Magnitude of Tetanus Toxoid Immunization and Associated Factors among Pregnant Women in Ethiopia

The Open Public Health Journal 10 Apr 2023 RESEARCH ARTICLE DOI: 10.2174/18749445-v16-e230111-2022-161



Maternal and neonatal tetanus remains a major global health problem. Two-thirds of the cases of neonatal tetanus occur in the poorest and least developed countries, including Ethiopia.


This study aimed to calculate the magnitude and identify associated factors of tetanus toxoid immunization among pregnant women in Ethiopia.


The 2016 Ethiopian demographic and health survey data were accessed and used for the analysis. A total of 7193 pregnant women were included in this study. A multilevel hurdle Poisson model was conducted to identify factors associated with tetanus toxoid immunization among pregnant women.

Results And Discussion:

Only 41.6% of pregnant women had received at least two doses of tetanus vaccine, while 58.4% received less than two doses. The multilevel hurdle Poisson model showed that residence, wealth index, education level of women, occupation of women, education level of husbands, ANC, presence of mobile phones, region, frequency of listening radio and frequency of watching television were significantly associated with tetanus toxoid immunization.


Tetanus toxoid immunization coverage in Ethiopia was low. The concerned governmental organization sought to resolve enumeration area variation in tetanus toxoid immunization and closely monitored its implementation. Providing quality antenatal care, enhancing women’s educational level, and involving husbands in tetanus toxoid immunization are effective strategies to increase tetanus toxoid immunization coverage. Besides, the low-income households and the rural settings should also be given special consideration.

Keywords: Pregnant women, Tetanus toxoid, Immunization, Multilevel, Hurdle poisson model, Infectious disease.
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