“If I am not aware then I don’t think the community is aware”: a mixed-methods study of health worker perspectives on future maternal group B streptococcus vaccination in Kenya

Abstract Group B streptococcus (GBS) is a leading cause of neonatal and infant sepsis, pneumonia, and meningitis and is also associated with preterm birth, stillbirth, and other negative pregnancy outcomes. Infants born to mothers colonized with GBS bacteria are at greatest risk of the disease, and more than 95% of GBS disease occurs in sub-Saharan Africa. Screening and intrapartum antibiotic prophylaxis are important but insufficient prevention strategies, and their implementation is inconsistent or absent in many low- and middle-income settings. Maternal GBS vaccines are now in clinical trials, aiming to confer protection to newborns through maternal antibody transfer. Strengthening community uptake of these vaccines, once available, will hinge on strong delivery systems to reach pregnant persons, including providers who can provide appropriate and effective information and recommendations to their patients. We conducted a mixed-methods study to describe providers’ knowledge, attitudes, and beliefs related to GBS and maternal vaccination in Nakuru and Mombasa Counties, Kenya. Based on a cross-sectional survey of 100 providers and 12 in-depth interviews, we found that provider lack of awareness of GBS disease and its burden in the community is a substantial barrier to future GBS vaccine decision-making and demand; perceived community awareness of GBS was also limited. Actual and perceived provider knowledge of GBS varies, emphasizing the need for preemptive education and training in advance of a GBS vaccine introduction. Providers are trusted sources of information for their patients and are very likely to recommend a maternal vaccine that is recommended by the Ministry of Health. With licensed GBS vaccines on the horizon, there is an important opportunity to build provider awareness and knowledge of GBS risk, help strengthen provider and community trust in maternal vaccination and prevent serious GBS disease. Competing Interest Statement The authors have declared no competing interest. Funding Statement Yes Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was reviewed and approved by the Johns Hopkins Bloomberg School of Public Health Institutional Review Board (protocol no. 14893), the Kenya Medical Research Institute Scientific and Ethics Review Unit (protocol no. 4211), and the National Commission for Science, Technology and Innovation. Oral informed consent was obtained from all participants. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable Data Availability Relevant quantitative data are within the paper and its supporting information. Qualitative data underlying the study are generated from semi-structured, in-depth interviews with health care providers in Kenya. Given the sensitivity of this information, and to protect participant confidentiality, data are not publicly available. In accordance with the informed consent obtained from participants at the time of data collection, interested parties can request de-identified transcripts or survey data by contacting the Johns Hopkins University Bloomberg School of Public Health Institutional Review Board (BSPH.irboffice{at}jhu.edu) all requests for access to the underlying study data will be reviewed and approved upon reasonable request.