A Facility-Based Survey of Maternal Anti-Tetanus Vaccination Schedule Completion in a Nigerian University Community
Keywords:Antenatal Care, Communication, Neonatal Tetanus, Tetanus Toxoid, Vaccination
Background: Maternal anti-tetanus vaccination is required to prevent maternal and neonatal tetanus. In the absence of lifetime protective dosing, repeat vaccination in every new pregnancy is needed to achieve protection of the newborn against tetanus.
Objectives: To determine maternal anti-tetanus vaccination schedule completion rates and the reasons for non-completion of the schedule.
Methods: This cross-sectional survey was conducted among Nigerian antenatal clinic attendees using an interviewee-administered questionnaire.
Results: Most (291/347; 83.9%) respondents had received a TT vaccine in the index pregnancy, and 280/347 (80.7%) received their first TT injection at the booking visit. In comparison, 202/238 (84.9%) of those eligible had received tetanus toxoid protective immunisation (TTPDI) in the index pregnancy. Although a majority (301/347; 86.7%) of the respondents had received at least a dose of TT in a previous pregnancy, only 23/246 (9.3%) eligible pregnant women had received complete vaccination (TT5) Parity (p<0.001) and ethnicity (0.013) were the main determinants of the maternal tetanus vaccination schedule (TT5) completion. However, the socio-demographic characteristics were similar for TTPDI. The commonest reason for non-completion was forgetfulness 172/218 (78.9%), and most (287/347; 89.1%) of the respondents wished to receive telephone reminders.
Conclusions: Although neonatal tetanus protective dosing of TT in the current pregnancy was high, a low proportion of mothers completed the five doses recommended by the WHO for lifetime immunity.
You D, Wardlaw T, Salama T, Jones G. Levels and trends in under -5 mortality, 1990-2008. The Lancet. 2010; 375: 100–103. https://doi.org/10.1016/S0140-6736(09)61601-9
Martines J, Paul V, Bhutta Z, Koblinsky M, Soucat A, Walker N, et al. Neonatal survival: a call for action. The Lancet 2005; 365: 1189–1197. https://doi.org/10.1016/S0140-6736(05)71882-1
Yaguo I, Uchenna-Onyenegecha T. Tetanus in Nigeria: Is the end in sight? Greener J Med Sci 2015; 5: 053–057. http://doi.org/10.15580/GJMS.2015.3.052615076
Blencowe H, Lawn J, Vandelaer J, Roper M, Cousens S. Tetanus toxoid immunisation to reduce mortality from neonatal tetanus. Int J Epidemiol 2010; 39: 102–109. https://doi.org/10.1093/ije/dyq027
Harmmalund E, Thomas A, Poore E, Amanna I, Rynko A, Mori M, et al. Durability of Vaccine-Induced Immunity Against Tetanus and Diphtheria Toxins: A Cross-sectional Analysis. Clin Infect Dis 2016; 62: 1111–1118. https://doi.org/10.1093/cid/ciw066
Kyu H, Mumford J, Stanaway J, Barber R, Hancock J, Vos T, et al. Mortality from tetanus between 1990 and 2015: findings from the global burden of disease study. BMC Public Health 2017; 17: 179. https://doi.org/10. 1186/ s12889- 017- 4111-4.
World Health Organization. Vaccine-Preventable Diseases: Monitoring System 2010 Global Summary. Immunisation, Vaccines and Biologicals. Geneva: WHO; 2010 [cited 2019 Jun 22]. Available from: http://whqlibdoc.who.int/hq/2010/WHO_IVB_2010_eng.pdf
National Population Commission [Nigeria], ICF International. Nigeria Demographic and Health Survey 2018. Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF International. Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF International.; 2019. National Population Commission; 2019 p. 1–20.
World Health Organization. Maternal and neonatal tetanus elimination: a programmatic update. Geneva, Switzerland: World Health Organization; 2021. Available from: https://www.who.int/initiatives/maternal-and-neonatal-tetanuselimination-( mnte)/programmatic-update
World Health Organisation. Maternal immunisation against tetanus: integrated management of pregnancy and childbirth (IMPAC). Standards for maternal and neonatal care1.Geneva: Department of Making Pregnancy Safer. Geneva: WHO; 2006. Available from: http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/immunization_tetanus.pdf
World Health Organisation. Maternal and Neonatal Tetanus (MNT) Elimination. Geneva; 2015. Available from: www.who.int/immunization/diseases/MNTE-initiative/en/
National Population Commission [Nigeria], ICF International. Nigeria Demographic and Health Survey 2013. Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF International. Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF International; 2014.
