Vaccination against influenza among pregnant women in southern Brazil and associated factors

Mendoza-Sassi, Raúl Andrés; Linhares, Angélica Ozório; Schroeder, Franciane Maria Machado; Maas, Nathalia Matties; Nomiyama, Seiko; César, Juraci Almeida

doi:10.1590/1413-812320182412.08382018

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FREE THEMES • Ciênc. saúde coletiva 24 (12) • Dec 2019 • https://doi.org/10.1590/1413-812320182412.08382018 copy

Vaccination against influenza among pregnant women in southern Brazil and associated factors

Vacinação contra Influenza entre gestantes no Sul do Brasil e fatores associados

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This article aims to identify the prevalence and factors associated with influenza vaccination in pregnant women. This is a cross-sectional study conducted in a municipality in the southernmost region of Brazil, which included all women giving birth in 2016. The outcome was having received the vaccine against influenza during pregnancy. Sociodemographic, behavioral and prenatal care characteristics and morbidities were analyzed. The analysis included sample description, the prevalence of vaccination for each independent variable and a multivariate analysis. Two thousand six hundred ninety-four pregnant women were interviewed, of which 53.9% reported having been vaccinated. Factors associated with increased prevalence of vaccination were mother’s higher schooling, prenatal care, tetanus vaccination and prenatal care performed in a public service. On the other hand, prenatal care onset after the first quarter reduced the prevalence of vaccination. The results point to the need to reinforce the importance of vaccination against influenza among pregnant women and among health professionals, regardless of the severity of the current epidemiological setting.

Key words
Influenza vaccine; Human influenza; Pregnant women; Risk factors; Vaccine coverage

Variable	N	%
Mother's age (2666)
< 20 years	449	16.84
20 to 29 years	1,328	49.81
30 years or more	889	33.35
Referred skin color (2,662)
Black/other	845	31.74
White	1,817	68.26
Full schooling years (2,670)
1 to 3	37	1.39
4 to 8	946	35.43
9 to 11	1,058	39.63
12 or more	629	23.55
Household income per capita (2,497)
1^st quartile (poorest)	625	25.03
2^nd quartile	673	26.95
3^rd quartile	581	23.27
4^th quartile (richest)	618	24.75
With partner (2,669)
No	435	16.30
Yes	2,234	83.70
Smoker (2,669)
No	2,378	89.10
Yes	291	10.90
Alcoholic beverage consumption (2,667)
No	2,624	98.39
Yes	43	1.61
Engaged in physical exercise (2668)
No	2,515	94.27
Yes	153	5.73
Performed prenatal care (2,670)
No	40	1.50
Yes	2,630	98.50
Delivery type (2,670)
Normal	1,223	45.81
Cesarean	1,447	54.19
Multiparous (2,670)
No	1,145	42.88
Yes	1,525	57.12
Prenatal care: 6 or more consultations (2,610)
No	377	14.44
Yes	2,233	85.56
Prenatal care trimester of onset (2,609)
1^st	2,071	79.38
2^nd	492	18.86
3^rd	46	1.76
Prenatal care location (2,591)
Public service	1,462	56.43
Private service	1,129	43.57
Received tetanus vaccine (2,629)
No	575	21.87
Yes, before current pregnancy	434	16.51
Yes, during current pregnancy	1,620	61.62
Asthma (2,669)
No	2,144	80.33
Yes	525	19.67
Hypertension (2,668)
No	2,179	81.67
Yes	489	18.33
Diabetes (2,665)
No	2,545	95.50
Yes	120	4.50

