Factors influencing acceptance of vaccination during pregnancy in The Gambia and Senegal.

BACKGROUND: Vaccination during pregnancy can protect pregnant women and their babies from infectious diseases. Tetanus vaccine, also known as tetanus toxoid, is the only vaccine given to pregnant women in The Gambia and Senegal, where it is given by antenatal care providers as part of the Expanded Programme on Immunization. A qualitative study was undertaken to explore factors influencing acceptance of vaccination during pregnancy in The Gambia and Senegal. METHODS: Focus group discussions and in-depth interviews were conducted across urban and rural settlements of The Gambia and Senegal. We explored the knowledge, attitudes, and perceptions of 152 women who were either pregnant or with an infant. NVivo 11 Qualitative Data Analysis Software was used for management and thematic analysis of the data. RESULTS: Women had sufficient knowledge of the need for tetanus vaccine from different information sources but insufficient knowledge of tetanus causes, signs and symptoms. Tetanus vaccine was perceived to be safe and side effects such as pain and swelling at site of injection did not deter uptake of future doses. Women overall had confidence in their sources of vaccine information and the health care workers who administered maternal vaccinations. Their willingness to accept vaccination during pregnancy was particularly influenced by their husbands and trusted healthcare workers. Women across all sites mentioned they would accept new maternal vaccines if they are sensitized beforehand about any potential risks and benefits to them and their babies. CONCLUSION: Vaccine acceptance can be influenced by several factors including contextual, individual or group influences and vaccine or vaccination-specific issues. Women across The Gambia and Senegal are generally vaccine acceptors with confidence in the health care workers who vaccinate them and few concerns about maternal vaccines. Women's acceptance of vaccination during pregnancy is based on previous vaccination experiences and individual weighing of risks and benefits.

The use of a speaking book® to enhance vaccine knowledge among caregivers in The Gambia: A study using qualitative and quantitative methods.

OBJECTIVES: To measure the usefulness of a Speaking Book (SB) as an educational tool for enhancing knowledge, understanding and recall of key vaccine-related information among caregivers in The Gambia, as well as its acceptability and relevance as a health promotion tool for caregivers and healthcare workers. DESIGN AND SETTING: We developed a multimedia educational tool, the vaccine Speaking Book, which contained prerecorded information about vaccines provided in The Gambia's Expanded Programme on Immunization. Using qualitative and quantitative methods, we then conducted a sequential study assessing the use of this tool among caregivers andhealthcare workers in The Gambia.Participants200 caregivers attending primary healthcare centres in The Gambia for routine immunisation services for their infants, and 15 healthcare workers employed to provide immunisation services at these clinics. OUTCOME MEASURES: We calculated the median knowledge scores on vaccine-related information obtained at baseline, 1-month and 3-month follow-up visits. Wilcoxon's matched-pairs signed-rank test was used to compare the difference in the median knowledge scores between baseline and 1-month, and between baseline and 3-month follow-up visits. RESULTS: Of the 113 caregivers who participated, 104 (92%) completed all three study visits, 108 (95.6%) completed the baseline and 1-month follow-up visits, and 107 (94.7%) completed the baseline and 3-month follow-up visits. The median knowledge score increased from 6.0 (IQR 5.0-7.0) at baseline to 11.0 (IQR 8.0-14.0) at 1-month visit (p<0.001), and 15.0 (IQR 10.0-20.0) at 3-month visit (p<0.001). Qualitative results showed high acceptability and enthusiasm for the Speaking Book among both caregivers and healthcare workers. The Speaking Book was widely shared in the community and this facilitated communication with healthcare workers at the primary healthcare centres. CONCLUSIONS: Context-specific and subject-specific Speaking Books are a useful communication and educational tool to increase caregiver vaccine knowledge in low/middle-income countries.

"We All Join Hands": Perceptions of the Kangaroo Method Among Female Relatives of Newborns in The Gambia.

Family support is essential for kangaroo mother care (KMC), but there is limited research regarding perceptions of female relatives, and none published from West African contexts. In-depth interviews were conducted from July to August 2017 with a purposive sample of 11 female relatives of preterm neonates admitted to The Gambia's referral hospital. Data were coded in NVivo 11, and thematic analysis was conducted applying an inductive framework. Female relatives were willing to support mothers by providing KMC and assisting with domestic chores and agricultural labor. Three themes were identified: (a) collective family responsibility for newborn care, with elder relatives being key decision makers, (b) balance between maintaining traditional practices and acceptance of KMC as a medical innovation, and (c) gendered expectations of women's responsibilities postnatally. Female relatives are influential stakeholders and could play important roles in KMC programs, encourage community ownership, and contribute to improved outcomes for vulnerable newborns.