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Objectives: The study examined the differentials in prevalence and correlates on the uptake of tetanus toxoid and intermittent preventive treatment of malaria among pregnant women in The Gambia. Methods: The 2018 data from The Gambia Multiple Indicators Cluster Survey were analyzed. Data from 6143 women of reproductive age who have given birth were extracted for the analysis. Percentages and Chi-square tests were used. In addition, a multivariable logistic regression model was used to calculate the adjusted odds ratios (with a corresponding 95% confidence interval). The level of significance was set at p < 0.05. Results: The prevalence of tetanus toxoid uptake among women in The Gambia was 88.2%, while that of the adequate tetanus toxoid doses was 34.8%. The prevalence of intermittent preventive treatment with sulfadoxine-pyrimethamine uptake among maternal women in The Gambia was 98.6%, while that of the adequate intermittent preventive treatment with sulfadoxine-pyrimethamine doses taken was 34.3%. The identified statistically significant covariates of tetanus toxoid immunization and intermittent preventive treatment with sulfadoxine-pyrimethamine uptake includes women’s age, local government areas, parity, use of radio, use of newspaper, and antenatal care visits. Conclusion: The current utilization rate for adequate intermittent preventive treatment with sulfadoxine-pyrimethamine and tetanus toxoid immunization during pregnancy in The Gambia is very low and even below universal levels. The country needs to strengthen more and effective mass media advocacy programs that would target both rural and urban populace, and motivate maternal women to ensure adequate vaccination against malaria and tetanus.
Secondary data from The Gambia MICS 2018 were used. 27 The data from 6143 women of reproductive age who have given birth were extracted for the analysis with a response rate of 95.4% of the original survey size of 13,640 women (age 15–49 years). 27 The Gambia MICS carried out in 2018 provided the opportunity to strengthen the national statistical capacity by providing technical guidance on the quality of survey information, statistical tracking, as well as data collation and analysis. The MICS ensures the measurement of key pointers which countries depend upon to generate data that are used in policy formulations and program planning to monitor their progress in achieving the sustainable development goals, as well as the national development plan (NDP) of The Gambia and other international commitments which the country is a signatory to. The contribution of the MICS on the strengthening of The Gambian’s improvement on data and systems monitoring and the provision of technical expertise in the design, implementation, and analysis of such systems. The major reason for the development of the MICS program by the United Nations Children’s Fund (UNICEF) was to assist countries in internationally comparable data collection on an extensive variety of indicators ranging from data on children to that of women. The Gambia MICS 2018 is a cross-sectional stratified survey designed to provide nationally representative estimates for children and women across local government areas (LGAs): Banjul, Kanifing, Brikama, Mansakonko, Kerewan, Kuntaur, Janjanbureh, and Basse. The urban and rural areas in each LGA have been designated as the principal sampling stratum. A two-stage sampling technique for the systemic selection of households was applied. The first step randomly selected enumeration areas (EAs), and clusters from each substratum were probability proportionate to the size of the 390 EAs identified in the MICS. 27 A systemic sample of 20 households was obtained in each enumeration area following household listing in the designated enumeration areas. During the fieldwork period, all the selected EAs were visited. This was the sixth round of MICS for The Gambia conducted by The Gambia Bureau of Statistics with technical support from UNICEF. A comprehensive sampling frame, error estimates, and allocation in their weighted forms as clearly presented in Appendix A of The Gambia MICS 2018 report from page 424 to 431. 27 Several other published articles only and briefly described the section as shown in several studies in The Gambia.31–33 The two dependent variables used for this study are not in variance with the previous study. 6 These two variables were uptake of TT and Fansidar (SP) during their last pregnancy. The question that participants were asked was whether or not they took TT vaccination and used IPTp-SP during their last pregnancy. Based on WHO recommendation, a minimum of (at least two doses) of TT was defined as adequate, and (at least three doses) of IPTp-SP were also determined as adequate. Below those values are regarded as inadequate doses for both IPTp-SP and TT. Thus, doses that are less than those stated above were considered inadequate. The maternal age was grouped as (15–19, 20–24, 25–29, 30–34, 35–39, 40–44, 45–49 years); residency: urban versus rural; LGA: Banjul, Kanifing, Brikama, Mansakonko, Kerewan, Kuntaur, Janjanbureh, Basse; education level: none, primary, secondary+; ethnicity: Mandinka, Wollof, Fula, Jola, Sarehule, Others, Non-Gambian; household wealth status: poorest, second, middle, fourth, richest; parity: 0–3, 4, and above; reading newspaper: do not use, few days a week, almost every day; listening to the radio: do not use, few days a week, almost every day; watching TV: do not use, few days a week, almost every day; ANC visits: less than five, five, and above; and currently pregnant: yes versus no. These inclusions of variables were as a result of the examined factors associated with the utilization of IPTp-SP and TT vaccination in previous studies.6,23 The original survey was conducted after being ethically approved by The Gambia Government Joint Research Ethics Committee (Ref. No: SCC1570v1.1). Before analysis, we obtained permission from The Gambia Bureau of Statistics and MICS program to access the dataset. The issue of privacy of the respondents was considered such that exclusive information such as respondents’ locations and their names as collected during the MICS interviews were consciously removed from datasets. It is also on record that participants’ consent was obtained either through signing or thumbprinted before their participation in the survey. For underage children, the adult’s consent was gotten in advance of the child’s assent. Prevalence rates of taking TT vaccination and IPTp-SP for each explanatory variable were shown as percentages in their weighted forms. The collinearity testing method was adopted in the correlation analysis to distinguish the interdependencies that exist between variables. To examine the multicollinearity that causes major concerns, a cutoff of 0.7 was used. 34 No variable from the correlation matrix was removed in the model as a result of a lack of multicollinearity. Chi-square bivariate tests were used to examine the association at p value <0.05. Controlled variables that showed p value <0.15 including those that had significant associations in the bivariate tests were included in the multivariable logistic regression model to compute the adjusted odds ratios with corresponding 95% confidence interval (CI) of the factors (covariates) associated with taking TT vaccinations and IPTp-SP. Statistical significance was set at a p value of <0.05 for all analyses. Data analysis was performed using IBM SPSS version 25.
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