Tetanus Toxoid Injection During Last Pregnancy Among Women in Reproductive Age in Nepal

AMPLITUDO 3(1) (2024) AMPLITUDO: Journal of Science & Technology Inovation https://journals.balaipublikasi.id Tetanus Toxoid Injection During Last Pregnancy Among Women in Reproductive Age in Nepal Ashfaque Raza Mikrani1*, Marlynda Happy Nurmalita Sari 2 1 Program Officer, USAID Momentum Privat Healthcare Delivery Project, Koshi Province, Nepal. 2 Departement of Midwifery, Poltekkes Kemenkes Semarang, Indonesia. Received: November 30, 2023 Revised: January 11, 2024 Accepted: February 15, 2024 Published: February 28, 2024 Corresponding Author: Ashfaque Raza Mikrani DOI: 10.56566/amplitudo.v3i1.158 © 2023 The Authors. This open access article is distributed under a (CC-BY License) Abstract: Tetanus toxoid injection is important as one mandatory vaccine for pregnant women to prevent maternal and neonatal tetanus. This study purposed to examine the barriers of not receiving tetanus toxoid vaccine among women of reproductive age in Nepal. This study used the secondary data using “Multiple Indicators Clusters Survey” round 6 in 2019. Total sample of this study are 2,494 women of reproductive aged 15 to 49 years. The data analysis was done for univariate, bivariate, and multivariate using binary logistic regression. The results in this study revealed that increasing child ever born (CEB) as the main predictor for not receiving TT vaccine, following by higher educational level and wealth index. In conclusion, the TT vaccine is a critical intervention to prevent maternal and neonatal tetanus. Understanding the determinants of TT vaccination coverage, ensuring accessibility to the vaccine, and addressing knowledge gaps among pregnant women are essential for improving TT vaccination rates during pregnancy. Keywords: Nepal; Pregnant Women; Tetanus Toxoid Introduction Tetanus toxoid (TT) vaccination is crucial in developing countries, particularly for pregnant women, to prevent maternal and neonatal tetanus. There is evident that tetanus toxoid (TT) vaccination during pregnancy is a crucial preventive measure to protect both the mother and the newborn from tetanus. The World Health Organization (WHO) recommends the TT vaccine for pregnant women in many countries (Yaya et al., 2020). The vaccine has been shown to be effective in preventing maternal tetanus deaths (Nguegang et al., 2021; Awosan & Hassan, 2018). In addition, maternal immunization with TT-containing vaccines is a cornerstone in preventing both maternal and neonatal tetanus (Islam et al., 2022). It is crucial for pregnant women to receive the TT vaccine to ensure immunity against tetanus for both themselves and their newborns (Shaikh, 2022; Jamil et al., 2022). Several studies have highlighted the determinants and predictors of TT vaccination coverage during pregnancy. Factors such as iron uptake during pregnancy, living standards, and access to healthcare services have been associated with the odds of poor TT immunization(Doraivelu et al., 2019; El-Adham et al., 2022; Liyew & Ayalew, 2021; Coleman et al., 2022; Wales et al., 2020). Furthermore, knowledge about tetanus and the TT vaccination has been identified as a crucial determinant of TT vaccination use among pregnant women (Chanie et al., 2021; Merritt et al., 2020; Tseng et al., 2022). The safety and immunogenicity of the TT vaccine during pregnancy have also been addressed. There is no evidence to indicate that TT administered during pregnancy is teratogenic (Khodr et al., 2017; Dhia & Biaee, 2017; Liang et al., 2018). Moreover, the TT vaccine has been coadministered with other vaccines during pregnancy, such as the tetanus, diphtheria, and acellular pertussis (Tdap) vaccine, to confer passive immunity to ___________ How to Cite: Mikrani, A. R., & Sari, M. H. N. (2024). Tetanus Toxoid Injection During Last Pregnancy Among Women in Reproductive Age in Nepal. AMPLITUDO: Journal of Science and Technology Innovation, 3(1), 33–40. https://doi.org/10.56566/amplitudo.v3i1.158 AMPLITUDO: Journal of Science & Technology Innovation infants for the first several months of life (Egan et al., 2023; Oduyebo et al., 2022; Khan et al., 2018). In Ethiopia, studies have highlighted determinants of poor TT immunization, emphasizing the need for improved vaccination uptake among mothers who recently gave birth (Gebremedhin et al., 2020; Zhang et al., 2022). Additionally, factors affecting maternal tetanus vaccination in Egypt have been explored, shedding light on the challenges and barriers to vaccination in developing country settings (Ahmed & El-Berrawy, 2019). Furthermore, a systematic review and metaanalysis in Ethiopia emphasized the importance of TT vaccination coverage among childbearing women, providing insights into associated factors and the need for improved vaccination strategies(Nigussie et al., 2021; Zhou et al., 2023). These studies collectively underscore the significance of TT vaccination in developing countries and the necessity for targeted interventions to enhance vaccination uptake among pregnant women. The research in Ethiopia has identified determinants of vaccination dropout among children, emphasizing the importance of maternal TT vaccination in completing the vaccination schedule for children (Chanie et al., 2021; Kharbanda et al., 2016; Yu et al., 2016). This highlights the indirect benefits of maternal TT vaccination on childhood immunization, further emphasizing its importance in developing country contexts. Overall, these studies underscore the critical role of TT vaccination in developing countries, particularly for pregnant women, and emphasize the need for targeted strategies to improve vaccination coverage and uptake in these settings. The barriers to receiving the tetanus toxoid (TT) vaccine, particularly among pregnant women in developing countries, have been a subject of research. Studies have highlighted determinants of vaccination dropout among children, revealing that mothers who hadn't received TT vaccination during pregnancy were less likely to complete vaccination than those who received tetanus toxoid vaccination (Chanie et al., 2021; Sato & Fitan, 2020). Additionally, research in The Gambia has shown that the current utilization rate for adequate intermittent preventive treatment with sulfadoxine-pyrimethamine and tetanus toxoid immunization during pregnancy is very low, indicating challenges in achieving universal levels of vaccination (Barrow et al., 2022; O’Leary et al., 2018; Shafiq et al., 2017). Furthermore, a study in Egypt emphasized the importance of determining the barriers of maternal TT vaccination in developing countries to strengthen the program and improve maternal and newborn health(Ahmed & El-Berrawy, 2019; Togora et al., 2014). In Ethiopia, knowledge and uptake of the TT vaccine among reproductive age women have been assessed, February 2024, Volume 3, Issue 1, 33-40 revealing that barriers to access, especially to the monovalent tetanus vaccine, pose challenges in achieving universal coverage of the vaccine (...truncated)