Peer-reviewed article
Antenatal care service delivery and factors affecting effective tetanus vaccine coverage in low- and middle-income countries: Results of the Maternal Immunisation and Antenatal Care Situational analysis (MIACSA) project
Michelle Giles, Elizabeth Mary Mason, Flor M. Muñoz, Allisyn Carol Moran, Philipp Lambach et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined how antenatal care services deliver tetanus vaccines to pregnant women in low- and middle-income countries and what factors affect vaccine coverage. Researchers collected data from 2016 to 2018 using surveys, interviews and country visits. The analysis found that countries offering more antenatal visits and those without user fees for care achieved higher protection of newborns against tetanus. The study recommends increasing antenatal visits, improving service quality, and removing cost barriers to increase vaccine coverage.
Key points
- Most low- and middle-income countries had policies on antenatal visit frequency but few implemented WHO guidelines recommending eight contacts
- Countries recommending more than 4 antenatal contacts were more likely to achieve high neonatal tetanus protection (>90%)
- User fees for antenatal care and maternal immunization were significantly associated with lower neonatal protection (<90%)
- Passive disease surveillance was the most common surveillance method, but the indicators recorded varied between countries
- Antenatal care services are positioned as an ideal platform for delivering maternal vaccines
Limitations
The study was cross-sectional and conducted between 2016-2018, so it cannot establish causation or reflect current service delivery changes. The document does not provide detailed information on the specific barriers experienced within individual countries or how implementation varies within countries.
Abstract
OBJECTIVES: To map the integration of existing maternal tetanus immunization programmes within antenatal care (ANC) services for pregnant women in low- and middle-income countries (LMICs) and to identify and understand the challenges, barriers and facilitators associated with high performance maternal vaccine service delivery. 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 was undertaken between 2016 and 2018. Associations of different service delivery process components with protection at birth (PAB) and with country groups were established. PAB was defined as the proportion of neonates protected at birth against neonatal tetanus. Regression analysis and structural equation modelling was used to assess associations of different variables with maternal tetanus immunization coverage. Latent class analysis (LCA), was used to group country performance for maternal immunization, and to address the problem of multicollinearity. SETTING: LMICs. RESULTS: The majority of LMICs had a policy on recommended number of ANC visits, however most were yet to implement the WHO guidelines recommending eight ANC contacts. Countries that recommended > 4 ANC contacts were more likely to have high PAB > 90%. Passive disease surveillance was the most common form of disease surveillance performed but the maternal and neonatal morbidity and mortality indicators recorded differed between countries. The presence of user fees for antenatal care and maternal immunization was significantly associated with lower PAB (<90%). CONCLUSIONS: Recommendations include implementing the current WHO ANC guideline to facilitate increased opportunities for vaccination during each pregnancy. Improved utilisation of ANC services by increasing the demand side by increasing the quality of services, reducing any associated costs and supporting user fee exemptions, or the supply side can also enhance utilisation of ANC services which are positioned as an ideal platform for delivery of maternal vaccines.