Factors influencing sufficient prenatal tetanus toxoid immunization among women in Kenya

Objectives: Although the effectiveness of tetanus toxoid (TT) immunization during pregnancy in preventing maternal and neonatal tetanus is well established, in many developing countries TT immunizations are not utilized as required. The objective of this study is to identify factors associated with sufficient prenatal TT immunization among women in Kenya. Methods: Secondary data analysis was conducted using de-identified data from the 2008-9 Kenyan Demographic and Health Survey (KDHS) for 1,723 female participants who were pregnant during or within the previous year of the cross-sectional survey. Chi-square tests and t-tests were conducted to assess bivariate associations and a multivariate hierarchical logistic regression analysis was used to examine associations before and after adjustment for socio-demographic, cultural, and access to care factors. Results: The main factors contributing to having been sufficiently immunized against tetanus were having three to four live children (OR =1.52; 95% CI, 1.11, 2.09), women's employment (OR = 1.41; 95% CI, 1.08, 1.87), making joint health-related decisions with a partner (OR = 1.46; 95% CI, 1.08, 1.97), higher number of antenatal care visits (OR = 1.17; 95% CI, 1.07, 1.28) and receiving antenatal care in a government or public health facility (OR = 4.71; 95% CI, 1.91, 11.52). Conclusions: Identification of factors contributing to being sufficiently immunized against tetanus can inform health care providers and other professionals involved in development of strategies and interventions aimed at improving immunization rates in the at-risk prenatal population.