Wolfson L, Gasse F, Lee-Martin S, Lydon P, Magan A, Tibouti A, et al. Estimating the cost of achieving the WHO-UNICEF Global Immunization Vision and Strategy, 2006-2015. Bull World Health Organ. 2008; 86: 27–39. https://doi.org/10.2471/blt.7.045096
Oyo-Ita A, Wiysonge C, Origanje C, Nwachukwu C, Oduwole O, Meremikwu M. Interventions for improving coverage of childhood immunisation in low-and middle-income countries. Cochrane Database Syst Rev 2016; 7(7): CD008145. https://doi.org/10.1002/14651858.CD008145.pub3
Ekhaguere O, Oluwafemi R, Badejoko B, Oyeneyin L, Butali A, Lowenthal E, et al. Automated phone call and text reminders for childhood immunisations (PRIMM): a randomised controlled trial in Nigeria. BMJ Glob Health 2019; 4: e001232. http://dx.doi.org/10.1136/bmjgh-2018-001232
Agbede C, Aja G, Owolabi P. Factors Influencing Pregnant Women's Utilisation of Maternal Health Care Services for Delivery in Ogun State, Nigeria. Glob J Sci Front Res 2015; 15: 16–22.
Kish L. Survey Sampling. New York: Wiley and Sons. Inc.; 1965.
Enuku C, Orru O. Awareness of tetanus toxoid vaccination by pregnant women attending antenatal clinic in Central Hospital, Benin City. J Sci Pract Pharm 2016; 3: 92–96.
Mihret M, Limenih M, Gudayu T. The role of timely initiation of antenatal care on protective dose tetanus toxoid immunisation: the case of northern Ethiopia postnatal mothers. BMC Preg Childbirth 2018; 18: 235. https://doi.org/10.1186/s12884-018-1878-y
Adegboye O, Adeboye M, Anoba S. Childhood tetanus; still a public health concern: A review of 95 cases. Savannah J Med Res Pract 2012; 1: 20–24.
Alhaji M, Bello M, Elechi H, Akuhwa R, Bukar F, Ibrahim H. A review of neonatal tetanus in University of Maiduguri Teaching Hospital North-eastern Nigeria. Niger Med J 2013; 54: 398–401.
Babatunde O, Adebara V, Atoyebi O, Oluwagbemi O. Neonatal tetanus in Federal Medical Center, Ido-Ekiti, Southwest Nigeria in a five-year retrospective study. Glob J Med Sci. 2014; 4: 42–47. https://doi.org/10.15580/GJMS.2014.2.062014273
Sule S, Nkem-Uchendu C, Onajole A, Ogunowo B. Awareness, perception and coverage of tetanus immunisation in women of childbearing age in an urban district of Lagos, Nigeria. Niger Postgrad Med J 2014; 21: 107–114.
Orimadegun A, Adepoju A, Akinyinka O. Prevalence and socio-demographic factors associated with non-protective immunity against tetanus among high school adolescent girls in Nigeria. Ital J Pediatr 2014; 40: 1–8. https://doi.org/10.1186/1824-7288-40-29
Nwokeukwu H, Ukegbu A, Emma-Ukaegbu U, Nwogu K, Nwankwo N, Osunkwo D, et al. Tetanus Toxoid Immunization Coverage in Federal Medical Centre, Umuahia, Abia State, Southeast Zone, Nigeria. Int J Trop Dis Health 2014; 4: 1268–1277. https://doi.org/10.9734/IJTDH/2014/12189
Muhammad-Idris Z, Shehu A, Isa F. Assessment of tetanus toxoid coverage among women of reproductive age in Kwarbai, Zaria. Arch Med Surg 2017; 2: 48–54. https://doi.org/10.4103/archms.archms_43_17
Maral I, Baykan Z, Aksakal F, Kayikcioglu F, Burnin M. Tetanus immunisation in pregnant women: evaluation of maternal tetanus vaccination status and factors affecting rate of vaccination coverage. Public Health 2001; 115: 359–364. https://doi.org/10.1038/sj/ph/1900780
Diamenu S, Bosnu G, Abotsi F, Tweneboa P, Okoh-Owusu M, Amoh P, et al. Introducing protection at birth (Pab) method of monitoring tetanus-diphtheria (td) vaccination coverage of mothers in Ghana. Int J Vaccines Immun 2015; 1(1). https://dx.doi.org/10.16966/2470-9948.102
Ethiopia Central Statistical Agency. Ethiopia Demographic and Health Survey 2011. Calverton: ICF International [Internet]. 2012. Available from: https://dhsprogram.com>pdf
Hashmi F, Islam M, Khan T, Tipu M. Vaccination coverage of mothers during pregnancy with tetanus toxoid and infants after Birth. Pak J Pharm 2011; 24: 1–3.
