Prevalence and determinants of antenatal tetanus vaccination in Sudan: a cross-sectional analysis of the Multiple Indicator Cluster Survey

Tropical Medicine and Health, Volume 50, No. 1, Year 2022

Interpretation

Background: Tetanus vaccination is an indispensable component of the antenatal care (ANC) and is considered one of the most effective and protective measures against tetanus deaths. However, data on antenatal tetanus vaccination in Sudan are scarce. We aimed to explore the level of antenatal tetanus vaccination and to identify the influencing factors in a nationally representative population sample. Methods: We used the latest available data (2014) of the Sudan Multiple Indicator Cluster Survey (MICS), developed by the United Nations Children’s Fund (UNICEF). We assessed the level of antenatal tetanus vaccination among women of childbearing age who gave at least one birth preceding the survey and defined adequate antenatal tetanus vaccination according to the World Health Organization (WHO) recommendations. Data analysis was performed using descriptive statistics, bivariate analysis, and multivariate logistic regression analysis. Results: The total number of women of childbearing age involved in this analysis was 5433. Most of the participants (28.6%) were 25–29 years old, and vast majority of them (73.7%) live in rural areas. The prevalence of mothers who had adequate tetanus vaccination was 60.0%. Antenatal tetanus vaccination was significantly associated with higher level of mothers’ education (AOR = 1.70, 95% CI 1.25–2.32), higher household wealth index (AOR = 1.89, 95% CI 1.41–2.54), having four or more ANC visits (AOR = 1.49, 95% CI 1.30–1.71), and living in areas with low intensity of armed conflicts (AOR = 1.34, 95% CI 1.14–1.57). Conclusions: Socioeconomic status had a significant impact on adequate antenatal tetanus vaccination. The results indicate the existence of variable rates and unequal access to tetanus vaccination among women of childbearing age in Sudan. This study was performed based on an analysis of the latest accessible data available from the Sudan Multiple Indicator Cluster Survey (MICS), a nationwide survey was conducted from August to December 2014 [17]. Sudan MICS is a part of the worldwide MICS program developed by United Nations Children’s Fund (UNICEF) and the survey was funded by several international collaborators, including the WHO, World Food Program (WFP), and the United Nations Population Fund (UNFPA) [13]. The global MICS program aimed to collect internationally comparable data on several indicators of maternal and childhood health condition, allowing countries to generate conclusive evidence for usage in health policies, assessing the current situation, and monitoring progress toward the achievement of the millennium development goals and other agreed-upon commitments [17]. The dataset was described and used by previous studies [18–20]. As previously reported, the study used a stratified two-stage clustered sampling method to recruit the participants. The overall target sample size of the study was 18,000 households and the total number of households reached 17,142. Of these, 16,801 households were successfully interviewed by trained interviewers using a questionnaire consisting of demographic characteristics, reproductive history, antenatal and postnatal care, and family planning. For this study, we included women of childbearing age (15–49 years) who gave at least one birth preceding the survey, with complete data on tetanus vaccination status. Adequate tetanus vaccination among women of childbearing age was defined previously as either receiving two doses of tetanus toxoid vaccine in the last pregnancy, more than one dose within the latest 3 years of birth, more than two doses within the latest 5 years of birth, more than three doses within the latest within 10 years of birth, or more than four doses at any time [6, 7]. Accordingly, the dependent variable (adequate tetanus vaccination) was coded as a binary (yes, no) for further analysis. The interviewers asked the participants to present their vaccination cards to record the dates of vaccination and to refer to information from the cards when available. Based on the availability of the data collected, the study has following variables: age group (15–19, 20–24, 25–29, 30–34, 35–39, 40–44, 45–49 years); mother education (none, primary, secondary, higher); household wealth quintile index (poorest, second, middle, fourth, richest); ANC visits (less than four, four or more); and area of residence (urban, rural). In addition, as Sudan has a long history of armed conflicts associated with poor health situation, the country’s states according to the armed conflicts intensity. A previous study done by Dahab et al. created this parameter by using the scale of the Heidelberg Institute for International Conflict Research (HIIK) and they classified the armed conflicts intensity in South Kordofan, Blue Nile, and the five states of Darfur was classified as high [18]. A descriptive statistics method was used to describe the variables and calculate the prevalence of adequate tetanus vaccination. We examined the relationship between adequate tetanus vaccination and the previously described factors. The variables that showed a statistically significant relationship at the bivariate analyses level (p < 0.05) were evaluated through multiple logistic regression analysis. The results were then described in odds ratios with the 95% confidence intervals. The results of all analyses with p-values < 0.05 were considered significant. Statistical analyses were performed using the SPSS software version 20 (SPSS Inc., Chicago, IL, USA).

