ReviewHuman vaccines & immunotherapeutics2024
Number of tetanus toxoid injections before birth and associated factors among pregnant women in low and middle income countries: Negative binomial poisson regression.
Review in Human vaccines & immunotherapeutics, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Facilitators and barriers to maternal immunization and strategies to improve uptake in low-income and lower-middle income countries: A systematic review.Human vaccines & immunotherapeutics · 2024Pooled it
- Determinants of the Number of Tetanus-Toxoid Injections Before Birth Among Pregnant Women in Somalia: A Multilevel Analysis.Public health challenges · 2026Article
- Interpretable prediction of neonatal mortality and its key predictors using machine learning and SHAP analysis.BMC medical informatics and decision making · 2026Article
- Global vaccine development.Nature medicine · 2026Review
- Determinants of tetanus toxoid immunization among pregnant women in Somaliland: evidence from the 2020 nationwide survey using a zero-inflated negative binomial model.AJOG global reports · 2026Article
- Determinants of tetanus-unprotected births in Tanzania: a multilevel analysis using the 2022 Tanzania Demographic and Health Survey data.Maternal health, neonatology and perinatology · 2026Article
- Residential differentials in prevalence and factors associated with tetanus toxoid uptake among women of reproductive age in Nigeria: a Multiple Indicator Cluster Survey analysis (MICS 2021).BMC public health · 2026Article
- Tetanus Control in the United States and Global Disaster Settings: Public Health Disparities and Prevention Strategies.Medicina (Kaunas, Lithuania) · 2026Review
- Tetanus toxoid immunization coverage and its determinants among pregnant women in Somalia: A cross-sectional analysis of the 2020 Demographic and Health Survey.Human vaccines & immunotherapeutics · 2025Article
- Maternal immunisation towards prevention of neonatal tetanus: insights from a cross-sectional study in Pru East Municipality, Ghana.BMJ public health · 2025Article
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13 authors.
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Abstract
backgroundIn low- and middle-income countries where vaccination rates are low, tetanus is still an important threat to public health. Although maternal and neonatal tetanus remains a major global health concern, its magnitude and determinates are not well studied. Therefore, this study aimed to assess the number of tetanus toxoid injections and associated factors among pregnant women in low- and middle-income countries.
methodsData from the most recent Demographic and Health Surveys, which covered 60 low- and middle-income countries from 2010 to 2022, was used for secondary data analysis. The study included a total of 118,704 pregnant women. A statistical software package, STATA 14, was used to analyze the data. A negative binomial regression of a cross-sectional study was carried out. Factors associated with the number of tetanus vaccinations were declared significant at a p-value of < 0.05. The incidence rate ratio and confidence interval were used to interpret the results. A model with the smallest Akaike Information Criterion and Bayesian Information Criterion values and the highest log likelihood was considered the best-fit model for this study.
resultsIn low- and middle-income countries, 26.0% of pregnant women took at least two doses of the tetanus toxoid vaccine. Factors such as maternal education, primary (IRR = 1.22, 95% CI: 1.17, 1.26), secondary (IRR = 1.19, 95% CI: 1.15, 1.23), higher (IRR = 1.16, 95% CI: 1.12, 1.20), employment (IRR = 1.11, 95% CI: 1.09, 1.13), 1-3 ANC visits (IRR = 2.49, 95% CI: 2.41, 2.57), ≥4 visits (IRR = 2.94, 95% CI: 2.84, 3.03), wealth index (IRR = 1.06; 95% CI: 11.04, 1.08), ≥birth order (IRR = 1.04, 95% CI: 1.02, 1.27), distance to health facility (IRR = 1.02, 95% CI: 1.00, 1.03), and health insurance coverage (IRR = 1.08; 95% CI: 1.06, 1.10) had a significant association with the number of tetanus vaccinations among pregnant women. CONCLUSIONS AND RECOMMENDATIONS: This study concludes that the number of tetanus toxoid vaccinations among pregnant women in low- and middle-income countries is low. In the negative binomial model, the frequency of tetanus vaccinations has a significant association with maternal employment, educational status, wealth index, antenatal care visits, birth order, distance from a health facility, and health insurance. Therefore, the ministries of health in low and middle-income countries should give attention to those women who had no antenatal care visits and women from poor wealth quantiles while designing policies and strategies.
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