Assessment of factors associated with tetanus toxoid vaccination uptake by pregnant women receiving care at Kakamega county referral hospital, Kenya

Abstract

According to the 2013 World Health Organization estimates, maternal tetanus toxoid (TT2) immunization coverage was 65% globally, and 66% in Africa. In Kenya, the vaccination was 48.7% in 2013 while 27.4% in Kakamega County. Since non-uptake of TT vaccination means a mother would not be able to develop immunity against tetanus, the mother would not pass anti-tetanus immunity to her neonate. In this case, Neonates born of 72.6% anti-tetanus naive mothers in Kakamega County are susceptible to infection and death from tetanus. Across the literature, no study has been undertaken for this Hospital to analyze the causes of low TT vaccination uptake in relation to health seeking behavior, examine the magnitude of vaccination attritions and identify the determinants of TT vaccination among pregnant women. This cross -sectional study was conducted at this Hospital to: examine the health seeking behavior; tetanus toxoid uptake and magnitude of tetanus toxoid vaccination attritions as well as to identify the determinants of tetanus toxoid vaccination uptake by pregnant women attending the Hospital. A total of 231 mothers of children aged between 1 day - 11 months sampled from a study population of 462 women, were proportionately stratified and systematically randomly sampled at a sampling interval of 2 in this hospital. Data was collected using questionnaires. Chi-square test was used to establish proportion of women for health seeking behavior as well as uptake and attrition of tetanus toxoid vaccination and the reasons for non-TT vaccination. Multivariate logistic regression was used to establish the association between socio-demographic; economic and health seeking behaviors influencing TT vaccination. Mothers who had <4 ANC visits were 116(50.2%) and 109(47.2%) had 4+ ANC visits. Mothers who delivered at the health facility were 186(80.5%) whereas 44(19.0%) delivered at home. Only 67(29.0%) mothers received 1+ TT injections; 95(41.1%) never received TT vaccination and 69(29.9%) were attrition cases. Approximately 140(85.4%) mothers were unaware of: need for TT vaccination; 8(4.9%) need to return for 2nd or 3rd TT dose. Mothers who had at least one ANC visit were 39 times [OR = 38.9 (95% CI = 5.620 – 269.44) P value <0.001]; more likely to receive TT vaccination. Mothers who delivered at the hospital were three times more likely to receive TT vaccination than those who delivered elsewhere [OR= 3.419; 95% CI = (1.578 – 7.403); p<0.001]. Mothers aged 15 - 19 were 2 times more likely to be vaccinated [OR = 1.944; 95% CI = 0.502 – 7.528), P = 0.336. Mothers with primary education were 1.27 times; [OR = 1.27; 95% CI = (1.079 – 1.080); P value <0.001] more likely to be vaccinated than illiterate mothers. Mothers from urban were two times more likely to be vaccinated [OR = 2.474; 95% CI = (1.205 – 5.076); p = 0.014] than those of rural residence [OR = 0.404; 95% CI = (0.197 – 0.830); p = 0.014]. TT2+ vaccination in Kakamega County Referral Hospital is below the WHO recommendations. The lack of awareness is the major reason for it. The public health awareness programs should be launched to increase the awareness and acceptance rate for TT vaccination.