Prevalence and predictive determinants of adherence to vaccination against COVID-19 among mothers who gave birth in the last two years in Morocco

  • Clinical Epidemiology and Global Health, Volume 20, Year 2023

listen audio

Study Justification:
– The study aims to assess the prevalence of COVID-19 vaccination among mothers who gave birth in the last two years in Morocco.
– It also aims to explore the determinants of reluctance or adherence to vaccination among this population.
– The study investigates the intention towards vaccination among the unvaccinated.
– The results of this study can provide valuable insights for public health decision-makers in increasing awareness of the benefits of vaccination and addressing factors limiting access to COVID-19 vaccination.
Study Highlights:
– The prevalence of vaccination among the participants was 61.8%.
– Among the unvaccinated, 64% wanted to be vaccinated either because they believed the vaccines were useful or because they wanted to get the vaccine pass.
– 36% of the unvaccinated participants refused to be vaccinated due to lack of sufficient information on the efficacy and safety of new vaccines against COVID-19.
– The age of the last child and no gestational diabetes during pregnancy were found to be positive predictors of vaccination adherence.
– The average or high monthly income and the lack of medical coverage were predictive factors limiting adherence to vaccination.
Recommendations:
– Increase awareness of the benefits of vaccination among mothers who gave birth in the last two years in Morocco.
– Provide sufficient information on the efficacy and safety of new vaccines against COVID-19 to address concerns and increase vaccine acceptance.
– Address economic and social factors limiting access to COVID-19 vaccination, such as ensuring affordability and availability of vaccines.
Key Role Players:
– Public health decision-makers
– Healthcare providers
– Community health workers
– Maternal and child health organizations
– Government agencies
Cost Items for Planning Recommendations:
– Vaccine procurement and distribution
– Communication and awareness campaigns
– Training and capacity building for healthcare providers
– Monitoring and evaluation of vaccination programs
– Research and data collection on vaccination rates and determinants of adherence
Please note that the cost items provided are general categories and not actual cost estimates. The actual cost will depend on the specific context and implementation strategies.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study design is described as descriptive and cross-sectional, which limits the ability to establish causality. The sample size of 458 participants is relatively large, increasing the generalizability of the findings. The study includes a standardized questionnaire and statistical analysis to explore the determinants of vaccination adherence. However, the study relies on self-reported data, which may introduce bias. To improve the strength of the evidence, future studies could consider using a longitudinal design to establish causal relationships and include objective measures of vaccination status rather than relying solely on self-reporting.

Background and aim: Vaccination against COVID-19 was one of the most important resolute to stop the spread of the pandemic; however, its acceptance was controversial especially by pregnant and lactating women. This study aims to assess the prevalence of vaccination among participants as well as to explore the determinants of reluctance or adherence to vaccination among this population, and to investigate the intention towards vaccination among the unvaccinated. Method: This is a cross-sectional study conducted among mothers (n = 458) residing in the prefecture of Skhirat-Temara in Morocco, and who have children aged between one month to 2 years, the survey was conducted on the basis of a semi-structured questionnaire. Result: The prevalence of vaccination among the participants was 61.8%, although they were all vaccinated after their delivery. Among the unvaccinated, 64% wanted to be vaccinated either because they believed the vaccines were useful or because they wanted to get the vaccine pass, while 36% absolutely refused to be vaccinated due to lack of sufficient information on the efficacy and safety of new vaccines against COVID-19. The age of the last child (p < 0.001) and no gestational diabetes during pregnancy (p = 0.016) were found to be positive predictors of vaccination adherence; however, the average or the high monthly income (p = 0.003) and the lack of medical coverage (p = 0.046) were predictive factors limiting adherence to vaccination. Conclusion: The results of this study suggest that public health decision-makers need to increase awareness of the benefits of vaccination and to address the economic and social factors limiting access to COVID-19 vaccination.

