The online version of this article (https://doi.org/10.1186/s12884-017-1655-3) contains supplementary material, which is available to authorized users.
The successful implementation of maternal vaccination relies on results of clinical trials, considering the prenatal and postnatal attendance at selected healthcare institutions. This study evaluated factors influencing maternal/infant access to healthcare facilities to identify potential barriers to participation in future clinical trials on maternal vaccination.
In this prospective, multi-centre, observational study, pregnant women (N = 3243) were enrolled at ten sites across Panama, the Dominican Republic, South Africa, and Mozambique between 2012 and 2014. They completed questionnaires at enrolment, delivery, and infant follow-up (90 days post-partum) visits, including questions on transportation, phone accessibility, alternative childcare, gestational age at enrolment, delivery location, and health status of their infant. Logistic regression was used to identify factors significantly associated with return to study site for delivery or infant follow-up visits.
Among 3229 enrolled women with delivery information, 63.6% (range across sites: 25.3–91.5%) returned to study site for delivery. Older women and those at later gestational age at enrolment were more likely to deliver at the study site. While heterogeneities were observed at site level, shorter travel time at delivery and increased transportation costs at enrolment were associated with increased likelihood of women returning to study site for delivery. Among 3145 women with live-born infants, 3077 (95.3%) provided 90-day follow-up information; of these, 68.9% (range across sites: 25.6–98.9%) returned to study site for follow-up visits. Women with other children and with lower transportation costs at delivery were more likely to return to study site for follow-up visits. Among 666 infants reported sick, 94.3% were taken to a healthcare facility, with only 41.9% (range across sites: 4.9–77.3%) to the study site.
Although high retention was observed from enrolment through 90 days after delivery, post-partum surveillance should be broadened beyond the study sites and additional follow-up visits should be planned within the neonatal period. The factors influencing maternal/infant access to healthcare facilities and the issues identified in this study should be taken into consideration in planning future clinical studies on maternal immunisation in low- and middle-income countries.
The study was registered at ClinicalTrial.gov (NCT01734434) on November 22, 2012.
Additional files 1: Survey Questionnaires. Survey questionnaires completed at enrolment, delivery (at study site or outside of study site) and infant 90-day follow-up visit. (PDF 57 kb)12884_2017_1655_MOESM1_ESM.pdf
Additional files 2: Supplementary Methods. Formula and details on odds ratios calculation. (PDF 85 kb)12884_2017_1655_MOESM2_ESM.pdf
United Nations Inter-agency Group for Child Mortality Estimation. Levels & trends in child mortality. Report 2015. Available at: http://www.childmortality.org/files_v20/download/IGME%20Report%202015_9_3%20LR%20Web.pdf. Accessed 1 Aug 2017.
World Health Organization. Newborns: reducing mortality. Fact sheet no. 333. http://www.who.int/mediacentre/factsheets/fs333/en/. Accessed 1 Aug 2017.
Akseer N, Lawn JE, Keenan W, Konstantopoulos A, Cooper P, Ismail Z, Thacker N, Cabral S, Bhutta ZA. Ending preventable newborn deaths in a generation. Int J Gynaecol Obstet. 2016;131:S43–8. CrossRef
World Health Organization. Maternal Mortality. Fact sheet no. 348. http://www.who.int/mediacentre/factsheets/fs348/en/. Accessed 1 Aug 2017.
World Health Organization. Maternal Immunization against tetanus. Standards for Maternal and Neonatal Care 2006. http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/immunization_tetanus.pdf. Accessed 1 Aug 2017.
Heyderman RS, Madhi SA, French N, Cutland C, Ngwira B, Kayambo D, Mboizi R, Koen A, Jose L, Olugbosi M, et al. Group B Streptococcus vaccination in pregnant women with or without HIV in Africa: a non-randomised phase 2, open-label, multicentre trial. Lancet Infect Dis. 2016;16:546–55. CrossRefPubMedPubMedCentral
Committee on Obstetric Practice, the American Institute of Ultrasound in Medicine, and the Society for Maternal-Fetal Medicine. Committee Opinion No 700: Methods for Estimating the Due Date. Obstet Gynecol. 2017;129(5):e150–4.
Bhorat H, Kanbur R, Stanwix B. Minimum wages in Sub-Saharan Africa: a primer. IZA Discussion Paper 9204, 2015. http://ftp.iza.org/dp9204.pdf. Accessed 1 Aug 2017.
Hervish A, Clifton D. Status Report: Adolescents and young people in Sub-Saharan Africa. Opportunities and challenges. 2012. www.prb.org/pdf12/status-report-youth-subsaharan-Africa.pdf. Accessed 1 Aug 2017.
Kruk ME, Hermosilla S, Larson E, Vail D, Chen Q, Mazuguni F, Byalugaba B, Mbaruku G. Who is left behind on the road to universal facility delivery? A cross-sectional multilevel analysis in rural Tanzania. Tropical Med Int Health. 2015;20:1057–66. CrossRef
- Factors influencing access of pregnant women and their infants to their local healthcare system: a prospective, multi-centre, observational study
Shabir A. Madhi
Luis M. Rivera
Mark F. Cotton
Mariëtha M. Luttig
- BioMed Central
Neu im Fachgebiet Gynäkologie und Geburtshilfe
Meistgelesene Bücher aus dem Fachgebiet
Mail Icon II