Yaya S, Kota K, Buh A, Bishwajit G. Prevalence and predictors of taking tetanus toxoid vaccine in pregnancy: a cross-sectional study of 8,722 women in Sierra Leone. BMC Public Health 2020; 20(855). https://doi.org/10.1186/s12889-020-08985-y
Qadir M, Murad R, Mumtaz S, Azmi A, Rehman R, Hani O, et al. Frequency of tetanus toxoid immunisation among college/university female students of Karachi. J Ayub Med Coll Abbottabad 2010; 22: 147–149.
Messeret E, Masresha B, Yakubu A, Daniel F, Okeibunor J, Akanmori B. Maternal and Neonatal Tetanus Elimination (MNTE) in The WHO African Region. J Immunol Sci 2018; 2 Suppl: 103–107.
Haile Z, Chertok I, Tewelderberhan A. Determinants of utilisation of sufficient tetanus toxoid immunisation during pregnancy: evidence from the Kenya demographic and health survey, 2008–2009. J Community Health 2013; 38: 492–499. https://doi.org/10.1007/s10900-012-9638-9
Edward B. Factors influencing the utilisation of antenatal care content in Uganda. Australas Med J 2011; 4:516–526. https//dx.doi.org/10.4066/AMJ.2011.849
Abir T, Ogbo F, Stevens G, Page A, Milton A, Agho K. The impact of antenatal care, iron–folic acid supplementation and tetanus toxoid vaccination during pregnancy on child mortality in Bangladesh. PLoS One 2017; 12: e0187090: e0187090. https://doi.org/10.1371/journal.pone.0187090
Koenig M, Roy N, McElrath T, Shahldullah M, Wojtynlak B. Duration of protective immunity conferred by maternal tetanus toxoid immunisation. Further evidence from Matlab, Bangladesh. Am J Public Health. 1998; 88: 903–907. https://doi.org/10.2105/ajph.88.6.903
Park K. Epidemiology of communicable diseases. In: Park JE (Eds). Park's Textbook of Preventive and Social Medicine. In India: Barnasidas Bhanot Publishers; 2014. p. 154–5.
IVAC 2018. IVAC, 2018. Nigeria national immunization coverage survey 2016–2017. Available from: https://www. jhsph. edu/ research/ centers- and institutes/ ivac/ resources/ Nigeria- National- Immunization- Coverage- Survey
Jacobson Vann J, Jacobson R, Coyne-Beasley T, Asafu-Adjei J, Szilagyi P. Patient reminder and recall interventions to improve immunisation rates (Review). Cochrane Database Syst Rev. 2018; (1): CD003941.
Bangure D, Chirundu D, Gombe N, Marufu T, Mandozana G, Tshimanga M, et al. Effectiveness of short message services reminder on childhood immunisation programme in Kadoma, Zimbabwe–a randomised controlled trial, 2013. BMC Public Health. 2015; 15: 137. https://doi.org/10.1186/s12889-015-1470-6
Schlumberger M, Bamoko A, Yameogo T, Rouvet F, Ouedraogo R, Traore B. Positive impact on the Expanded Immunisation Program of sending reminder SMS from a computerised register, Bobo-Dioulasso (Burkina Faso). Bull Société Pathol Exot. 2015; 108: 349–354. https://doi.org/10.1007/s13149-015-0455-4.
Eze G, Adeleye O. Enhancing routine immunisation performance using innovative technology in an urban area of Nigeria. West Afr J Med 2015; 34: 3–10.
Copyright (c) 2022 Annals of Health Research
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The articles and other materials published in the Annals of Health Research are protected by the Nigerian Copyright laws. The journal owns the copyright over every article, scientific and intellectual materials published in it. However, the journal grants all authors, users and researchers access to the materials published in the journal with the permission to copy, use and distribute the materials contained therein only for academic, scientific and non-commercial purposes.