Factors Affecting Uptake of Tetanus Toxoid Vaccine among Women of Childbearing Age in Low-And-Middle-Income Countries: A Systematic Review

Tetanus is a life-threatening infection caused by Clostridium tetani, particularly affecting high-risk groups in low- and middle-income countries in sub-Saharan Africa, Africa, and Asia. This is often due to unhygienic birth practices. Vaccination with tetanus toxoid-containing vaccine during and around pregnancy provides protection. A literature review from 1995 to 2024 was conducted in PubMed/MEDLINE, African Journals Online, and Google Scholar following PRISMA guidelines to identify relevant publications. Thirteen studies met the inclusion criteria and were assessed for evidence quality using an expanded PRISMA checklist. The studies identified key factors influencing poor vaccination uptake among women of childbearing age, including age(25-35years: AOR; 0.510-0.925), marital status (Married: AOR; 0.400-1.038), parity (3-4 Children: AOR; 0.200-5.050), antenatal care visits (Four or more: AOR; 0.048-1.710), place of delivery (Health facility: AOR; 1.130-23.380), distance to health facilities (<30 minutes: AOR;1.050-4.600), media exposure (Yes: AOR;1.968-2.820), wealth index (Rich: AOR; 0.630-7.230 or poor), educational level (Secondary: AOR; 0.600-6.200), and knowledge of tetanus and the vaccine (Yes: AOR; 0.900-3.450). Health education, engagement of women, and targeted vaccination of high-risk groups are essential strategies to improve vaccination rates.

Tetanus toxoid containing vaccine

1. Aboagye, R.G., Amu, H., Dowon, R.K., Bansah, P., Oaikhena, I.O., Bain, L.E., (2023). Prevalence and correlates of tetanus toxoid uptake among women in sub-Saharan Africa: multilevel analysis of demographic and health survey data. PLOS ONE; 18(12): e0296172. https://doi.org/10.1371/journal.pone.0298174 [Google Scholar] [Crossref]

2. Anatea, M. D., Mekonnen, T. H., Dachew, B. A., (2018). Determinants and perceptions of the utilization of tetanus toxoid immunization among reproductive-age women in Dukem Town, Eastern Ethiopia: a community-based cross-sectional study. Biomedical Centre for International Health and Human Rights; 18: 27 – 36. https://doi.org/10.1186/s12914-018-0168-0 [Google Scholar] [Crossref]

3. Barrow, A., Barrow, S., Jobe, A., (2022). Differentials in prevalence and correlates on uptake of tetanus toxoid and intermittent preventive treatment with sulfadoxine-pyrimethamine during pregnancy: A community-based cross-sectional study in The Gambia. SAGE Open Medicine; 10: 1 – 12. [Google Scholar] [Crossref]

4. Belay, A. T., Fenta, S. M., Agegn, S. B., Muluneh, M. W., (2022). Prevalence and risk factors associated with rural women’s protected against tetanus in East Africa: Evidence from demographic and health surveys of ten East African countries. PLOS ONE; 17(3): 1 – 15. https://doi.org/10.1371/journal.pone.0265906 [Google Scholar] [Crossref]

5. Deming MS, Roungou J-B, Kristiansen M, Heron I, Yango A, Guenengafo A, et al. Tetanus toxoid coverage as an indicator of serological protection against neonatal tetanus. Bulletin of the World Health Organization. 2002; 80:696–703. [Google Scholar] [Crossref]

6. El-Adham, A. F., El-Nagar, A. E., Hashem, S. M., (2022). Determinants of tetanus toxoid vaccination use among pregnant women. Tanta Scientific Nursing Journal; 27(4): 30 – 52. [Google Scholar] [Crossref]

7. Fenta, S. M., Fenta, H. M., (2023). Magnitude of Tetanus Toxoid Immunization and Associated Factors among Pregnant Women in Ethiopia. The Open Public Health Journal; 16: 1 – 10. [Google Scholar] [Crossref]