This was a descriptive and cross-sectional study, conducted in the health centers of the Skhirat-Temara prefecture in Morocco among adult mothers who resided in the same prefecture and accompanied their children aged one to 24 months (who were born or were breastfed during the first three waves of the Covid-19 pandemic in Morocco) for vaccination or other care. The survey period was from October 2021 to January 2022. Only mothers aged 18 years and up and given consent to participate to the study were included. Those who refused to participate in the study were excluded. The sample size required for the results of this survey to be representative was calculated using the following formula7: Where: n = sample size z = 1.96 for a 95% confidence level p = 0.5 (to our knowledge, no national study available to inform us on the prevalence of pregnant or lactating women vaccinated) m = 0.05 (margin of sampling error tolerated). However, our survey included 458 participants who completed a standardized questionnaire divided into two sections. The first section was used to provide information on demographics, socioeconomic and clinical characteristics (maternal age, marital status, education level, place of residence, maternal occupation, monthly household income, history of gestational diabetes, history of COVID-19, etc.), as well as the vaccination status of the participants during pregnancy and after delivery and the age of their last child. The second section provides information on perceptions and future intentions to adhere to vaccination among participants initially reported as unvaccinated. Descriptive statistics and frequencies were computed for each variables of the questionnaire. Univariate analysis was performed using the Chi-square test and Fisher's exact test according to the test conditions. The logistic regression analysis was performed to assess the independent effect of age, residence, couple's education level, monthly household income, medical coverage, age of last child, history of COVID-19, and previous gestational diabetes on vaccination against COVID-19. The list of the explanatory variables was established according to the results of the univariate analysis. A difference was considered to be statistically significant if the p value was less than 0.05. The associations were expressed in odds ratio (OR) at a confidence interval of 95%. Data analysis was performed using the statistical software Jamovi 1.6. This study was conducted with the approval of the Ethics Committee for Biomedical Research, Faculty of Medicine and Pharmacy, Mohamed V University of Rabat, Morocco (ethical approval n° C68/20 issued on February 18, 2021). All the Participants were provided with a briefing note explaining the purpose of the study, the interview process, the confidentiality of the data, and the utility of the study results. Subsequently, oral and written informed consent was obtained from the participants before the interview began.

N/A

Based on the provided information, here are some potential innovations that could improve access to maternal health:

1. Mobile Health (mHealth) Applications: Develop and promote mobile applications that provide information on the benefits, safety, and efficacy of COVID-19 vaccines for pregnant and lactating women. These apps can also provide reminders for vaccination appointments and track vaccination status.

2. Telemedicine Services: Expand telemedicine services to provide virtual consultations and counseling for pregnant and lactating women regarding COVID-19 vaccination. This can help address concerns and provide accurate information to improve vaccine acceptance.

3. Community Outreach Programs: Implement community-based programs to raise awareness about the importance of COVID-19 vaccination for pregnant and lactating women. These programs can include educational sessions, workshops, and distribution of informational materials in local languages.

4. Collaboration with Healthcare Providers: Collaborate with healthcare providers to ensure they have up-to-date information on COVID-19 vaccines for pregnant and lactating women. This can help them address concerns and provide accurate guidance to their patients.

5. Targeted Messaging Campaigns: Develop targeted messaging campaigns that address the specific concerns and barriers faced by pregnant and lactating women regarding COVID-19 vaccination. These campaigns can use various communication channels, such as social media, radio, and television, to reach a wide audience.

6. Vaccine Access and Equity: Ensure equitable access to COVID-19 vaccines for pregnant and lactating women by prioritizing their vaccination in healthcare settings. This can include dedicated vaccination clinics or specific appointment slots for this population.

7. Peer Support Networks: Establish peer support networks for pregnant and lactating women to share experiences, information, and support regarding COVID-19 vaccination. This can help address concerns and provide a sense of community.

8. Training for Healthcare Providers: Provide training and education for healthcare providers on the latest guidelines and recommendations for COVID-19 vaccination in pregnant and lactating women. This can help improve their knowledge and confidence in discussing vaccination with their patients.

9. Partnerships with Maternal Health Organizations: Collaborate with maternal health organizations to integrate COVID-19 vaccination information and services into existing maternal health programs. This can help reach a larger audience and leverage existing resources.

10. Research and Data Collection: Conduct further research to understand the barriers and determinants of COVID-19 vaccine acceptance among pregnant and lactating women. This can inform the development of targeted interventions and strategies to improve access to vaccination.

It’s important to note that these recommendations are based on the specific context of the study conducted in Morocco. The implementation of these innovations should be tailored to the local healthcare system, cultural norms, and resources available in each setting.
AI Innovations Description
The study you described aimed to assess the prevalence of COVID-19 vaccination among mothers in Morocco and explore the determinants of reluctance or adherence to vaccination in this population. The study found that the prevalence of vaccination among the participants was 61.8%, with factors such as the age of the last child and no gestational diabetes during pregnancy being positive predictors of vaccination adherence. On the other hand, factors such as average or high monthly income and lack of medical coverage were predictive factors limiting adherence to vaccination.

