» Articles » PMID: 37112781

Health Systems Determinants of Delivery and Uptake of Maternal Vaccines in Low- and Middle-Income Countries: A Qualitative Systematic Review

Overview
Date 2023 Apr 28
PMID 37112781
Authors
Affiliations
Soon will be listed here.
Abstract

Maternal vaccination is considered a key component of the antenatal care package for improving maternal and child health. Low- and middle-income countries (LMICs) fall short of global targets to prevent maternal and neonatal deaths, with a disproportionate burden of vaccine-preventable diseases. Strategies towards ending preventable maternal mortality necessitate a health systems approach to adequately respond to this burden. This review explores the health systems determinants of delivery and uptake of essential maternal vaccines in LMICs. We conducted a qualitative systematic review of articles on maternal vaccination in LMICs, published between 2009 and 2023 in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Thematic analysis was conducted to identify key themes in the literature, interpreted within a conceptual framing that explores the systems determinants influencing maternal vaccines. Our search yielded 1309 records, of which 54 were included, covering 34 LMICs. Most of the included studies were from South America (28/54) and included pregnant women as the primary study population (34/54). The studies explored influenza (25/54) and tetanus toxoid (20/54) vaccines predominantly. The findings suggest that systems hardware (lack of clear policy guidelines, ineffective cold-chain management, limited reporting and monitoring systems) are barriers to vaccine delivery. Systems software (healthcare provider recommendations, increased trust, higher levels of maternal education) are enablers to maternal vaccine uptake. Findings show that formulation, dissemination and communication of context-specific policies and guidelines on maternal vaccines should be a priority for decision-makers in LMICs.

Citing Articles

How has the concept of health system software been used in health policy and systems research? A scoping review.

Burger N, Gilson L Health Policy Plan. 2025; 40(3):391-408.

PMID: 39821049 PMC: 11886817. DOI: 10.1093/heapol/czaf001.


Public funding and young children vaccination coverage: Evidence from Socialist-Oriented Market Economy.

Luong T, Le-Van D Health Econ Rev. 2024; 14(1):95.

PMID: 39562375 PMC: 11577889. DOI: 10.1186/s13561-024-00569-5.


Recommendations for Integrating Traditional Birth Attendants to Improve Maternal Health Outcomes in Low- and Middle-Income Countries.

Rutledge J, Kiyanda A, Jean-Louis C, Raskin E, Gaillard J, Maxwell M Int J MCH AIDS. 2024; 13:e019.

PMID: 39526165 PMC: 11544515. DOI: 10.25259/IJMA_16_2024.


Facilitators and barriers to maternal immunization and strategies to improve uptake in low-income and lower-middle income countries: A systematic review.

Khan T, Malik S, Rafeekh L, Halder S, Desai S, Bhattacharya S Hum Vaccin Immunother. 2024; 20(1):2411823.

PMID: 39473171 PMC: 11533802. DOI: 10.1080/21645515.2024.2411823.


Differences in PCV13 Recommendation Practices between Pediatric Care Providers and Primary Care Providers in China: A Cross-Sectional Survey of Behavior and Social Drivers.

Dang Y, Wang L, Liu Y, Wang B, Deng H, Ye C Vaccines (Basel). 2024; 12(9).

PMID: 39340112 PMC: 11435928. DOI: 10.3390/vaccines12091082.


References
1.
Wong V, Fong D, Lok K, Wong J, Sing C, Choi A . Brief education to promote maternal influenza vaccine uptake: A randomized controlled trial. Vaccine. 2016; 34(44):5243-5250. DOI: 10.1016/j.vaccine.2016.09.019. View

2.
Puchalski Ritchie L, Khan S, Moore J, Timmings C, van Lettow M, Vogel J . Low- and middle-income countries face many common barriers to implementation of maternal health evidence products. J Clin Epidemiol. 2016; 76:229-37. DOI: 10.1016/j.jclinepi.2016.02.017. View

3.
Morales K, Menning L, Lambach P . The faces of influenza vaccine recommendation: A Literature review of the determinants and barriers to health providers' recommendation of influenza vaccine in pregnancy. Vaccine. 2020; 38(31):4805-4815. PMC: 7306152. DOI: 10.1016/j.vaccine.2020.04.033. View

4.
Choudhary M, Solomon R, Awale J, Dey R . Demand-side determinants of timely vaccination of oral polio vaccine in social mobilization network areas of CORE Group polio project in Uttar Pradesh, India. BMC Infect Dis. 2018; 18(1):222. PMC: 5956729. DOI: 10.1186/s12879-018-3129-2. View

5.
Erazo C, Erazo C, Grijalva M, Moncayo A . Knowledge, attitudes and practices on influenza vaccination during pregnancy in Quito, Ecuador. BMC Public Health. 2021; 21(1):72. PMC: 7791889. DOI: 10.1186/s12889-020-10061-4. View