“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

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.