8. Gashaw, A., Hunie, M., Amare, E., Zewdie, A., Abebe, M., Demeke, M., Kefelegn, S., Yehualashet, D., Alemu, A., Adamu, Y., Gugsa, T., Tagele, A., (2023). Proportion of births protected against neonatal tetanus and its associated factors among mothers who gave birth within the past 6 months in Gozamn district, Northwest Ethiopia, 2022. Human Vaccines and Immunotherapeutics; 19: 2 – 10. https://doi.org/10.1080/21645515.2023.2223066 [Google Scholar] [Crossref]

9. Gebremedhin, T. S., Welay, F. T., Mengesha, M. B., Assefa, N. E., Werid, W. M., (2020). Tetanus toxoid vaccination uptake and associated factors among mothers who gave birth in the last 12 months in Errer District, Somali Regional State, Eastern Ethiopia. Biomedical Research International: 1 – 8. https://doi.org/10.1155/2020/4023031 [Google Scholar] [Crossref]

10. Giles, M. L.., Mantel, C., Munoz, F. M., Moran, A., Yusuf, N., Diaz, T., Ahun, M., Nic Lochlainn, L. M., Wootton, E., Pathirana, J., Rendell, S., Tuncalp, O., Perut, M., Hombach, J., Merten, S., Lambach, P., (2020). Vaccine implementation factors affecting maternal tetanus immunization in low- and middle-income countries: Results of the Maternal Immunization and Antenatal Care Situational Analysis (MIACSA) project. Vaccine; 38: 5268 – 5277. https://doi.org/10.1016/j.vaccine.2020.05.084 [Google Scholar] [Crossref]

11. Ibrahim, Z. A., Sabahelzain, M. M., Elhadi, Y. A. M., Malande, O. O., Babiker, S. (2023). Predictors of tetanus vaccine uptake among pregnant women in Khartoum State, Sudan: A hospital-based cross-sectional study. Vaccines; 11: 1268 – 1276. https://doi.org/10.3390/vaccines11071268 [Google Scholar] [Crossref]

12. Madubueze, U. C., Una, A. F. I., Okedo-Alex, I. N., Agha, V. M., Umeokonkwo, C. D., Eze, I. I., Utulu, R., Okeke, K. C., Agbo, U. N., Nwobashi, L. N., Alo, C., Azuogu, B. N., (2022). Awareness, knowledge, risk perception and uptake of maternal vaccination in rural communities of Ebonyi State, Nigeria. African Health Sciences; 22(2): 306 – 317. https://dx.doi.org/10.4314/ahs.v22i4.36 [Google Scholar] [Crossref]

13. Mehanna, A. A. (2021). Recommendation of tetanus toxoid vaccination for pregnant females in a country that achieved elimination of maternal and neonatal tetanus. a commentary on the study: Knowledge and health beliefs of reproductive-age women in Alexandria about tetanus toxoid immunization. Archives of Obstetrics and Gynaecology; 2(1): 5 – 8. [Google Scholar] [Crossref]

14. Mehanna, A., Ali, M. H., Kharboush, I., (2020). Knowledge and health beliefs of reproductive-age women in Alexandria about tetanus toxoid immunization. Journal of the Egyptian Public Health Association; 95: 22 – 33. https://doi.org/10.1186/s42506-020-00049-8 [Google Scholar] [Crossref]

15. Mohammed, S. O. O., Ahmed, E. M., (2022). Prevalence and determinants of antenatal tetanus vaccination in Sudan: a cross‑sectional analysis of the Multiple Indicator Cluster Survey. Tropical Medicine and Health; 50: 7 – 13. https://doi.org/10.1186/s41182-022-00398-4 [Google Scholar] [Crossref]

16. Morhason-Bello, I., Kareem, Y. O., Illah, O., Akinyemi, J. O., Abdus-salam, R., Lawal, O., Bellow, O., Obajini, G., Adewole, I. F., (2022). Factors Associated with the Uptake of Antenatal Tetanus Toxoids Containing Vaccine by First-Time Mothers in Nigeria: Findings from the 2018 Nigerian Demographic Health Survey. Journal of Pregnancy: 1 – 12. https://doi.org/10.1155/2022/7607993 [Google Scholar] [Crossref]

