Factors associated with tetanus vaccination in pregnant women living in Minas Gerais State, Brazil: A cross-sectional study

Determinants of tetanus immunization among pregnant women where tetanus has not been eliminated: a multilevel analysis of 6 countries

Background

Two or more doses of the tetanus toxoid (TT) vaccine in pregnancy afford the fetus passive immunity and reduce neonatal mortality by 96%. In developing nations, the use of TT during pregnancy is still uncommon but presents a serious risk to public health. Thus, the current study aimed to identify determinants of adequate TT immunization among pregnant women in six countries that have not eliminated maternal and neonatal tetanus.

Methods

A cross-sectional study was conducted using recent demographic and health survey datasets from 6 countries that didn't achieve maternal and neonatal tetanus elimination. A total of 84,248 weighted samples were included. A multilevel logistic regression model was fitted. An adjusted odds ratio with a 95% CI and p-value < 0.05 was used to declare significant factors.

Results

Being married [AOR = 1.36, CI: 1.20, 1.54], poorest [AOR = 1.46, CI: 1.36, 1.57], the poorer [AOR = 1.48, CI: 1.39, 1,59], middle [AOR = 1.33, CI: 1.26, 1.42], and the richer [AOR = 1.19, CI: 1.13, 1.26] wealth quintile, giving birth between the ages of 24 and 30 years [AOR = 1.10, CI: 1.04, 1.16], being primiparous [AOR = 1.09; CI: 1.02, 1.17], female house head [AOR = 1.13; CI: 1.06, 1.20], 4 and above antenatal care (ANC) visits [AOR = 5.94, CI: 5.60, 6.30], attending post-natal checkup [AOR = 1.18, CI: 1.13, 1.23], and institutional delivery [AOR = 1.22, CI: 1.18, 1.27] were positively related to adequate TT immunization. While unemployment [AOR = 0.68, CI: 0.66, 0.71], poor health facility visits [AOR = 0.72, CI: 0.70, 0.75], abortion [AOR = 0.89, CI: 0.85, 0.93], low community media exposure [AOR = 0.74, CI: 0.67, 0.81], and rural residence [AOR = 0.80, CI: 0.77, 0.84] were significant risk factors for inadequate TT immunization.

Conclusion

Marital status, wealth index, age at first birth, decision about women's health care, parity, sex of household head, ANC, postnatal checkup, distance to health facility, and health insurance were significant predictors of adequate TT vaccination. Therefore, TT immunization can be improved by promoting maternal employment, improving post-abortion care, media coverage, community literacy, and health accessibility, and encouraging pregnant women to receive ANC and postnatal care.

Protective doses of tetanus toxoid immunization and its associated factors among mothers in southern Ethiopia

The World Health Organization recommends tetanus toxoid immunization before or during pregnancy for all women of childbearing age. The goal is to reduce maternal and neonatal mortality due to tetanus. According to the 2016 Ethiopia Demographic and Health Survey (EDHS) report, more than half (51%) of women did not receive protective doses of tetanus immunization. To the best of our knowledge, this study uniquely tried to assess the level of protective doses of tetanus toxoid immunization in southern Ethiopia. A community-based cross-sectional study was conducted among 580 randomly selected participants. Variable with p-value of less than .25 in the bivariate analysis were included in the multivariable logistic regression analysis. Finally, statistical significance was declared at a p-value of less than .05. The proportion of protective doses of tetanus toxoid immunization uptake in the area was found to be 41.9% (95% CI: 38-46%). Being enrolled in formal education [AOR = 6.55, 95% CI: 3.23-9.01], having at least two postnatal care visits [AOR = 3.82; 95% CI: 1.78-6.40], having at least four antenatal care visits [AOR = 2.56; 95% CI: 1.41-4.34], and being visited by Health Extension Workers [AOR = 2.66; 95% CI: 1.42-4.01] were found to be factors enhancing the uptake of protective doses of tetanus toxoid immunization. Generally, the uptake or prevalence of the protective doses of tetanus toxoid immunization in the area was lower than the World Health Organization's target. Therefore, all responsible bodies, including healthcare providers, need to strengthen counseling mothers to enhance the uptake of tetanus toxoid immunization.

Number of tetanus toxoid injections before birth and associated factors among pregnant women in low and middle income countries: Negative binomial poisson regression

BACKGROUND

In low- and middle-income countries where vaccination rates are low, tetanus is still an important threat to public health. Although maternal and neonatal tetanus remains a major global health concern, its magnitude and determinates are not well studied. Therefore, this study aimed to assess the number of tetanus toxoid injections and associated factors among pregnant women in low- and middle-income countries.

METHODS

Data from the most recent Demographic and Health Surveys, which covered 60 low- and middle-income countries from 2010 to 2022, was used for secondary data analysis. The study included a total of 118,704 pregnant women. A statistical software package, STATA 14, was used to analyze the data. A negative binomial regression of a cross-sectional study was carried out. Factors associated with the number of tetanus vaccinations were declared significant at a p-value of < 0.05. The incidence rate ratio and confidence interval were used to interpret the results. A model with the smallest Akaike Information Criterion and Bayesian Information Criterion values and the highest log likelihood was considered the best-fit model for this study.

RESULTS

In low- and middle-income countries, 26.0% of pregnant women took at least two doses of the tetanus toxoid vaccine. Factors such as maternal education, primary (IRR = 1.22, 95% CI: 1.17, 1.26), secondary (IRR = 1.19, 95% CI: 1.15, 1.23), higher (IRR = 1.16, 95% CI: 1.12, 1.20), employment (IRR = 1.11, 95% CI: 1.09, 1.13), 1-3 ANC visits (IRR = 2.49, 95% CI: 2.41, 2.57), ≥4 visits (IRR = 2.94, 95% CI: 2.84, 3.03), wealth index (IRR = 1.06; 95% CI: 11.04, 1.08), ≥birth order (IRR = 1.04, 95% CI: 1.02, 1.27), distance to health facility (IRR = 1.02, 95% CI: 1.00, 1.03), and health insurance coverage (IRR = 1.08; 95% CI: 1.06, 1.10) had a significant association with the number of tetanus vaccinations among pregnant women.

CONCLUSIONS AND RECOMMENDATIONS

This study concludes that the number of tetanus toxoid vaccinations among pregnant women in low- and middle-income countries is low. In the negative binomial model, the frequency of tetanus vaccinations has a significant association with maternal employment, educational status, wealth index, antenatal care visits, birth order, distance from a health facility, and health insurance. Therefore, the ministries of health in low and middle-income countries should give attention to those women who had no antenatal care visits and women from poor wealth quantiles while designing policies and strategies.