Individual and community-level determinants of poor tetanus toxoid immunization among pregnant women in Ethiopia using data from 2016 Ethiopian demographic and health survey; multilevel analysis

Alemneh Mekuriaw Liyew,Hiwotie Getaneh Ayalew

doi:10.1186/s13690-021-00622-3

Alemneh Mekuriaw Liyew, Hiwotie Getaneh Ayalew

Open Access

https://doi.org/10.1186/s13690-021-00622-3

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Abstract

BackgroundTetanus is a vaccine-preventable disease that can occur in all populations, with neonates and pregnant women being at the most risk. Ethiopia has the highest maternal and neonatal tetanus morbidity and mortality rates. Besides, only 49% of mothers get vaccinated with adequate tetanus toxoid in Ethiopia which is below the world health organization recommendation. To date, there is limited evidence on the individual and community level determinants of poor tetanus toxoid (TT) immunization. Therefore, this study aimed to assess individual and community-level factors associated with poor TT immunization coverage in Ethiopia.MethodSecondary data analysis was conducted using the 2016 Ethiopian demographic and health survey. A total of 7043 pregnant women were included in the current study. A multilevel logistic regression model was used to identify individual and community level determinants of poor tetanus toxoid immunization. Finally, the adjusted odds ratio with a 95% confidence interval was reported.ResultsIn the multilevel logistic regression model adjustment, having no Antenatal care visit (AOR = 5.64; 95% CI:2.48,7.30) and having one to three antenatal care visit (AOR = 1.50; 95% CI: 1.19–1.82); poor wealth index (AOR = 1.26; 95% CI: 1.03, 1.54); not being exposed to media (AOR = 1.29; 95% CI: 1.10, 1.51); maternal unemployment (AOR = 1.15; 95% CI: 1.10, 1.31); rural residence (AOR = 1.13; 95% CI: 1.08, 1.72); and high community illiteracy (AOR = 1.28; 95% CI: 1.03, 1.58) were associated with higher odds of poor tetanus toxoid immunization. Whereas, iron uptake during pregnancy (AOR = 0.59; 95% CI: 0.51, 0.68), was associated with lower odds of poor tetanus toxoid immunization.ConclusionIn this study tetanus toxoid (TT) vaccine utilization was affected by both community and individual-level factors. Therefore, focusing on antenatal care services especially encouraging pregnant women to have at least four visits, consulting women to be exposed to media, improving community literacy and maternal employment will help to minimize TT underutilization.

Highlights

Tetanus is a vaccine-preventable disease that can occur in all populations, with neonates and pregnant women being at the most risk
In this study tetanus toxoid (TT) vaccine utilization was affected by both community and individuallevel factors
Focusing on antenatal care services especially encouraging pregnant women to have at least four visits, consulting women to be exposed to media, improving community literacy and maternal employment will help to minimize TT underutilization

Summary

Introduction

Tetanus is a vaccine-preventable disease that can occur in all populations, with neonates and pregnant women being at the most risk. Ethiopia has the highest maternal and neonatal tetanus morbidity and mortality rates. Only 49% of mothers get vaccinated with adequate tetanus toxoid in Ethiopia which is below the world health organization recommendation. There is limited evidence on the individual and community level determinants of poor tetanus toxoid (TT) immunization. Tetanus is a life-threatening bacterial disease caused by spores of Clostridium tetani found throughout the world [1]. It is common in areas of poor hygiene, the most disadvantaged, economically poor, and without access to adequate health services [2]. Even though there is a great stride in the reduction of maternal and neonatal mortality through maternal and neonatal tetanus elimination initiatives, Ethiopia is among 21 countries that had not yet attained the elimination of the disease [6]

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