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BMJ Open. 2019 Jun 4;9(6):e024449. doi: 10.1136/bmjopen-2018-024449.

Maternal Immunization and Antenatal Care Situation Analysis (MIACSA) study protocol: a multiregional, cross-sectional analysis of maternal immunization delivery strategies to reduce maternal and neonatal morbidity and mortality.

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Department of Maternal Newborn Child and Adolescent Health (MCA), Epidemiology Monitoring and Evaluation (EME), World Health Organization, Geneva, Switzerland.
Department of Immunization, Vaccines and Biologicals (IVB), Initiative for Vaccine Research (IVR), World Health Organization, Geneva, Switzerland.
Independant consulting and advisory group, MMGH Consulting GmbH, Zürich, Switzerland.
Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
Faculty of epidemiology and population health, Department of infectious disease epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA.
Department of Obstetrics and Gynaecology, Monash University and Monash Health, Melbourne, Australia.



Maternal immunization (MI) with tetanus toxoid containing vaccine, is a safe and cost-effective way of preventing neonatal tetanus. Given the prospect of introducing new maternal vaccines in the near future, it is essential to identify and understand current policies, practices and unmet needs for introducing and/or scaling up MI in low-income and middle-income countries (LMICs).


The Maternal Immunization and Antenatal Care Situation Analysis (MIACSA) is a mixed methods, cross-sectional study that will collect data in four phases: (1) a review of global databases for selected health indicators in 136 LMICs; (2) a structured online survey directed at Maternal, Newborn and Child Health and Expanded Programme on Immunization focal points in all 136 LMICs; (3) semistructured telephone interviews of 30 selected LMICs and (4) 10 week-long country visits, including key informant interviews, health facility visits and focus group discussions. The principal analyses will assess correlations between the various aspects of MI delivery strategies and proxy measures of health systems performance related to vaccine-preventable disease control. The primary outcome will be a typology of existing MI delivery models, and secondary outcomes will include country profiles of child and maternal health indicators, and a MI gaps and needs analysis.


The protocol was approved by the WHO Ethics Review Committee (ERC.0002908). The results will be made available in a project report and submitted for publication in peer-reviewed journals that will be shared broadly among global health decision-makers, researchers, product developers and country-level stakeholders.


maternal immunisation; maternal mortality; maternal tetanus; neonatal mortality; neonatal tetanus; study protocol

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