Perry H, Weierbach R, Hossain I, Islam R
MCH-FP Extension Project (Urban), International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
Bull World Health Organ. 1998;76(5):449-57.
Neonatal tetanus is still an important public health problem in both urban and rural Bangladesh, with an estimated 41,000 cases occurring annually. This article analyses the coverage of tetanus toxoid (TT) immunizations among women of reproductive age in Zone 3 of Dhaka City in 1995. Although 85% of women with a child under 1 year of age had received two TT immunizations, only 11% of women of reproductive age had obtained the complete series of five TT immunizations and only 52% of women of reproductive age had received one or more TT immunizations. Access to TT immunization, as defined by having had at least one such immunization, was lower among women aged over 30 years and also among those aged under 20 years, especially those who were not yet married or who had not yet become pregnant. Characteristics associated with TT immunization status included the following: educational level of the woman, distance from the nearest immunization centre, and level of contact with family planning field workers. Additional characteristics that influenced women's TT immunization status included age, marital and working status, recency of migration from rural to urban area, and number of children. The relationships were complex and varied depending on the number of TT immunizations received (one or two) and on the type of analysis being carried out (bivariate or multivariate). The findings point to the need for a broad-based campaign to promote access to TT immunization as well as to promote the completion of all five TT doses in Bangladesh. Reducing missed opportunities for promotion of immunization as well as targeting home visitation of women in need of additional immunizations constitute further approaches to improving coverage. Although TT coverage rates were only marginally lower among women in slum households, such women were more likely than those in non-slum households to be pregnant and hence more likely to bear a baby at risk of neonatal tetanus. Furthermore, the environment of slum households, where deliveries normally take place, is more conducive to the development of neonatal tetanus among unprotected neonates; a strategy of focusing on slum households is therefore also needed.
新生儿破伤风在孟加拉国城乡仍是一个重要的公共卫生问题，估计每年有41000例病例。本文分析了1995年达卡市第3区育龄妇女破伤风类毒素（TT）免疫接种的覆盖率。虽然85%有1岁以下孩子的妇女接受了两次TT免疫接种，但只有11%的育龄妇女完成了全部五次TT免疫接种，只有52%的育龄妇女接受过一次或多次TT免疫接种。按照至少接受过一次此类免疫接种的定义，30岁以上的妇女以及20岁以下的妇女，尤其是未婚或未怀孕的妇女，获得TT免疫接种的机会较低。与TT免疫接种状况相关的特征包括：妇女的教育水平、与最近免疫接种中心的距离以及与计划生育现场工作人员的接触程度。影响妇女TT免疫接种状况的其他特征包括年龄、婚姻和工作状况、从农村到城市地区的最近迁移情况以及子女数量。这些关系很复杂，取决于接受的TT免疫接种次数（一次或两次）以及所进行的分析类型（双变量或多变量）。研究结果表明，在孟加拉国需要开展一项基础广泛的运动，以促进获得TT免疫接种，并促进完成全部五次TT剂量的接种。减少免疫接种推广的错失机会以及针对需要额外免疫接种的妇女进行家访是提高覆盖率的进一步方法。虽然贫民窟家庭妇女的TT覆盖率仅略低，但这类妇女比非贫民窟家庭妇女更有可能怀孕，因此更有可能生下有新生儿破伤风风险的婴儿。此外，通常在贫民窟家庭进行分娩，这种环境更有利于未受保护的新生儿发生新生儿破伤风；因此还需要一项关注贫民窟家庭的战略。