Level	Variable	Prevalence	Crude analysis		Adjusted analysis
Level	Variable	Prevalence	PR (CI 95%)	P-Value	PR (CI 95%)	P-value
1^st	Mother's age (years)			0.86		0.17a
	< 20	54.57	1		1
	20 to 29	53.69	0.98 (0.89-1.08)		0.93 (0.84-1.03)
	≥ 30	53.88	0.99 (0.89-1.09)		0.91 (0.81-1.02)
	Self-referred skin color			0.46		0.89
	Blak/other	52.90	1		1
	White	54.43	1.03 (0.95-1.11)		0.99 (0.92-1.07)
	Schooling (full years)			0.01a		0.01a
	1 to 3	48.65	1		1
	4 to 8	50.42	1.04 (0.74-1.45)		1.02 (0.73-1.44)
	9 to 11	55.67	1.14 (0.82-1.60)		1.15 (0.82-1.60)
	≥ 12	56.44	1.16 (0.83-1.63)		1.17 (0.83-1.64)
	Household income per capita			0.37b		0.50b
	1^st quartile (poorest)	52.96	1		1
	2^nd quartile	54.53	1.03 (0.93-1.14)		0.99 (0.90-1.10)
	3^rd quartile	52.50	0.99 (0.89-1.10)		0.93 (0.83-1.05)
	4^th quartile (richest)	56.31	1.06 (0.96-1.18)		0.98 (0.87-1.10)
	With partner			0.09		0.10
	No	50.11	1		1
	Yes	54.66	1.09 (0.98-1.21)		1.09 (0.98-1.21)
2^nd	Smoker			0.03		0.23
	No	54.71	1		1
	Yes	47.42	0.87 (0.76-0.98)		0.96 (0.88-1.04)
	Consumed alcoholic beverage			0.06		0.09
	No	54.19	1		1
	Yes	37.21	0.67 (0.46-1.01)		0.71 (0.48-1.05)
	Performed physical exercise			0.55		0.89
	No	53.80	1		1
	Yes	56.21	1.04 (0.90-1.21)		1.01 (0.87-1.17)
3^rd	Performed prenatal care			< 0.01		< 0.01
	No	7.50	1		1
	Yes	54.60	7.28 (2.45-21.63)		6.65 (2.25-19.67)
	Multiparous			0.01		0.22
	No	57.03	1		1
	Yes	51.54	0.90 (0.84-0.97)		0.95 (0.87-1.03)
	Delivery type			0.43	1	0.73
	Normal	53.07	1		0.99 (0.92-1.06)
	Cesarean	54.60	1.03 (0.96-1.10)
4^th	Prenatal care: 6 or more consultations			< 0.01		0.13
	No	42.18	1		1
	Yes	56.83	1.35 (1.19-1.52)		1.12 (0.97-1.30)
	Prenatal care trimester of onset			< 0.01a		< 0.01a
	1^st	57.07	1		1
	2^nd	47.15	0.83 (0.75-0.91)		0.88 (0.78-0.99)
	3^rd	26.09	0.46 (0.28-0.74)		0.48 (0.26-0.88)
	Prenatal care location			0.01		< 0.01
	Public service	56.70	1		1
	Private service	51.55	0.91 (0.84-0.98)		0.84 (0.77-0.92)
	Received tetanus vaccine			< 0.01a		< 0.01a
	No	35.65	1		1
	Yes, before current pregnancy	53.00	1.49 (1.29-1.71)		1.35 (1.15-1.58)
	Yes, during current pregnancy	61.73	1.73 (1.54-1.94)		1.61 (1.41-1.83)
	Asthma			0.51		0.35
	No	54.20	1		1
	Yes	52.57	0.97 (0.87-1.06)		0.96 (0.87-1.05)
	Hypertension			0.14		0.74
	No	53.28	1		1
	Yes	56.85	1.07 (0.98-1.16)		1.02 (0.92-1.12)
	Diabetes			0.30		0.32
	No	53.75	1		1
	Yes	58.33	1.08 (0.93-1.27)		1.09 (0.92-1.29)

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[1] Collaborations

RA Mendoza-Sassi participated in the design of the study, analysis and interpretation of the data, writing of the paper, review of the final article and approval of final version for publication, and agree to be accountable for all aspects of the work. JA César participated in the design of the study, review of the final article and approval the final version for publication and agree to be accountable for all aspects of the work. AO Linhares, FMM Schroeder, NM Maas and S Nomiyama participated in the analysis and interpretation of the data, writing of the article, final review and approval of final version for publication and agree to be accountable for all aspects of the work.