Determinants and perceptions of the utilization of tetanus toxoid immunization among reproductive-age women in Dukem Town, Eastern Ethiopia: a community-based cross-sectional study

Abstract

BackgroundMaternal and neonatal tetanus (MNT) is still the major public health problem in about 25 countries, mainly in Africa and Asia. However, the utilization of intervention strategies, like tetanus toxoid (TT) immunization remains low in these countries. In Ethiopia, only 49% of the pregnant mothers received TT2+ in 2016. This study was designed to evaluate perceptions and factors affecting the utilization of TT immunization among reproductive-age women in Dukem town, Eastern Ethiopia, 2016.MethodsWe conducted a community-based cross-sectional study from May to October 2016. A simple random sampling method was employed to select samples of 422 women. Data were collected using a, pretested semi-structured and a face-to-face interviewer-administered questionnaire. We entered data in to Epi Info version 7 and analyzed them by SPSS version 20 software. Odds ratios and a 95% CI at 0 < 0.05 p-value were calculated to ascertain the significance of associations.ResultsResponse rate was 98.6% (N = 416). Mean age with standard deviation was 29.25± 5.11 years, and average family size was 4.19. Our study showed the utilization of TT immunization was 39.2% (N = 163). Of the participants, 33.9% (N = 141) had never been vaccinated. ANC follow up service [AOR: 2.56, 95% CI: (1.18, 5.49)], distance from health facilities [AOR: 2.27, 95% CI: (1.27, 4.09)], knowing vaccination date [AOR: 1.98, 95% CI: (1.23, 3.18)], having a TV set in the house [AOR: 1.80, 95% CI: (1.11, 2.917)], maternal education [AOR: 1.41, 95% CI: (1.84, 2.30), and place of delivery [AOR: 1.19, 95% CI: (1.00, 1.43)] were factors significantly associated with the utilization of TT immunization.ConclusionsThis study indicated the utilization of TT immunization was low. ANC service follow up, distance from health facilities, knowing vaccination date, having a TV in the house, mothers’ educational status, and place of delivery were significant predictors. Our study suggests that policymakers and other stakeholders should consider the need for increasing access to maternal education, like basic adult education, ANC follow up services, providing accessible health facilities, improving varieties of communication media, promoting female occupational status, and providing appropriate vaccination cards.

Perception and utilization of tetanus toxoid immunization among pregnant women attending a tertiary centre in North-West Nigeria

“…5 While evidence from studies has shown that immunization of pregnant women or women of child bearing age with two or more doses of tetanus vaccine (TT2+) protects the mother and the newborn baby from tetanus (with 94% reduction in mortality from neonatal tetanus), and at least 80% TT2+ coverage is needed to achieve MNT elimination, 6,7 data from the Nigeria Demographic and Health Survey (NDHS) 2013 showed wide variation and predominantly low TT2+ coverage rates across the country, ranging from 27.1% in the North-West geopolitical zone of the country (the study area) to 82.0% in the South-East zone; and with a national TT2+ coverage rate of 48%. 4 Similar to the situation in Nigeria, studies conducted in other sub-Saharan African countries including Ethiopia, 8 Kenya, 9 and Benin Republic, 10 also established a direct association between health facility utilization by pregnant women (particularly antenatal clinic attendance) and acceptance of TTCV by them, as the ANC visits avail the healthcare providers the opportunity to educate them on the benefits of TT immunization and its schedule. While the concomitantly low utilization of health facility delivery services and low TT2+ coverage rate in North-West Nigeria is not surprising, it is alarming as it exposes the vulnerability of women and newborns in the zone to tetanus infection and the dire consequences.…”

“…Contrary to the findings in studies conducted in Nigeria, reports from studies conducted in other sub-Saharan African countries not only showed higher utilization of the mass media in sensitizing the public about TT immunization, but also established an association between owning a radio or television and TT2+ uptake. 8,10 These findings underscore the need for periodic and sustained sensitization of the populace about TT immunization through the mass media.…”

“…immunization among the respondents in this study (87.0%) is in consonance the with high levels of awareness of TT immunization in studies conducted in other cities in Nigeria including Lagos (89.0%), 18 and Benin City (69%), 19 it is substantially higher than the low level of awareness (30.6%) reported in a recent study conducted in Duken Town, Eastern Ethiopia. 8 This could be due to the efforts being made to eliminate MNT in Nigeria, being one of the countries where MNT is still a problem of public health importance in sub-Saharan Africa, unlike the situation in Ethiopia where the disease has been eliminated, and perhaps less attention is being given to it. It is therefore necessary to make the Government and other stakeholders in the countries where MNT has been eliminated know that promotion of TT immunization should be sustained to achieve at least 80% immunization coverage among pregnant women and women of child bearing age to be able to maintain the MNT elimination they have achieved in their respective countries (as recommended by the World Health Organization).…”

Tetanus toxoid immunization Coverage and associated factors in Ethiopia: A systematic review and meta-analysis.

“…In this review, primary studies with a total of 13,731 study participants were included. The studies were conducted from 2010 to 2020 and were retrieved from ve regions of the country: 4 from the southern region, 3 from Amahara, 3 from Oromia, 1 from Tigray, 1 from Somalia, and another study was based on EDHS data [34][35][36][37][38][39][40][41][42][43][44][45][46]. All of these studies included in this review were community-based cross-sectional studies with sample sizes ranging from 239 to 7193 participants as reported from studies done in Bahir Dar and studies from EDHS data respectively [34,39].…”

“…Three primary studies included in our meta-analysis reported that media exposure (TV, radio) was signi cantly associated with TT 2+ immunization [34,40,43]. To see the association between media exposure and tetanus toxoid vaccination coverage, 8,289 study participants were included in the analysis.…”