Acceptance of Vaccine Against Influenza in Pregnant Women in Urban Slum Areas in Karachi, Pakistan Pubblico

Abstract

Background: Very little is known about facilitators and barriers to Influenza vaccination programs amongst pregnant women in the developing world, particularly in South Asia. We assessed intention to accept Influenza vaccine amongst ethnically diverse low-income pregnant women in Pakistan.

Methods: Between May-August 2013, we conducted a cross-sectional survey of pregnant women who frequented 3 health centers in urban slum areas in Karachi, Pakistan. Our main outcome of interest, intention to accept Influenza vaccine, was assessed against variables including socio-demographic factors, vaccination history, vaccine recommendation sources and their reliability, and other facilitators and barriers to vaccine acceptance.

Results: A total of 283 pregnant women participated in our study. Ninety-seven percentage of the respondents intended to accept Influenza vaccine but none were vaccinated against Influenza. Except for 1, all pregnant women had heard about Influenza disease. Perceived vaccine safety, efficacy, and disease susceptibility were significantly associated with intention to accept Influenza vaccine (p<0.001). Only 50% of pregnant women received recommendation about any vaccines from physicians, whereas 95% of the participants rated healthcare providers as a highly reliable source of information (p<0.01, 95% Confidence Interval [CI] 2.95-36.31). Parents-in-law and husbands were named as the primary decision makers in the family by 88% of the respondents. The most often cited reason for accepting Influenza vaccine was if a physician recommended it (p<0.01) whereas, not getting permission from a family member was cited as an important reason to refuse vaccination.

Conclusion: Future maternal flu vaccination efforts should target decision makers in the family. Furthermore, healthcare providers should be encouraged to recommend Influenza vaccine as it may increase vaccine uptake.

Table of Contents

TABLE OF CONTENTS

CHAPTER 1: LITERATURE REVIEW........................................................................................ 8

BACKGROUND.................................................................................................................. 9

Overview......................................................................................................................... 9

Causes and Transmission.................................................................................................... 9

Signs and symptoms.......................................................................................................... 10

Diagnosis......................................................................................................................... 11

Morbidity and Mortality........................................................................................................11

Epidemics and Pandemics....................................................................................................12

Treatment.........................................................................................................................13

Vaccination........................................................................................................................13

Pregnant Women................................................................................................................15

Challenges to Vaccine Acceptance..........................................................................................16

Vaccine Acceptance in Pakistan.............................................................................................20

CHAPTER 2: MANUSCRIPT................................................................................................. 24

INTRODUCTION...................................................................................................................25

MATERIALS AND METHODS................................................................................................... 26

Study location.....................................................................................................................26

Study Design...................................................................................................................... 26

Outcome measures...............................................................................................................27

Statistical Analyses...............................................................................................................29

Ethical consideration and financial disclosures...........................................................................29

RESULTS............................................................................................................................ 30

Health Belief Model...............................................................................................................31

Influenza Disease Knowledge and Vaccine Administration History................................................. 32

Vaccine Recommendation and information sources..................................................................... 32

Facilitators and Barriers to Vaccine Administration..................................................................... 33

DISCUSSION....................................................................................................................... 34

TABLES...............................................................................................................................37

FIGURES.............................................................................................................................43

CHAPTER 3: PUBLIC HEALTH IMPLICATIONS.............................................................................. 46

REFERENCES...................................................................................................................... 50

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Parola chiave	Pakistan Maternal Immunization Healthcare providers Influenza Vaccine Acceptance
Committee Chair / Thesis Advisor	Omer, Saad B, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs University, college or educational institution (other than Emory)

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