Evaluating Vaccine Rates, Barriers To, and Perceptions of Vaccination in Guatemalan Children Through Provider Surveys

Background: Understanding baseline vaccination rates is critical. Unvaccinated children are more likely to be hospitalized with vaccine preventable diseases with increased associated morbidity and mortality (Diaz, Janepsy, et al 2016). A 2018 UNICEF report on infant vaccination rates in Guatemala revealed 86% received 3 Diphtheria Tetanus Pertussis doses, 3 Hemophilus influenzae type B doses, and 3 Hepatitis B vaccine doses. These are lower vaccination rates compared to other Central American countries, underscoring the need to investigate this issue in Guatemala.

Methods: An anonymous self-administered electronic pediatric provider survey using google forms was administered to assess their perceptions of vaccine utilization, barriers to vaccine utilization and vaccine knowledge. The survey was distributed January 12th, 2021 – February 16th, 2021 to all pediatric residents, attendings and nurses at the National Hospital of Guatemala in Escuintla. IRB approval was obtained through Atrium Health and the National Hospital of Guatemala in Escuintla.

Results: There were 128 responses (66.4% nurses, 25.8% residents, and 7.8% Faculty). Data was separated into 2 cohorts: pediatric physicians (residents and faculty) and pediatric nurses. For the cohort of physicians, over 65% reported vaccines are not easily accessible for their patients, most commonly because they are perceived to be unavailable and expensive. Over 95% reported vaccines are very important, safe, and prevent illness with 95.3% reporting they inquire about patient vaccination status at every admission and recommend vaccines to their hospitalized patients. Of physicians, 41.8% believed some and 39.5% believed most of their hospitalized patients were up to date on vaccines. The majority (58.1%) reported patient’s vaccination status impacts their patient management. Physicians reported wanting more education on vaccine safety, adverse events, preventable diseases and benefits. In the nurse cohort, similarly, over 50% reported vaccines are not easily accessible and are expensive for their patients. Over 90% reported vaccines are very important, safe, and prevent illness. Of nurses, 49.4% believe that some of their hospitalized patients were up to date on vaccines. Of nurses, 88.1% reported frequently recommending vaccines to their hospitalized patients. 100% of nurses reported wanting more education on vaccine safety, adverse events, preventable diseases, and benefits.

Conclusion: At the National Hospital of Guatemala in Escuintla, pediatric physicians and nurses believe vaccines are important, safe, and prevent illness. Many perceive vaccine availability and expense to be barriers for some of their patients. The vast majority of physicians and nurses, want more education on vaccine safety, adverse events, preventable diseases and benefits. However not all providers recommend vaccines to their patients and there are very few vaccines available for administration in the hospital. More vaccine education for pediatric providers and improving access to vaccinations by offering routine vaccines prior to discharge from the hospital may promote overall higher vaccination rates in Escuintla, Guatemala.