Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Department of Community Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
BMC Pregnancy Childbirth. 2023 Oct 23;23(1):745. doi: 10.1186/s12884-023-05911-z.
Tetanus is a major public health problem caused by clostridium tetani. Although it is vaccine-preventable, the case fatality rate among neonates in areas with poor immunization coverage and limited access to clean deliveries reaches 80-100%. Vaccination of pregnant mothers with the tetanus toxoid (TT) vaccine is the most effective way to protect against neonatal tetanus. This study aimed to examine the spatial distribution and determinants of tetanus toxoid immunization among pregnant mothers using the 2016 EDHS data.
Secondary analysis of the Ethiopia Demographic and Health Survey 2016 was done to assess the spatial distribution and determinants of tetanus toxoid vaccine among pregnant women in Ethiopia. Spatial autocorrelation analysis and hot spot analysis were used to detect spatial dependency and spatial clustering of the tetanus toxoid vaccine in Ethiopia. Spatial interpolation was used to predict the tetanus toxoid vaccine coverage in unsampled areas. The multilevel binary logistic regression model was fitted to identify factors associated with tetanus toxoid vaccination. An adjusted odds ratio with 95% CI was calculated and used as the measure of association and a p-value less than 0.05 were considered statistically significant.
From the total of 7043 pregnant women, 42.4% of them have taken at least two doses of tetanus toxoid immunization. Spatial clustering of TT immunization was observed in the Northern, Southwestern and Southwestern parts of Ethiopia. Whereas, low TT coverage was observed in the Eastern and Western parts of the country. Increased ANC visits and the richest economic status favored TT immunization, whereas living in Addis Ababa and Dire Dewa cities decreased the TT immunization coverage.
The finding of this study reveals that TT immunization had spatial dependency, with the highest immunization coverage observed in the Northern, Southwestern and Southeastern parts of the Country. Thus, geographically targeted interventions should be implemented particularly in the eastern and western parts of the country.
破伤风是由梭状芽孢杆菌引起的主要公共卫生问题。尽管它可以通过疫苗预防，但在免疫覆盖率低且清洁分娩机会有限的地区，新生儿的病死率仍高达 80-100%。为新生儿预防破伤风的最有效方法是为孕妇接种破伤风类毒素（TT）疫苗。本研究旨在使用 2016 年 EDHS 数据，检查孕妇破伤风类毒素免疫的空间分布和决定因素。
对 2016 年埃塞俄比亚人口与健康调查进行二次分析，以评估破伤风类毒素疫苗在埃塞俄比亚孕妇中的空间分布和决定因素。空间自相关分析和热点分析用于检测埃塞俄比亚破伤风类毒素疫苗的空间依赖性和空间聚类。空间插值用于预测未抽样地区的破伤风类毒素疫苗覆盖率。使用多水平二元逻辑回归模型来确定与破伤风类毒素接种相关的因素。计算调整后的比值比（95%CI）作为关联的度量，并将 p 值<0.05 视为具有统计学意义。
在总共 7043 名孕妇中，有 42.4%的孕妇至少接受了两剂破伤风类毒素免疫。在埃塞俄比亚的北部、西南部和西南部观察到 TT 免疫的空间聚类。然而，在该国的东部和西部观察到低 TT 覆盖率。增加 ANC 就诊次数和最富裕的经济地位有利于 TT 免疫，而居住在亚的斯亚贝巴和 Dire Dewa 市则降低了 TT 免疫覆盖率。
本研究的结果表明，TT 免疫具有空间依赖性，该国北部、西南部和东南部地区的免疫覆盖率最高。因此，应在该国的东部和西部实施具有地域针对性的干预措施。
