E AU - Wootton E AD - Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland. FAU - Pathirana, J AU - Pathirana J AD - Medical Research Council: Respiratory and Meningeal Pathogens Research Unit and Department of Science and Technology/ National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. FAU - Rendell, S AU - Rendell S AD - Department of Anthropology University of Pennsylvania, Philadelphia, USA. FAU - Tuncalp, O AU - Tuncalp O AD - Department of Sexual and Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, WHO, Geneva, Switzerland. FAU - Perut, M AU - Perut M AD - Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland. FAU - Hombach, J AU - Hombach J AD - Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland. FAU - Merten, S AU - Merten S AD - Swiss Tropical and Public Health Institute and University of Basel, Basel, Switzerland. FAU - Lambach, P AU - Lambach P AD - Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20200622 PL - Netherlands TA - Vaccine JT - Vaccine JID - 8406899 SB - IM MH - Child MH - Cross-Sectional Studies MH - *Developing Countries MH - Female MH - Humans MH - Immunization MH - Infant, Newborn MH - Pregnancy MH - Prenatal Care MH - *Tetanus/prevention & control MH - Vaccination PMC - PMC7342017 OTO - NOTNLM OT - LMICs, MIACSA OT - Maternal Immunization OT - Pregnancy OT - Service Delivery OT - Tetanus OT - Vaccination COIS- Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions or policies of the institutions with which they are affiliated. EDAT- 2020/06/27 06:00 MHDA- 2021/04/28 06:00 PMCR- 2020/07/14 CRDT- 2020/06/27 06:00 PHST- 2020/03/08 00:00 [received] PHST- 2020/05/15 00:00 [revised] PHST- 2020/05/27 00:00 [accepted] PHST- 2020/06/27 06:00 [pubmed] PHST- 2021/04/28 06:00 [medline] PHST- 2020/06/27 06:00 [entrez] PHST- 2020/07/14 00:00 [pmc-release] AID - S0264-410X(20)30739-8 [pii] AID - 10.1016/j.vaccine.2020.05.084 [doi] PST - ppublish SO - Vaccine. 2020 Jul 14;38(33):5268-5277. doi: 10.1016/j.vaccine.2020.05.084. Epub 2020 Jun 22.