Based on the study findings, here is a recommendation that can be developed into an innovation to improve access to maternal health:

1. Increase awareness: Public health decision-makers should focus on increasing awareness of the benefits of vaccination among pregnant and lactating women. This can be done through targeted educational campaigns that provide accurate information about the efficacy and safety of COVID-19 vaccines. The campaigns should address the concerns and misconceptions that may contribute to vaccine hesitancy.

2. Address economic and social factors: To improve access to vaccination, it is important to address the economic and social factors that limit adherence. This can be achieved by implementing policies that provide financial support or incentives for vaccination, especially for women with lower incomes. Additionally, efforts should be made to ensure that all women, regardless of their socioeconomic status, have access to affordable healthcare and medical coverage.

3. Tailored interventions: Recognizing that different factors may influence vaccine acceptance or refusal, interventions should be tailored to address the specific needs and concerns of different subgroups of pregnant and lactating women. This may involve providing targeted information and support to address specific barriers or misconceptions related to vaccination.

4. Collaboration and partnerships: Collaboration between healthcare providers, community organizations, and other stakeholders is crucial for improving access to maternal health. By working together, these entities can develop comprehensive strategies that address the multifaceted challenges faced by pregnant and lactating women in accessing healthcare services, including vaccination.

By implementing these recommendations, it is possible to develop innovative approaches that can improve access to maternal health, including vaccination against COVID-19.
AI Innovations Methodology
Based on the provided information, here are some potential recommendations to improve access to maternal health:

1. Increase awareness: Public health decision-makers should prioritize increasing awareness about the benefits of vaccination among pregnant and lactating women. This can be done through targeted educational campaigns, informational materials, and community outreach programs.

2. Address concerns and provide information: To address the reluctance to vaccination, it is important to provide sufficient information on the efficacy and safety of COVID-19 vaccines. This can be achieved through clear and accessible communication channels, such as public health websites, helplines, and healthcare provider consultations.

3. Improve access to healthcare: Economic and social factors limiting access to COVID-19 vaccination should be addressed. Efforts should be made to ensure that maternal healthcare services, including vaccination, are accessible and affordable for all women, regardless of their income or medical coverage status. This may involve expanding healthcare coverage, reducing financial barriers, and improving the availability of healthcare facilities in underserved areas.

4. Targeted interventions: Tailored interventions can be developed to address specific barriers to vaccination. For example, programs can be designed to specifically target women with gestational diabetes or those with lower education levels, providing them with additional support and information to encourage vaccination.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Define indicators: Identify key indicators that reflect access to maternal health, such as vaccination rates among pregnant and lactating women, knowledge levels about vaccination, and healthcare utilization rates.

2. Data collection: Collect data on the identified indicators before implementing the recommendations. This can be done through surveys, interviews, or analysis of existing data sources.

3. Implement recommendations: Implement the recommended interventions, such as awareness campaigns, information dissemination strategies, and improvements in healthcare access.

4. Monitor and evaluate: Continuously monitor the impact of the interventions on the identified indicators. Collect data on vaccination rates, knowledge levels, and healthcare utilization after the implementation of the recommendations.

5. Analyze data: Analyze the collected data to assess the impact of the recommendations on improving access to maternal health. This can be done through statistical analysis, comparing pre- and post-intervention data, and assessing changes in the identified indicators.

6. Draw conclusions: Based on the analysis, draw conclusions about the effectiveness of the recommendations in improving access to maternal health. Identify any gaps or areas for further improvement.

7. Refine and iterate: Use the findings from the evaluation to refine the recommendations and interventions. Iterate the process to continuously improve access to maternal health.

By following this methodology, decision-makers can gain insights into the potential impact of the recommendations and make informed decisions to improve access to maternal health.


Identifiers:
DOI: 10.1016/j.cegh.2023.101241
Research Areas:
COVID, Health System and Policy, Maternal Access, Maternal and Child Health, Noncommunicable Diseases, Sexual and Reproductive Health, Social Determinants
Study Countries:
Morocco
Study Design:
Case-Control Study, Cross Sectional Study
Study Approach:
Quantitative
Participants Gender:
Female
Share this:
Facebook
Twitter
LinkedIn
WhatsApp
Email