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Background: Maternal immunization is known to be one of the best strategies to protect both mothers and their infants from infectious diseases. Studies have shown that healthcare providers play a critical role in implementation of maternal immunization. However, little is known about providers’ attitudes and beliefs towards vaccination that can influence their vaccine recommendations, specifically in low to middle income countries (LMIC). Methods: A self-administrated knowledge, attitude and behavior (KAB) survey was provided to 150 antenatal care providers across four different regions (Nairobi, Mombasa, Marsabit, and Siaya counties) of Kenya. The research staff visited the 150 clinics and hospitals and distributed a quantitative KAB survey. Results: Nearly all of the antenatal care providers (99%) recommended tetanus maternal vaccination. Similarly, 99% of the providers agreed that they would agree to provide additional vaccinations for pregnant women and reported that they always advise their patients to get vaccinated. Between 80 and 90% of the providers reported that religious beliefs, ethnicity, cultural background and political leaders do not affect their attitude or beliefs towards recommending vaccines. Conclusions: Considering the positive responses of healthcare providers towards vaccine acceptance and recommendation, these results highlight an opportunity to work in partnership with these providers to improve coverage of maternal vaccination and to introduce additional vaccines (such as influenza). In order to achieve this, logistical barriers that have affected the coverage of the currently recommended vaccines, should be addressed as part of this partnership.
Data for this analysis are part of a larger study aimed at identifying determinants of maternal vaccine acceptance in Kenya 14, 15, which was conducted between June 2016 and August 2018. The study was conducted by Emory University, in collaboration with the Centers for Disease Control and Prevention (CDC) and the Kenya Medical Research Institute (KEMRI). Approval for the study was obtained from Emory University’s [IRB00089673] and KEMRI’s Institutional Review Boards [SSC 3292]. Written informed consent was obtained from participants before enrolling in the study. The study population included 150 antenatal care providers working in antenatal care clinics and hospitals, from primary care to referral settings, in four different areas in Kenya (Nairobi, Mombasa, Marsabit, and Siaya counties). The sample size was calculated in order to estimate correlations between predictors and ANC responses based on a conservative distribution of 50% for response variables, assuming 80% power and an alpha of 0.05. The inclusion criteria for participants were being employed in a clinic or hospital in the target sites as an ANC provider and providing services to pregnant women. The recruitment sites varied from small clinics to large hospitals with patient population ranges between tens to hundreds of women. The study sites were selected to represent the geographic diversity of Kenya and based on the study team ability to access them: Nairobi is the capital and largest city of Kenya; Mombasa is a coastal city with a majority Muslim population; Marsabit is a remote region with low population density and nomadic groups; and Siaya represents western Kenyan rural region. The research staff visited the 150 clinics and hospitals and distributed a quantitative knowledge, attitude and behavior (KAB) survey to the antenatal care (ANC) providers (see extended data for questionnaire 16). Inclusion criteria were being listed as an active ANC provider in one of the participating clinics or hospitals and agreeing to respond to the survey. The survey was specifically developed for this study based on information collected in the qualitative phase of the study, which included 111 semi-structured interviews with ANC providers 17 and pilot tested by the study team in all sites. Participants were recruited both as a convenience sample from study facilities and referral through the healthcare workers and colleagues. The self-administered KAB included questions on vaccine-preventable diseases (including burden and perceived risk), vaccine effectiveness, vaccine safety, vaccination norms, prior experience with vaccination (either for themselves, their children, their patients, etc.), positive and negative motivations to vaccinate, and values around vaccination. The survey also collected socio-demographic information. All the questionnaires were translated into the local languages, including Luo, Kikyo, Luhya, Kamba, Swahili, Mijikenda, Taita, Borana, Rendile, Burji and Somali. For the purpose of analysis, the questionnaires were translated back to English. Demographic variables were categorized as follows: age, education and marital status were dichotomized (<30 vs. ≥30 years; college or less vs. more than college; and single vs. married/cohabitation) respectively. Religion was divided into four categories: catholic, protestant, Muslim and traditional African churches/traditional religion/others. To get an aggregate of positive, neutral or negative responses, we collapsed the five item Likert scale into three. Strongly agree and agree were summarized as agree and strongly disagree and disagree were summarized as disagree. Descriptive statistics (means and standard deviations, proportions) were summarized for all the variables and survey questions. using SAS, version 9.4 (SAS Institute, Cary, NC).
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