The association between area of residence and sufficient antenatal tetanus vaccination in women ages 15–49 in Afghanistan: an analysis of the 2015 DHS dataset

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Abstract

Background

Neonatal tetanus (NT) is a deadly nervous system disorder that is endemic to Afghanistan. Administering sufficient doses of tetanus toxoid containing vaccine (TTCV) during pregnancy can pass antibodies to the fetus and therefore prevent NT. Using survey data, we investigated the association between area of residence (urban or rural) and sufficient antenatal TTCV coverage among women aged 15–49 years in Afghanistan during their most recent pregnancy in the past 5 years that resulted in a live birth. Mother’s education level was also assessed as a potential effect modifier.

Methods

Secondary analysis was performed on data from the 2015 Afghanistan Demographic and Health Survey (AfDHS). The 2015 AfDHS was a nationally representative survey with participants selected in a stratified two-stage sample design from urban and rural areas across Afghanistan’s 34 provinces. Data were analyzed on 19,737 women ages 15–49 that had a live birth in the 5 years preceding the survey. The relationship between area of residence and sufficient antenatal TTCV was assessed in a multivariable logistic regression model, adjusting for several confounding variables.

Results

55.1% (95% CI = 51.6–58.5%) of urban women and 53.9% (95% CI = 49.7–57.9%) of rural women had sufficient tetanus vaccination coverage in their most recent pregnancy. In multivariate analysis, there was strong evidence for greater odds of sufficient antenatal tetanus vaccination in rural areas (OR = 1.62; 95% CI = 1.18–2.24, p = 0.003). There was no effect modification on this association by mother’s education level.

Conclusions

Women in rural areas of Afghanistan have greater odds of receiving sufficient antenatal tetanus vaccination than women in urban areas. Further study into factors contributing to this urban-rural disparity is needed. Targeted antenatal tetanus vaccination strategies for urban and rural women will be necessary as Afghanistan continues to work towards NT eradication.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41256-020-00180-1.

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Most cited references 30

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Utilization of maternal health care services in Southern India.

K Navaneetham, A Dharmalingam (2002)

This paper examines the patterns and determinants of maternal health care utilization across different social settings in South India: in the states of Andhra Pradesh, Karnataka, Kerala and Tamil Nadu. Data from the National Family Health Survey (NFHS) carried out during 1992-93 across most states in India are used. Results show that utilization of maternal health care services is highest in Kerala followed by Tamil Nadu, Andhra Pradesh and Karnataka. Utilization of maternal health care services is not only associated with a range of reproductive, socio-economic, cultural and program factors but also with state and type of health service. The interstate differences in utilization could be partly due to variations in the implementation of maternal health care program as well as differences in availability and accessibility between the states. In the case of antenatal care, there was no significant rural-urban gap, thanks to the role played by the multipurpose health workers posted in the rural areas to provide maternal health care services. The findings of this study provide insights for planning and implementing appropriate maternal health service delivery programs in order to improve the health and well-being of both mother and child.

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Maternal and neonatal tetanus.

C. Louise Thwaites, Nicholas J. Beeching, Charles Newton (2015)

Maternal and neonatal tetanus is still a substantial but preventable cause of mortality in many developing countries. Case fatality from these diseases remains high and treatment is limited by scarcity of resources and effective drug treatments. The Maternal and Neonatal Tetanus Elimination Initiative, launched by WHO and its partners, has made substantial progress in eliminating maternal and neonatal tetanus. Sustained emphasis on improvement of vaccination coverage, birth hygiene, and surveillance, with specific approaches in high-risk areas, has meant that the incidence of the disease continues to fall. Despite this progress, an estimated 58,000 neonates and an unknown number of mothers die every year from tetanus. As of June, 2014, 24 countries are still to eliminate the disease. Maintenance of elimination needs ongoing vaccination programmes and improved public health infrastructure. Copyright © 2015 Elsevier Ltd. All rights reserved.

