Non-protective immunity against tetanus in primiparous women and newborns at birth in rural and urban settings in Ibadan, Nigeria

Abstract

IntroductionNigeria remains among the few countries that are yet to achieve eradication of neonatal tetanus in the world despite the availability of an effective vaccine. This study investigated immunity against tetanus in primiparous mothers and neonates at birth, and identified associated factors.MethodsThis cross-sectional study involved consecutive selection of 244 primiparous mother-neonate pairs (119 from rural areas, 125 from urban areas, 137 male neonates and 107 female neonates) delivered at primary healthcare facilities in Ibadan, Nigeria. Socio-demographic characteristics, obstetric history, immunisation and birthweight were obtained from mothers by interview. A validated immunochromatographic rapid diagnostic test kit was used to test for immunity against tetanus. Positive and negative results were interpreted as protective immunity against tetanus (PIaT) and non-protective immunity against tetanus (NPIaT), respectively. Data were analysed using descriptive statistics, Chi-square and logistic regression at p = 0.05.ResultsThe mean age of mothers was 27.9±3.4 years (range: 20-33) and median birthweight was 2700g (range: 1760-3300). Of the 244 mothers, 198 (81.1%) received at least two doses of tetanus toxoid injection during pregnancy and prevalence of NPIaT and PIaT was 28.7% and 71.3%, respectively. The prevalence of PIaT was significantly higher among mothers in urban areas (n= 96; 80.7%) than rural (n=78; 62.4%), p<0.001.The prevalence of NPIaT among neonates was 36.5% (n= 89). Predictors of NPIaT among neonates were residence in rural LGA (OR = 2.22; 95% CI = 1.23-3.99) and maternal tetanus immunisation <2 doses (OR = 11.68; 95% CI = 4.05-21.75).ConclusionLack of protective immunity against tetanus among neonates of primiparous women in Ibadan is prevalent and a more conscientious enforcement of routine tetanus prevention practices is needed.

The association between area of residence and sufficient antenatal tetanus vaccination in women ages 15–49 in Afghanistan: an analysis of the 2015 DHS dataset

“…A secondary analysis of the 2005-06 India DHS found rural women were 48% less likely to receive antenatal TTCV than urban women (p < 0.001), although a woman was considered protected if she received even one TTCV dose [19]. A cross-sectional study of Nigerian women found those in rural areas had 2.5 greater odds of insufficient TTCV compared to urban women (p < 0.001) [20]. A multivariate analysis from Turkey found rural women actually had nearly four times greater odds of receiving at least one dose of antenatal TTCV compared to urban women (p < 0.001) [21], The researchers concluded that urban ANC providers administered less antenatal TTCV than rural ANC providers, as they felt their patients were at minimal risk for tetanus infection due to likely delivering in a hospital [21].…”

“…A secondary analysis of the 2005–06 India DHS found rural women were 48% less likely to receive antenatal TTCV than urban women ( p < 0.001), although a woman was considered protected if she received even one TTCV dose [ 19 ]. A cross-sectional study of Nigerian women found those in rural areas had 2.5 greater odds of insufficient TTCV compared to urban women ( p < 0.001) [ 20 ].…”

Coverage and determinants of protective dose tetanus toxoid vaccine among postnatal women delivered at university of Gondar comprehensive specialized hospital, northwest Ethiopia, 2019

“…Those women who reside in urban areas were 3.63 times more likely to have TT protective dose immunization as compared to their counterparts (AOR = 3.626, 95%CI: 1.510-8.707). Women whose Husbands' educational status of secondary [9][10][11][12] and college and above were 7.40 and 9.54 more likely took TT protective dose immunization as compared to never attended (AOR = 7.397, 95%CI: 1.873-29.211) (AOR = 9.539, 95%CI: 2.277-39.969) respectively. The odds of TT protective dose immunization were 3.98 times higher among mothers who stated that the provision of TT vaccine service was good" than their counterparts (AOR = 3.978, 95%CI 1.303-12.146).…”

“…9 A cross-sectional study conducted in Ibadan, Nigeria revealed that about 81.1% of mothers were taken at least two doses of TT vaccine. 10 Ethiopian demographic and health survey (EDHS 2016) report showed that the proportion of TT protective dose immunization was 49%. 11 A systematic review and Meta-analysis done on TT protective dose immunization in Ethiopia is also showed that about 52.6% of women were vaccinated during pregnancy at least twice.…”

“…12,[16][17][18][20][21][22] Another variable significantly associated with TT protective dose utilization was the number of antenatal care visits. 12,[16][17][18][19]23,24 Also, other variables such as residence, 10,14,15,23 center to far, 12,16,18,21 lack of knowledge on the benefit, 21,22,24,25 health staff attitude, 26 perceived good quality of service, 17 owing TV in the household, 18 joint health decision, 16 low income, 20,21 occupational status 22 were significantly associated with a utilization rate of TT protective dose vaccine. As our search is concerned, there is no study conducted on the study area about a protective dose of tetanus vaccine.…”