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

Abstract

Background Neonatal tetanus (NT) is a deadly nervous system disorder that is endemic to Afghanistan. Administering sufficient doses of tetanus toxoid containing vaccine (TTCV) during pregnancy can pass antibodies to the fetus and therefore prevent NT. Using survey data, we investigated the association between area of residence (urban or rural) and sufficient antenatal TTCV coverage among women aged 15–49 years in Afghanistan during their most recent pregnancy in the past 5 years that resulted in a live birth. Mother’s education level was also assessed as a potential effect modifier. Methods Secondary analysis was performed on data from the 2015 Afghanistan Demographic and Health Survey (AfDHS). The 2015 AfDHS was a nationally representative survey with participants selected in a stratified two-stage sample design from urban and rural areas across Afghanistan’s 34 provinces. Data were analyzed on 19,737 women ages 15–49 that had a live birth in the 5 years preceding the survey. The relationship between area of residence and sufficient antenatal TTCV was assessed in a multivariable logistic regression model, adjusting for several confounding variables. Results 55.1% (95% CI = 51.6–58.5%) of urban women and 53.9% (95% CI = 49.7–57.9%) of rural women had sufficient tetanus vaccination coverage in their most recent pregnancy. In multivariate analysis, there was strong evidence for greater odds of sufficient antenatal tetanus vaccination in rural areas (OR = 1.62; 95% CI = 1.18–2.24, p = 0.003). There was no effect modification on this association by mother’s education level. Conclusions Women in rural areas of Afghanistan have greater odds of receiving sufficient antenatal tetanus vaccination than women in urban areas. Further study into factors contributing to this urban-rural disparity is needed. Targeted antenatal tetanus vaccination strategies for urban and rural women will be necessary as Afghanistan continues to work towards NT eradication.

High rates of COVID-19 vaccine refusal among Afghan pregnant women: a cross sectional study

“…Studies indicated the coverage of full vaccination was low among mothers and children in Afghanistan, especially in remote areas 27 , 28 . Prolong conflict, lack of health essential knowledge, illiteracy, misinformation, and parental refusal are the key barriers to get the vaccination 29 .…”

Prevalence and determinants of antenatal tetanus vaccination in Sudan: a cross-sectional analysis of the Multiple Indicator Cluster Survey

“…Adequate tetanus vaccination among women of childbearing age was defined previously as either receiving two doses of tetanus toxoid vaccine in the last pregnancy, more than one dose within the latest 3 years of birth, more than two doses within the latest 5 years of birth, more than three doses within the latest within 10 years of birth, or more than four doses at any time [ 6 , 7 ]. Accordingly, the dependent variable (adequate tetanus vaccination) was coded as a binary (yes, no) for further analysis.…”

“…It has been estimated that antenatal tetanus vaccination can reduce neonatal mortality from tetanus by 94% [ 5 ]. For previously non-immunized adults or those with unknown immunization status, a total of five tetanus toxoid vaccine doses are recommended by the World Health Organization (WHO) to combat MNT [ 5 – 7 ]. Obtaining two doses of the tetanus toxoid vaccine is recommended during the first pregnancy.…”

“…The first dose is provided at first contact with healthcare services, and the second dose is provided 4 weeks later and at least 2 weeks before delivery. While the third dose should be given at least 6 months after the second, the last two boosters can be provided during succeeding pregnancies or at least 1 year later [ 6 , 7 ].…”

Maternal and Neonatal Tetanus Elimination: Where are We Now?

“…19,36,37 In Afghanistan, a conflict-ridden country with difficult terrain and gender bias, TTCV coverage was found to be insufficient in 46% of women; 38.1% of women did not receive any ANC. 38 The percentage of home deliveries in rural and urban Afghan women was 75% and 35%, respectively. 39 An audit from Guinea and another from Pakistan pointed towards association of NT with low TTCV coverage, poor ANC, and unhygienic cord care practices.…”