Predictors for Uptake of Tetanus Toxoid Vaccination During Pregnancy Among Women of Reproductive Age in Tanzania; An Analysis of Data from the 2015-16 Tanzania Demographic and Health Survey and Malaria Indicators Survey

Background: Tetanus is a vaccine preventable disease. Tanzania through its Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC) recommend all women should receive at least ve TT doses in their reproductive life. Little is known on predictors of TT uptake during pregnancy among women of reproductive age in Tanzania Method: The study used data from the 2015-16 Tanzania Demographic and Health Survey and Malaria Indicators Survey (2015-16 TDHS-MIS). A total of 6924women of active reproductive age from 15 to 49 were included in the analysis. Both univariate and multiple regression analyses were used to determine the predictors of TT uptake during pregnancy among women of reproductive age in Tanzania. Results: More than half, 3480 (50.3%) of the study population had either no or one tetanus injection. A total of 3444 (49.7%) had two or more tetanus injection during pregnancy. After adjusted for confounders, predictors of uptake of tetanus vaccination were early antenatal booking (AOR=1.174 at 95% CI=1.033-1.335, p=0.014), age group of women [ 20 to 34 years (AOR=1.433 at 95% CI= 1.155-1.778, p=0.001), more than 34 years (AOR=1.379 at 95% CI=1.065-1.786, p=0.015)], wealth index [ rich (AOR=1.261 at 95% CI= 1.083-1.468, p = 0.003)], parity [para 2-4 (AOR=0.401 at 95% CI=0.343-0.468, p<0.001), para 5 and above (AOR=0.217 at 95% CI=0.178-0.265, p<0.001)], level of education [ primary level, (AOR=0.864 at 95% CI=0.754-0.99, p=0.035)] zones [Unguja Zanzibar Island (AOR=0.434 at 95% CI=0.309-0.609, Pemba adequate ANC visits maternal and neonatal tetanus infection; high coverage of TT vaccine among WRA including clean action in areas (2).


Study Area and period
The study was conducted in the United Republic of Tanzania from August 22, 2015, through February 14, 2016.Tanzania is among the countries found in East Africa. It is the largest country that covers 940,000 square kilometers and 60,000 square kilometers is inland water. The country lies south of the equator and shares borders with eight countries: Kenya and Uganda to the North; Rwanda, Burundi, the Democratic Republic of Congo, and Zambia to the West; and Malawi and Mozambique to the South.

Study Design
It was a national-based cross-sectional study utilizing the 2015-16 Tanzania Demographic and Health Survey and Malaria Indicator Survey (TDHS-MIS) dataset.

Study Population
All women of reproductive age (aged 15-49 years) were the study population. The study used Individual le recode (TZIR7BFL) with a total of 13266 women who responded to the survey (97% response rate). The study included only women who remembered the timing for antenatal booking of their youngest child.
Those who were not able to recall the timing and those who did not respond to the question were removed from the analysis. A total of 6924 women who had birth within ve years preceding the survey were included in the study.

Sampling Technique
Two stages of sampling were used to obtain a sample for urban and rural areas in Tanzania Mainland and Zanzibar. In the rst stage, a total of 608 clusters were selected and in the second stage, a systematic selection of households was involved. A total of 22 households were then systematically selected from each cluster, yielding a representative probability sample of 13,376 households for the 2015-16 TDHS-MIS.

Data Collection Tool
The 2015-16 TDHS-MIS used household questionnaires and individual questionnaires. These questionnaires based on the Measure DHS standard AIDS Indicator Survey and Malaria Indicator Survey questionnaires standards. They were adapted and modi ed to re ect the Tanzanian population. They were translated into Kiswahili, Tanzania's national language. The data presented in this study are from the individual questionnaire.

Study Variables
Dependent TT vaccine uptake Independent variables Sociodemographic characteristics (Maternal age, maternal education, place of residence, Wealth Index, marital status, and parity.

Discussion
The proportional of those not using either a single dose of TT during pregnancy revealed to be a half of the total study population, re ecting the general population. Likewise, the study further noted that less than fty percent of women of reproductive age received either TT2+, despite numerous government interventions to increase the coverage.