PREreview of Pregnant women’s attitudes and intentions toward tuberculosis, malaria, group B streptococcus, and respiratory syncytial virus vaccines in pregnant: Findings from pregnant women living in Brazil, Ghana, Kenya, and Pakistan

Introduction

This preprint summarizes the findings of a major, multi-country cross-sectional study that investigated pregnant women's views and intentions toward TB, malaria, GBS, and RSV vaccines. The study, which was conducted in Brazil, Ghana, Kenya, and Pakistan, provides timely and policy-relevant findings, especially given that some of these maternal vaccinations are in the late stages of development. The study is well-motivated, the methodologies are mostly suitable, and the results have obvious implications for the design of maternal immunization programs and clinical trials.

Minor adjustments to improve clarity in the methods and results sections, as well as to remove a few language inconsistencies, will improve its readability and utility to public health audiences.

Strengths

Some of the key strengths include:

·      Multi-country perspective: Including four different LMICs gives useful comparative data and increases the worldwide significance of the findings.

·      Large sample size: With 1,603 participants, the study offers excellent statistical power and descriptive potential.

·      Well-structured instrument: The questionnaire covers immunization intentions, decision-making considerations, hesitancy, and familial influence.

·      Clarity of findings: The data clearly show that "safety for the baby" is the primary driver of immunization intention, with significant variances between nations and vaccines.

Concerns and Limitations

While the study is solid overall, there are a few limitations to consider:

·      Selection bias: Participants were recruited solely from antenatal care (ANC) facilities, which may skew the sample toward women who are more engaged with the healthcare system and, therefore, more tolerant of vaccination.

·      Generalizability: Because the study was conducted using facility-based, urban sampling, the findings may not be representative of rural or hard-to-reach groups where vaccine hesitancy or access difficulties differ.

·      Measurement limitations: While condensing Likert responses into binary "agree/disagree" categories simplifies interpretation, it risks masking important variation.

·      Social desirability bias: Conducting interviews at health facilities, presumably in front of healthcare staff, may have impacted vaccine-positive results.

Areas for Improvement

To improve the manuscript's clarity and rigor, I suggest the following revisions.

·      Edit the abstract for brevity and repair minor typographical errors (e.g., "safety for the baby").

·      Methods Clarification: 1) Indicate if the surveys were administered by an interviewer or completed by the respondents themselves. 2) Provide more information on sample representativeness (for example, demographics of the general pregnant population in each country).

·      Discuss the ramifications of these findings, including how they could drive tailored communication methods and culturally appropriate messaging during vaccination distribution.

Conclusion

This preprint contributes significantly to the research on maternal immunization. Its merits include its rigorous multi-country design, huge sample size, and practical emphasis on maternal preferences and views of future immunizations. While some modest editing and structural changes would improve the clarity and presentation of the data, the study is notable for its significance to global health policy and maternity vaccine implementation planning.

Finally, this study demonstrates that pregnant women in low- and middle-income countries are not only open to, but frequently eager for, access to immunizations that protect both their children and themselves. The safety of the baby remains the most important concern, and the statistics show positive levels of vaccine intention for future maternal vaccines.

Competing interests

The author declares that they have no competing interests.