Vaccines safety and maternal knowledge for enhanced maternal immunization acceptability in rural Uganda: A qualitative study approach

Abstract

Background Maternal immunization is a successful and cost-effective public health strategy. It protects pregnant women and their infants from vaccine-preventable diseases. Uganda is exploring new vaccines for pregnant women like replacing Tetanus Toxoid (TT) with Tetanus-Diphtheria (Td). Research on knowledge, attitudes, beliefs, and willingness among pregnant women is needed before the introduction of vaccines for pregnant women. This study was aimed at exploring maternal knowledge, attitudes, willingness, and beliefs towards maternal immunization among pregnant women in rural Uganda. Methods This was a qualitative descriptive study. Ten focus group discussions (FGDs) were conducted at antenatal care (ANC) clinics and in a rural community of Uganda. Five key informant interviews (KIIs) were done with health workers, for triangulation. Considering context and research characteristics, data were collected and thematically analyzed. Results Women were familiar with the importance of maternal vaccines, had positive attitudes, and expressed willingness to take them. Acceptance of a new vaccine could be affected by worries of pregnant women and that of their partners, who influence health seeking decisions in a home concerning adverse events, following the maternal immunization (AEFI). There were misconceptions about introduction of vaccines such as the belief that vaccines treat malaria and general body weakness, and being used as guinea pigs to test for the vaccine before its introduction to the larger population. Conclusion A range of diverse sentiments and beliefs may affect uptake and acceptability of vaccines that are introduced in communities. For instance, ignoring vaccine safety concerns may impede maternal immunization acceptability, because pregnant women and their husbands are concerned about AEFI. Moreover, husbands make all health-seeking decisions at home, and their opinion is key, when considering such interventions.

Assessing risk perceptions that contribute to tetanus toxoid maternal vaccine hesitancy in Kilifi County, Kenya

“…As much as the healthcare workers would like to maintain a high vaccine coverage, issues such as delays in vaccine delivery to the health facilities meant that even when mothers showed up and demanded to be vaccinated the vaccines were out of stock, causing a missed opportunity. Similar to what has been found in Ethiopia (Gebremichael et al 2018), Tanzania (Maluka et al 2020) and Uganda (Kajungu et al 2020), we observed that if a health care worker was harsh, abusive or rude, it could discourage women from attending ANC clinics, which has a ripple effect on uptake of vaccines by the mothers.…”

Maternal Vaccination in Uganda: Exploring Pregnant Women, Community Leaders and Healthcare Workers’ Perceptions

“…This could be due to the fact that tetanus toxoid vaccination during pregnancy is integrated into antenatal care [10], leading to participants' confusion and difficulty in differentiating between interventions or, as we found, due to the perception that all medication that protects against infection is a "vaccination". A study in Eastern Uganda also identified issues with women describing antimalarial medication as a vaccine, which highlights the need for future public information campaigns to focus on the meaning of vaccination [11].…”

“…Currently, there is limited evidence on factors that may influence pregnant women's acceptance and refusal of maternal vaccination in Uganda that could be used to inform public health programmes [11]. However, studies in other countries report various factors that affect vaccination uptake; for example, in Somalia, concerns about vaccine safety and limited knowledge were mentioned to have affected vaccine uptake among the women [12].…”

Ethical and practical considerations arising from community consultation on implementing controlled human infection studies using Schistosoma mansoni in Uganda

“…A study in the western part of Uganda showed that the involvement of mothers enhances adhering to prompt vaccination of their children (Vonasek et al, 2016 ). Pregnant women who have experienced maternal vaccination are willing to receive new vaccines If they are sensitised about new vaccines (Kajungu et al, 2020 ). The participant willingness to take part in a vaccine trial targeting schistosomiasis has also been noted in several fishing communities in Uganda (Sanya et al, 2017 ).…”