AI Digest

Study Justification:

– The study aimed to explore the level of antenatal tetanus vaccination in Sudan, as data on this topic were scarce.
– Antenatal tetanus vaccination is an important component of antenatal care and is effective in preventing tetanus deaths.
– Understanding the prevalence and determinants of antenatal tetanus vaccination can help inform policies and interventions to improve vaccination rates.

Study Highlights:

– The study used data from the Sudan Multiple Indicator Cluster Survey (MICS), a nationwide survey conducted in 2014.
– The analysis included 5,433 women of childbearing age who had given birth prior to the survey.
– The prevalence of adequate tetanus vaccination among these women was found to be 60%.
– Factors associated with higher rates of vaccination included higher levels of education, higher household wealth, more ANC visits, and living in areas with low intensity of armed conflicts.

Study Recommendations:

– Improve access to antenatal tetanus vaccination by targeting women with lower levels of education and lower household wealth.
– Increase awareness about the importance of antenatal tetanus vaccination and the recommended number of doses.
– Strengthen ANC services to ensure that women receive the recommended number of ANC visits.
– Address the impact of armed conflicts on vaccination rates by providing targeted interventions in areas with high conflict intensity.

Key Role Players:

– Ministry of Health: Responsible for implementing vaccination programs and policies.
– United Nations Children’s Fund (UNICEF): Provides support and funding for vaccination programs.
– World Health Organization (WHO): Provides technical guidance and support for vaccination programs.
– Non-governmental organizations (NGOs): Implement vaccination programs at the community level and provide support for awareness campaigns.

Cost Items for Planning Recommendations:

– Vaccine procurement and distribution: Budget for purchasing and distributing tetanus toxoid vaccine.
– Training and capacity building: Budget for training healthcare workers on vaccination protocols and best practices.
– Awareness campaigns: Budget for developing and implementing campaigns to increase awareness about antenatal tetanus vaccination.
– Strengthening ANC services: Budget for improving infrastructure, equipment, and staffing in ANC clinics.
– Monitoring and evaluation: Budget for monitoring vaccination coverage and evaluating the impact of interventions.

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study utilized a nationally representative sample and employed descriptive statistics, bivariate analysis, and multivariate logistic regression analysis. The study also referenced previous studies that used the same dataset. However, the study did not provide information on the response rate or any potential limitations. To improve the strength of the evidence, the authors could include information on the response rate and address any limitations of the study, such as potential biases or confounding factors.