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Mortality from tetanus between 1990 and 2015: findings from the global burden of disease study 2015

Hmwe H. Kyu, John Mumford, Jeffrey D Stanaway … (2017)

Background Although preventable, tetanus still claims tens of thousands of deaths each year. The patterns and distribution of mortality from tetanus have not been well characterized. We identified the global, regional, and national levels and trends of mortality from neonatal and non-neonatal tetanus based on the results from the Global Burden of Disease Study 2015. Methods Data from vital registration, verbal autopsy studies and mortality surveillance data covering 12,534 site-years from 1980 to 2014 were used. Mortality from tetanus was estimated using the Cause of Death Ensemble modeling strategy. Results There were 56,743 (95% uncertainty interval (UI): 48,199 to 80,042) deaths due to tetanus in 2015; 19,937 (UI: 17,021 to 23,467) deaths occurred in neonates; and 36,806 (UI: 29,452 to 61,481) deaths occurred in older children and adults. Of the 19,937 neonatal tetanus deaths, 45% of deaths occurred in South Asia, and 44% in Sub-Saharan Africa. Of the 36,806 deaths after the neonatal period, 47% of deaths occurred in South Asia, 36% in sub-Saharan Africa, and 12% in Southeast Asia. Between 1990 and 2015, the global mortality rate due to neonatal tetanus dropped by 90% and that due to non-neonatal tetanus dropped by 81%. However, tetanus mortality rates were still high in a number of countries in 2015. The highest rates of neonatal tetanus mortality (more than 1,000 deaths per 100,000 population) were observed in Somalia, South Sudan, Afghanistan, and Kenya. The highest rates of mortality from tetanus after the neonatal period (more than 5 deaths per 100,000 population) were observed in Somalia, South Sudan, and Kenya. Conclusions Though there have been tremendous strides globally in reducing the burden of tetanus, tens of thousands of unnecessary deaths from tetanus could be prevented each year by an already available inexpensive and effective vaccine. Availability of more high quality data could help narrow the uncertainty of tetanus mortality estimates. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4111-4) contains supplementary material, which is available to authorized users.

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Author and article information

Contributors

Jillian Sherley:

ORCID: http://orcid.org/0000-0002-3642-9752

sherley@ualberta.ca

Sam Newton: Sam.Newton@lshtm.ac.uk

Journal

Journal ID (nlm-ta): Glob Health Res Policy

Journal ID (iso-abbrev): Glob Health Res Policy

Title: Global Health Research and Policy

Publisher: BioMed Central (London )

ISSN (Electronic): 2397-0642

Publication date (Electronic): 30 November 2020

Publication date PMC-release: 30 November 2020

Publication date Collection: 2020

Volume: 5

Electronic Location Identifier: 51

Affiliations

[1 ]GRID grid.4464.2, ISNI 0000 0001 2161 2573, London School of Hygiene & Tropical Medicine, , University of London, ; London, UK

[2 ]GRID grid.9829.a, ISNI 0000000109466120, School of Public Health, , Kwame Nkrumah University of Science and Technology, ; Kumasi, Ghana

Author information

Jillian Sherley http://orcid.org/0000-0002-3642-9752

Article

Publisher ID: 180

DOI: 10.1186/s41256-020-00180-1

PMC ID: 7702667

PubMed ID: 33292868

SO-VID: 329ef2b0-58ac-4d5f-9a6f-8345e628d562

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 15 May 2020

Date accepted : 16 November 2020

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Keywords: tetanus,antenatal,afghanistan,rural,urban

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Keywords: tetanus, antenatal, afghanistan, rural, urban

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The association between area of residence and sufficient antenatal tetanus vaccination in women ages 15–49 in Afghanistan: an analysis of the 2015 DHS dataset

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Most cited references 30

Utilization of maternal health care services in Southern India.

Maternal and neonatal tetanus.

Mortality from tetanus between 1990 and 2015: findings from the global burden of disease study 2015

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