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

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


Introduction: 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).

Methods and analysis: 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.

Ethics and dissemination: 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.

Keywords: maternal immunisation; maternal mortality; maternal tetanus; neonatal mortality; neonatal tetanus; study protocol.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Clinical Protocols
  • Cross-Sectional Studies
  • Female
  • Humans
  • Immunization / methods*
  • Infant
  • Infant Mortality
  • Maternal Mortality
  • Multicenter Studies as Topic
  • Neurotoxins
  • Perinatal Mortality
  • Pregnancy
  • Pregnancy Complications, Infectious / prevention & control*
  • Prenatal Care / methods*
  • Research Design
  • Tetanus / prevention & control*
  • Tetanus Toxin*
  • Tetanus Toxoid


  • Neurotoxins
  • Tetanus Toxin
  • Tetanus Toxoid