Abstract

This study was performed based on an analysis of the latest accessible data available from the Sudan Multiple Indicator Cluster Survey (MICS), a nationwide survey was conducted from August to December 2014 [17]. Sudan MICS is a part of the worldwide MICS program developed by United Nations Children’s Fund (UNICEF) and the survey was funded by several international collaborators, including the WHO, World Food Program (WFP), and the United Nations Population Fund (UNFPA) [13]. The global MICS program aimed to collect internationally comparable data on several indicators of maternal and childhood health condition, allowing countries to generate conclusive evidence for usage in health policies, assessing the current situation, and monitoring progress toward the achievement of the millennium development goals and other agreed-upon commitments [17]. The dataset was described and used by previous studies [18–20]. As previously reported, the study used a stratified two-stage clustered sampling method to recruit the participants. The overall target sample size of the study was 18,000 households and the total number of households reached 17,142. Of these, 16,801 households were successfully interviewed by trained interviewers using a questionnaire consisting of demographic characteristics, reproductive history, antenatal and postnatal care, and family planning. For this study, we included women of childbearing age (15–49 years) who gave at least one birth preceding the survey, with complete data on tetanus vaccination status. Adequate tetanus vaccination among women of childbearing age was defined previously as either receiving two doses of tetanus toxoid vaccine in the last pregnancy, more than one dose within the latest 3 years of birth, more than two doses within the latest 5 years of birth, more than three doses within the latest within 10 years of birth, or more than four doses at any time [6, 7]. Accordingly, the dependent variable (adequate tetanus vaccination) was coded as a binary (yes, no) for further analysis. The interviewers asked the participants to present their vaccination cards to record the dates of vaccination and to refer to information from the cards when available. Based on the availability of the data collected, the study has following variables: age group (15–19, 20–24, 25–29, 30–34, 35–39, 40–44, 45–49 years); mother education (none, primary, secondary, higher); household wealth quintile index (poorest, second, middle, fourth, richest); ANC visits (less than four, four or more); and area of residence (urban, rural). In addition, as Sudan has a long history of armed conflicts associated with poor health situation, the country’s states according to the armed conflicts intensity. A previous study done by Dahab et al. created this parameter by using the scale of the Heidelberg Institute for International Conflict Research (HIIK) and they classified the armed conflicts intensity in South Kordofan, Blue Nile, and the five states of Darfur was classified as high [18]. A descriptive statistics method was used to describe the variables and calculate the prevalence of adequate tetanus vaccination. We examined the relationship between adequate tetanus vaccination and the previously described factors. The variables that showed a statistically significant relationship at the bivariate analyses level (p < 0.05) were evaluated through multiple logistic regression analysis. The results were then described in odds ratios with the 95% confidence intervals. The results of all analyses with p-values < 0.05 were considered significant. Statistical analyses were performed using the SPSS software version 20 (SPSS Inc., Chicago, IL, USA).

Materials

N/A

Innovations

Based on the information provided, here are some potential innovations that could improve access to maternal health:

1. Mobile Health (mHealth) Solutions: Implementing mobile health technologies, such as SMS reminders and mobile apps, to provide information and reminders about antenatal tetanus vaccination. This can help increase awareness and ensure that women receive timely vaccinations.

2. Community Health Workers: Training and deploying community health workers to educate women about the importance of antenatal tetanus vaccination and provide vaccinations in remote or underserved areas. These workers can also address any concerns or misconceptions that women may have.

3. Telemedicine: Using telemedicine platforms to provide virtual consultations and follow-up care for pregnant women, including discussions about antenatal tetanus vaccination. This can help overcome geographical barriers and improve access to healthcare services.

4. Public-Private Partnerships: Collaborating with private sector organizations, such as pharmaceutical companies or technology companies, to improve the availability and distribution of tetanus vaccines. This can help ensure a steady supply of vaccines and reach more women in need.

5. Health Information Systems: Strengthening health information systems to collect and analyze data on antenatal tetanus vaccination coverage. This can help identify gaps in coverage and target interventions to areas with low vaccination rates.

6. Financial Incentives: Introducing financial incentives, such as conditional cash transfers or vouchers, to encourage pregnant women to receive antenatal tetanus vaccination. This can help overcome financial barriers and increase demand for vaccination services.

7. Health Education Campaigns: Conducting targeted health education campaigns to raise awareness about the importance of antenatal tetanus vaccination among women, their families, and communities. This can help dispel myths and misconceptions and promote vaccination uptake.

It’s important to note that the specific context and needs of Sudan should be taken into consideration when implementing these innovations.

AI Innovations Description

Based on the analysis of the Sudan Multiple Indicator Cluster Survey (MICS), the study found that there is a need to improve access to antenatal tetanus vaccination among women of childbearing age in Sudan. The study identified several factors that influence the level of antenatal tetanus vaccination, including mothers’ education, household wealth index, number of ANC visits, and the intensity of armed conflicts in the area of residence.

