Abstract
Background Tetanus is a bacterial disease caused by the Clostridium tetani, which is a highly fatal, noncommunicable, and toxin-mediated disease. Globally, maternal and neonatal tetanus is a public health problem due to low maternal tetanus toxoid immunization. Ethiopia has the highest neonatal mortality and morbidity related to tetanus due to low tetanus toxoid immunization and the high number of home deliveries. The main objective of this systematic review and meta-analysis was to estimate the pooled coverage of at least two doses of tetanus toxoid immunization, and the pooled effect sizes of associated factors in Ethiopia. Methods Primary studies for this review were searched from the PubMed/MEDLINE online, ScienceDirect, Hinari, Google, and Google Scholar databases. Primary articles published from 2010 up to August 30, 2020, were included in this meta-analysis. Data were extracted in Microsoft Excel format and exported to STATA Version 14.0. A random-effects meta-analysis model was used to estimate the pooled coverage of two or more tetanus toxoid immunizations and its associated factors. Heterogeneity was evaluated by the I2 test. Egger's weighted regression test was used to assess publication bias. Results We retrieved 212 records; of these, 199 articles were excluded for reasons. Finally, 14 studies were included in this meta-analysis. The pooled estimate of receiving at least two doses of tetanus toxoid immunization coverage in Ethiopia was 52.2% (95% CI: 42.47-61.93, I2 = 98.4%). Antenatal care (OR = 7.8 (95% CI: 3.2, 19.2), I2 = 96.3%), media exposure (OR = 8.3 (95% CI: 2.1, 33.3), I2 = 98.1%), distance from the health facility (OR = 2.64 (95% CI: 1.1, 6.6), I2 = 94.1%), educational status of women (OR = 4.7 (95% CI: 2.07, 9.56), I2 = 94.2%), and educational status of husbands (OR = 2.995 (95% CI: 1.194, 7.512), I2 = 92.5%) were factors significantly associated with receiving at least two doses of tetanus toxoid immunization coverage in Ethiopia. Conclusions The coverage of tetanus toxoid immunization among childbearing women was low in Ethiopia. Strengthening maternal health service utilization (antinatal care and institutional delivery) to the nearest health facility even in health posts and empowering education for both women and their husbands is recommended to increase tetanus toxoid immunization coverage in Ethiopia.
Highlights
Tetanus is a bacterial disease caused by the Clostridium tetani, which is a highly fatal, noncommunicable, and toxin-mediated disease [1, 2]
The World Health Organization (WHO) report showed that 90% of maternal and neonatal tetanus occurred in South East Asian (SEA) and SubSaharan African (SSA) countries, and almost all cases end with death [11]
Cross-sectional and case-control studies with original data reporting the coverage of TT2+ immunization and/or its associated factors among childbearing women in Ethiopia published from 2010 to 2020 were included (The authors were interested to show the coverage of TT2+ for 10 years since maternal health service utilization assumed to be improved in the last 10 years according to the government reports)
Summary
Tetanus is a bacterial disease caused by the Clostridium tetani, which is a highly fatal, noncommunicable, and toxin-mediated disease [1, 2]. Ethiopia has the highest neonatal mortality and morbidity related to tetanus due to low tetanus toxoid immunization and the high number of home deliveries. The main objective of this systematic review and meta-analysis was to estimate the pooled coverage of at least two doses of tetanus toxoid immunization, and the pooled effect sizes of associated factors in Ethiopia. Antenatal care (OR = 7:8 (95% CI: 3.2, 19.2), I2 = 96:3%), media exposure (OR = 8:3 (95% CI: 2.1, 33.3), I2 = 98:1%), distance from the health facility (OR = 2:64 (95% CI: 1.1, 6.6), I2 = 94:1%), educational status of women (OR = 4:7 (95% CI: 2.07, 9.56), I2 = 94:2%), and educational status of husbands (OR = 2:995 (95% CI: 1.194, 7.512), I2 = 92:5%) were factors significantly associated with receiving at least two doses of tetanus toxoid immunization coverage in Ethiopia. Strengthening maternal health service utilization (antinatal care and institutional delivery) to the nearest health facility even in health posts and empowering education for both women and their husbands is recommended to increase tetanus toxoid immunization coverage in Ethiopia
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