Knowledge, attitudes and practices about influenza vaccination among pregnant women and healthcare providers serving pregnant women in Managua, Nicaragua

Abstract

Background Nicaragua implemented an influenza vaccination program for pregnant women with high-risk obstetric conditions in 2007. In 2014, the recommendation of influenza vaccination expanded to include all pregnant women. Given the expansion in the recommendation of vaccination, we evaluated knowledge, attitudes and practices of pregnant women and their healthcare providers towards influenza vaccination and its recommendation. Methods We conducted surveys among pregnant women and their healthcare providers from June to August 2016 at two hospitals and 140 health facilities in Managua. The questions were adapted from the U.S. national CDC influenza survey and related to knowledge, attitudes and practices about influenza vaccination and barriers to vaccination. We analyzed reasons for not receiving vaccination among pregnant women as well as receipt of vaccination recommendation and offer by their healthcare providers. Results Of 1,303 pregnant women enrolled, 42% (5 4 5) reported receiving influenza vaccination in the 2016 season. Of those who reported not receiving vaccination, 46% indicated barriers to vaccination. Pregnant women who were vaccinated were more likely to be aware of the recommendation for vaccination and the risks of influenza illness during pregnancy and to perceive the vaccine as safe and effective, compared to unvaccinated pregnant women (p-values < 0.001). Of the 619 health workers enrolled, over 89% recalled recommending influenza vaccination to all pregnant women, regardless of obstetric risk. Of the 1,223 women who had a prenatal visit between the start date of the influenza vaccination and the time of interview, 44% recalled receiving a recommendation for influenza vaccination and 43% were offered vaccination. Vaccination rates were higher for those receiving a recommendation and offer of vaccination compared with those who received neither (95% vs 5%, p-value < 0.001). Conclusion Pregnant women in Managua had positive perceptions of influenza vaccine and were receptive to receiving influenza vaccination, especially after the offer and recommendation by their healthcare providers.

Factors that influence vaccination decision-making among pregnant women: A systematic review and meta-analysis

“…The majority of studies with quantitative results for the pertussis vaccine had investigated intention to be vaccinated rather than actual vaccination status. Pregnant women who had received an HCP recommendation had 12-times higher odds of accepting seasonal influenza vaccination (OR 12.02, 95% CI 6.80–21.23, 21 studies, 14,099 women) [ 21 – 41 ] and 10-times greater odds of accepting pertussis vaccine (OR 10.33, 95% CI 5.49–19.43, 2 studies, 637 women) [ 27 , 29 ] compared to those who had not received recommendations. For pandemic vaccine the recommendation increased the odds of antenatal H1N1 vaccine uptake by six times (OR 6.76, 95% CI 3.12–14.64, 5 studies, 6898women) [ 42 – 46 ].…”

“…Pregnant women who received a seasonal influenza vaccination during a prior pregnancy had nine-times higher odds of accepting a pandemic influenza vaccine in their current pregnancy than those who did not vaccinate in a prior pregnancy (OR 9.12, 95% CI 1.99–41.76, 2 studies, 442 women) [ 43 , 53 ]. There was no evidence to suggest an association between prior maternal vaccination and season influenza vaccinations (OR 1.51, 95% CI 0.71–3.24, 3 studies, 2,339 women) [ 21 , 22 , 47 ].…”

“…In contrast, the odds of being vaccinated were eight-times higher when pregnant women believed that the pandemic influenza vaccine benefits the mother (OR 8.44, 95% CI 2.90-24.61, 2 studies, 338 women) [49,54]. The odds of accepting the seasonal influenza vaccine were seven-times greater when pregnant women perceived the vaccine as generally effective (OR 7.22, 95% CI 3.49-14.93, 6 studies, 5,814 women) [21,24,37,39,40,57], three-times greater when they believed the vaccine benefits the mother (OR 3.47, 95% CI 2. 19-5.51, 6 studies, 3,144 women) [23,25,31,37,49,56], and almost two-times greater when they believed the vaccine benefits their baby (OR 1.74, 95% CI 1.18-2.57, 7 studies, 2546 women) [25,31,37,38,41,49,56].…”

The partnership for influenza vaccine introduction (PIVI): Supporting influenza vaccine program development in low and middle-income countries through public-private partnerships

“…All 17 countries have received technical and/or financial support for program and/or policy development and evaluation (Table 1). KAPP surveys about influenza and vaccination have been conducted or are planned for 2019 in 16 countries with the first work occurring in Lao PDR [20]. These surveys focused on vaccine target groups, including health workers (12), pregnant women and their providers (12), persons with chronic disease (3) or caretakers and providers of health care for children (1).…”

What do pregnant women think about influenza disease and vaccination practices in selected countries

“…6 In countries where influenza vaccines are recommended for pregnant women, studies have identified health-care provider recommendation, referral, women's knowledge, attitudes and beliefs about influenza and influenza vaccine as important predictors of influenza vaccine acceptance among pregnant women, but available data are limited. [7][8][9][10][11][12][13][14] Understanding predictors of vaccination against influenza among pregnant women in low-and uppermiddle-income countries is important and may inform strategies for improving vaccine uptake in this population. Using data from a multi-country prospective cohort study conducted in a low middle-income country (India) and two upper middlecountries (Peru and Thailand, Table 1), 15 we assessed what factors were associated with influenza vaccination among CONTACT Carmen S. Arriola wus3@cdc.gov Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA.…”