Determinants and perceptions of the utilization of tetanus toxoid immunization among reproductive-age women in Dukem Town, Eastern Ethiopia: A community-based cross-sectional study

Background: Maternal and neonatal tetanus (MNT) is still the major public health problem in about 25 countries, mainly in Africa and Asia. However, the utilization of intervention strategies, like tetanus toxoid (TT) immunization remains low in these countries. In Ethiopia, only 49% of the pregnant mothers received TT2+ in 2016. This study was designed to evaluate perceptions and factors affecting the utilization of TT immunization among reproductive-age women in Dukem town, Eastern Ethiopia, 2016. Methods: We conducted a community-based cross-sectional study from May to October 2016. A simple random sampling method was employed to select samples of 422 women. Data were collected using a, pretested semi-structured and a face-to-face interviewer-administered questionnaire. We entered data in to Epi Info version 7 and analyzed them by SPSS version 20 software. Odds ratios and a 95% CI at 0 < 0.05 p-value were calculated to ascertain the significance of associations. Results: Response rate was 98.6% (N = 416). Mean age with standard deviation was 29.25± 5.11 years, and average family size was 4.19. Our study showed the utilization of TT immunization was 39.2% (N = 163). Of the participants, 33.9% (N = 141) had never been vaccinated. ANC follow up service [AOR: 2.56, 95% CI: (1.18, 5.49)], distance from health facilities [AOR: 2.27, 95% CI: (1.27, 4.09)], knowing vaccination date [AOR: 1.98, 95% CI: (1.23, 3.18)], having a TV set in the house [AOR: 1.80, 95% CI: (1.11, 2.917)], maternal education [AOR: 1.41, 95% CI: (1.84, 2.30), and place of delivery [AOR: 1.19, 95% CI: (1.00, 1.43)] were factors significantly associated with the utilization of TT immunization. Conclusions: This study indicated the utilization of TT immunization was low. ANC service follow up, distance from health facilities, knowing vaccination date, having a TV in the house, mothers' educational status, and place of delivery were significant predictors. Our study suggests that policymakers and other stakeholders should consider the need for increasing access to maternal education, like basic adult education, ANC follow up services, providing accessible health facilities, improving varieties of communication media, promoting female occupational status, and providing appropriate vaccination cards. This study was intended to investigate the status and factors determining the utilization of TT immunization among reproductive age women in Dukem town, Eastern Ethiopia. A cross-sectional study design was employed to assess the level and factors affecting the utilization of TT immunization. We collected data based on the number of reproductive -age women currently living in Dukem town from May to October 2016. Dukem town, which is located 35 km to the East of Addis Ababa, the capital of Ethiopia, was our study area. We purposively selected the town and its surroundings. In its four kebeles, the town had a projected total population of 114, 207 according to the 2007 population and housing census of the Central Statistical Agency (CSA) of Ethiopia [25]. Child bearing age women (CBAW) were estimated to be 25,234 (22.2%) of the total population, and approximately 3957(3.47%) of them became pregnant annually. The health facilities of the town during the study included a public health center, a maternal and child health (MCH) clinic, four public health posts and eight medium private clinics. The source population was all child bearing age women who were living in Dukem town at the moment. All women in the reproductive age group who had lived in the study area for at least two years were included. We excluded all reproductive age women who had never given births in the past 2 years. We employed the simple random sampling method to select eligible participants. Participant mothers were proportionally selected based on the number of resident mothers in each of the 4 kebeles. Single population proportion was used to calculate the required sample size. A 50% assumption of prevalence and an absolute precision of 5% were considered. We also assumed of a 95% confidence level to obtain adequate power for analysis. After including an additional grant of 10% for no response, 422 women were included. ♣ Child Bearing Age Women (CBAW) - Any women aged 15 to 49 years irrespective of fertility status. ♣ Vaccinated by history: Mothers’ self-report of TT vaccination doses received without any documented evidences. ♣ Vaccinated by card only: A documented evidence of TT doses on immunization cards only. ♣ Vaccinated by card plus history: Both documented and mothers’ self-reported TT doses received. ♣ Valid TT doses: Mothers who received at least 2 doses of TT (TT2) in the recommended intervals We collected data by using a semi-structured interviewer administered questionnaire. The questionnaire was adopted from the Ethiopian demographic and health survey and other related literature [10, 19, 20, 24–26]. We employed a face-to-face interviewer administered data collection technique. We included age, mothers’ marital status, mother and husband’s educations, mothers’ ethnic group, religion, radio and TV in the house to gather information on the socio-demographic characteristics of the participants. There also were questions about mothers’ future birth intentions, ANC service follow ups, parity of birth, permission from husbands to go to health facilities, and knowing the next date of TT vaccination dose to evaluate the determinants of TT vaccination among participants. Questions like the accessibility of vaccination site, quality of services provided, behavior of health care providers, time for travel to health facilities, privacy issues during services, and husbands’ encouragement to visit HF were also incorporated to assess mothers’ perceptions toward the utilization of TT vaccinations. We also asked some questions concerning mother’s knowledge of the purpose of TT immunizations. We emphasized quality in the data collection tools. The questionnaire was first designed in English and translated into the local language ‘Afaan Oromoo’ and back to English by language experts to verify its consistency. We also recruited 7 data collectors and 5 supervisors (health extension workers) who had experience and skills in the task. They were trained and oriented for 2 days before the actual survey. The training focused on the purposes of the study, clarity of tools, techniques of interview, confidentiality of information, informed consent, and the roles & responsibilities of data collectors and supervisors. During the data collection process, the principal investigator supervised both groups. Moreover, we conducted a pretest study prior to the actual process to test the validity and consistency of the data collection instrument by using 10% of the sample in a neighboring town, Gelan. Based on the pretest analysis, we modified some misinterpretations, minimized the number of interview questions, and made corrections to some other objections. The collected data were checked manually for clarity and completeness. We coded data, labeled, verified, categorized, and entered into EpiInfo version 7. We employed SPSS version 20 to analyze the data. Descriptive statistics, like frequencies, percentages, means and standard deviations were computed. Using a binary logistic regression analysis, we fitted each predictor variable in to a bivariate logistic regression model separately to explore associations with the dependent variable (TT immunization status). Significant predictors at p-value < 0.2 in a bivariate analysis were exported to the multivariable logistic regression model to control possible effects of confounders. Variables were dropped in to the multivariate logistic regression model with a backward variable selection method. We proved goodness of fit model by Hosmer and Lemeshow and the assumption was satisfied (p-value > 0.05). Odds ratios (OR) with 95% confidence intervals (CI) were applied to ascertain the significance of association.