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Factors influencing access of pregnant women and their infants to their local healthcare system: a prospective, multi-centre, observational study
BACKGROUND: 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 potentia...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5769295/ https://www.ncbi.nlm.nih.gov/pubmed/29334920 http://dx.doi.org/10.1186/s12884-017-1655-3 |
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author | Madhi, Shabir A. Rivera, Luis M. Sáez-Llorens, Xavier Menéndez, Clara Carrim-Ganey, Nazira Cotton, Mark F. Katzman, Darren Luttig, Mariëtha M. Candelario, Rosalba Baker, Sherryl Roychoudhury, Mahua |
author_facet | Madhi, Shabir A. Rivera, Luis M. Sáez-Llorens, Xavier Menéndez, Clara Carrim-Ganey, Nazira Cotton, Mark F. Katzman, Darren Luttig, Mariëtha M. Candelario, Rosalba Baker, Sherryl Roychoudhury, Mahua |
author_sort | Madhi, Shabir A. |
collection | PubMed |
description | BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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. TRIAL REGISTRATION: The study was registered at ClinicalTrial.gov (NCT01734434) on November 22, 2012. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12884-017-1655-3) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-5769295 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-57692952018-01-25 Factors influencing access of pregnant women and their infants to their local healthcare system: a prospective, multi-centre, observational study Madhi, Shabir A. Rivera, Luis M. Sáez-Llorens, Xavier Menéndez, Clara Carrim-Ganey, Nazira Cotton, Mark F. Katzman, Darren Luttig, Mariëtha M. Candelario, Rosalba Baker, Sherryl Roychoudhury, Mahua BMC Pregnancy Childbirth Research Article BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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. TRIAL REGISTRATION: The study was registered at ClinicalTrial.gov (NCT01734434) on November 22, 2012. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12884-017-1655-3) contains supplementary material, which is available to authorized users. BioMed Central 2018-01-15 /pmc/articles/PMC5769295/ /pubmed/29334920 http://dx.doi.org/10.1186/s12884-017-1655-3 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Madhi, Shabir A. Rivera, Luis M. Sáez-Llorens, Xavier Menéndez, Clara Carrim-Ganey, Nazira Cotton, Mark F. Katzman, Darren Luttig, Mariëtha M. Candelario, Rosalba Baker, Sherryl Roychoudhury, Mahua Factors influencing access of pregnant women and their infants to their local healthcare system: a prospective, multi-centre, observational study |
title | Factors influencing access of pregnant women and their infants to their local healthcare system: a prospective, multi-centre, observational study |
title_full | Factors influencing access of pregnant women and their infants to their local healthcare system: a prospective, multi-centre, observational study |
title_fullStr | Factors influencing access of pregnant women and their infants to their local healthcare system: a prospective, multi-centre, observational study |
title_full_unstemmed | Factors influencing access of pregnant women and their infants to their local healthcare system: a prospective, multi-centre, observational study |
title_short | Factors influencing access of pregnant women and their infants to their local healthcare system: a prospective, multi-centre, observational study |
title_sort | factors influencing access of pregnant women and their infants to their local healthcare system: a prospective, multi-centre, observational study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5769295/ https://www.ncbi.nlm.nih.gov/pubmed/29334920 http://dx.doi.org/10.1186/s12884-017-1655-3 |
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