Tilahun Werkneh Melkie, Geremew Habtamu, Yohannes Abay Lamrot, Kebie Adugnaw Bantie, Simegn Mulat Belay
Department of Public Health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia.
College of Health Science, Oda Bultum University, Chiro, Ethiopia.
Front Glob Womens Health. 2025 Mar 13;6:1481771. doi: 10.3389/fgwh.2025.1481771. eCollection 2025.
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.
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 -value < 0.05 was used to declare significant factors.
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.
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.
孕期接种两剂或更多剂破伤风类毒素（TT）疫苗可使胎儿获得被动免疫，并将新生儿死亡率降低96%。在发展中国家，孕期使用TT疫苗的情况仍然不常见，但对公共卫生构成严重风险。因此，本研究旨在确定6个尚未消除孕产妇和新生儿破伤风的国家中孕妇充分接种TT疫苗的决定因素。
使用6个未实现消除孕产妇和新生儿破伤风目标国家的最新人口与健康调查数据集进行横断面研究。共纳入84248个加权样本。拟合了一个多水平逻辑回归模型。采用调整后的比值比及95%置信区间和P值<0.05来确定显著因素。
已婚[AOR = 1.36，CI：1.20，1.54]、最贫困[AOR = 1.46，CI：1.36，1.57]、较贫困[AOR = 1.48，CI：1.39，1.59]、中等[AOR = 1.33，CI：1.26，1.42]和较富裕[AOR = 1.19，CI：1.13，1.26]财富五分位数、24至30岁生育[AOR = 1.10，CI：1.04，1.16]、初产妇[AOR = 1.09；CI：1.02，1.17]、女性户主[AOR = 1.13；CI：1.06，1.20]、产前检查（ANC）4次及以上[AOR = 5.94，CI：5.60，6.30]、产后检查[AOR = 1.18，CI：1.13，1.23]以及机构分娩[AOR = 1.22，CI：1.18，1.27]与充分接种TT疫苗呈正相关。而失业[AOR = 0.68，CI：0.66，0.71]、健康机构就诊不佳[AOR = 0.72，CI：0.70，0.75]、流产[AOR = 0,89，CI：0.85，0.93]、社区媒体曝光率低[AOR = 0.74，CI：0.67，0.81]以及农村居住[AOR = 0.80，CI：0.77，0.84]是TT疫苗接种不足的显著风险因素。
婚姻状况、财富指数、初产年龄、妇女医疗保健决策、产次、户主性别、产前检查、产后检查、到医疗机构的距离以及医疗保险是充分接种TT疫苗的显著预测因素。因此，可通过促进孕产妇就业、改善流产后护理、媒体报道、社区识字率和医疗可及性，并鼓励孕妇接受产前检查和产后护理来改善TT疫苗接种情况。