17. Muhammad-Idris, Z., Shehu, A., Isa, F., (2017). “Assessment of tetanus toxoid coverage among women of reproductive age in Kwarbai, Zaria,” Archives of Medicine and Surgery; 2(2): 48–54. [Google Scholar] [Crossref]

18. Ngussie, J., Girma, B., Molla, A., Mareg, M., (2021). Tetanus Toxoid vaccination coverage and associated factors among child bearing women in Ethiopia: A systematic Review and meta-analysis; BioMedical Research International; 5529315: 10 pages. https://doi.org/10.1155/2021/5529315. [Google Scholar] [Crossref]

19. Nguyen TD, Dang AD, Van Damme P, Nguyen CV, Duong HT, Goossens H, et al. (2015). Coverage of the expanded program on immunization in Vietnam: results from 2 cluster surveys and routine reports. Human Vaccine Immunotherapy; 11:1526–33. [Google Scholar] [Crossref]

20. Raja, S., Mehraj, J., Guriro, S., Shaikh, M. A., (2019). Factors Contributing to Low Tetanus Toxoid Vaccination Coverage among Young Adult Women in Khairpur District, Sindh. Indian Journal of Science and Technology; 12(34):1 – 7. [Google Scholar] [Crossref]

21. Teshale, A.B., Tesema, B.A., (2020). “Determinants of births protected against neonatal tetanus in Ethiopia: a multilevel analysis using EDHS 2016 data,” PLoS One; 15(12): e0243071. [Google Scholar] [Crossref]

22. Tungaraza, M. B., Moshi, F. V., (2020). Predictors for uptake of tetanus toxoid vaccination during pregnancy among women of reproductive age in Tanzania; An analysis of data from the 2015- 16 Tanzania Demographic and Health Survey and Malaria Indicators Survey. Research Square: 1 – 11. [Google Scholar] [Crossref]

23. Vouking, M. Z., Tadenfok, C. N., Ekani, J. M. E., (2017). Strategies to increase immunization coverage of tetanus vaccine among women in Sub Saharan Africa: a systematic review. The Pan African Medical Journal; 27(3): 25 – 28. http://www.panafrican-med-journal.com/content/series/27/3/25/full [Google Scholar] [Crossref]

24. World Health Organization (2018). Tetanus vaccines: WHO position paper, February 2017—Recommendations. Vaccine 2018; 36: 3573–3575. [Google Scholar] [Crossref]

25. Yaya, S., Kota, K., Buh, A., Bishwajit, G., (2020). Prevalence and predictors of taking tetanus toxoid vaccine in pregnancy: a cross sectional study of 8,722 women in Sierra Leone. Biomedical Centre for Public Health; 20: 855 – 864. https://doi.org/10.1186/s12889-020-08985-y [Google Scholar] [Crossref]

26. Yusuf, N., Raza, A. A., Chang-Blanc, D., Ahmed, B., Hailegebriel, T., Luce, R. R., Tanifum, P., Masresha, B., Faton, M., Omer, M. D., Farrukh, A., Aung, K. D., Scobie, M., Tohme, R. A., (2021). Progress and barriers towards maternal and neonatal tetanus elimination in the remaining 12 countries. Lancet Global Health; 9: 1610 – 1617. [Google Scholar] [Crossref]

• Tribal Child Nutrition and Health in District of Sundargarh: A Public Health Review of ICDS Intervention
• Knowledge, Attitudes and Practices Towards Prostate Cancer Screening Amongst Men Aged 40-60 Years in The Buea Health District: A Cross-Sectional Study
• Compliance with JCI Protocols: A Focus on Employee Safety
• Influence and Involvement of Teachers in Menstrual Hygiene Management of Female Secondary School Students in Kogi State, Nigeria
• A Critical Evaluation of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana in Bihar