To develop this recommendation into an innovation to improve access to maternal health, the following steps can be taken:

1. Strengthening Health Education: Implement targeted health education programs to increase awareness among women of childbearing age about the importance of antenatal tetanus vaccination. This can be done through community outreach programs, workshops, and the use of multimedia platforms to disseminate information.

2. Improving Accessibility: Enhance the availability and accessibility of antenatal care services, including tetanus vaccination, by increasing the number of healthcare facilities in rural areas. This can be achieved by establishing mobile clinics or expanding existing healthcare centers to reach remote areas.

3. Financial Support: Provide financial support or subsidies to women who cannot afford the cost of antenatal care services, including tetanus vaccination. This can be done through government-funded programs or partnerships with non-governmental organizations to ensure that cost does not become a barrier to accessing maternal health services.

4. Strengthening Healthcare Infrastructure: Invest in improving healthcare infrastructure, including the availability of vaccines and trained healthcare professionals, to ensure that antenatal tetanus vaccination is readily available in all healthcare facilities.

5. Monitoring and Evaluation: Establish a robust monitoring and evaluation system to track the progress of antenatal tetanus vaccination coverage and identify areas that require additional attention. This can help in identifying gaps and implementing targeted interventions to improve access to maternal health services.

By implementing these recommendations, it is expected that access to antenatal tetanus vaccination and overall maternal health in Sudan will improve, leading to a reduction in maternal and neonatal tetanus cases.

AI Innovations Methodology

Based on the provided study, here are some potential recommendations to improve access to maternal health:

1. Strengthen education and awareness programs: Increase efforts to educate women of childbearing age about the importance of antenatal tetanus vaccination. This can be done through community health workers, health education campaigns, and targeted messaging.

2. Improve accessibility of vaccination services: Ensure that vaccination services are easily accessible to all women, especially those in rural areas. This can be achieved by establishing mobile vaccination clinics, increasing the number of healthcare facilities in rural areas, and providing transportation support for women to reach vaccination centers.

3. Enhance antenatal care services: Promote the importance of regular antenatal care visits and provide comprehensive antenatal care services that include tetanus vaccination. This can be done by training healthcare providers, improving the availability of necessary resources and equipment, and implementing quality assurance measures.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Define indicators: Identify key indicators that reflect access to maternal health, such as the percentage of women receiving adequate tetanus vaccination, the number of antenatal care visits, and the percentage of women with access to healthcare facilities.

2. Collect baseline data: Gather data on the current status of these indicators before implementing the recommendations. This can be done through surveys, interviews, and data analysis of existing health records.

3. Implement recommendations: Roll out the recommended interventions, such as education and awareness programs, improved accessibility of vaccination services, and enhanced antenatal care services.

4. Monitor and evaluate: Continuously monitor the progress and impact of the implemented recommendations. Collect data on the indicators identified in step 1 at regular intervals.

5. Analyze data: Use statistical analysis software, such as SPSS, to analyze the collected data. Compare the baseline data with the data collected after implementing the recommendations to assess the impact on access to maternal health.

6. Interpret results: Interpret the results of the analysis to determine the effectiveness of the recommendations in improving access to maternal health. Identify any trends or patterns that emerge from the data.

7. Adjust interventions: Based on the findings, make any necessary adjustments to the interventions to further improve access to maternal health. This could involve refining the education and awareness programs, modifying the accessibility of vaccination services, or enhancing antenatal care services.

8. Repeat the process: Continuously repeat steps 3 to 7 to monitor and evaluate the impact of the adjusted interventions. This iterative process allows for ongoing improvement and optimization of the recommendations to achieve the desired outcomes in improving access to maternal health.

Author

Dima Health

Statistics:

Citations: 2

Identifiers:

DOI: 10.1186/s41182-022-00398-4

ISSN: 13488945

Research Areas:

Food Security, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants

Study Countries:

Sudan

Study Design:

Cross Sectional Study

Study Approach:

Quantitative

Participants Gender:

Female