Tetanus immunization in pregnant women: evaluation of maternal tetanus vaccination status and factors affecting rate of vaccination coverage I Maral 1 *, Z Baykan 1 , FN Aksakal 1 , F Kayikcioglu 2 and MA Bumin 1 1 Department of Public Health at Gazi University Faculty of Medicine, Ankara, Turkey; and 2 Department of Obstetrics and Gynaecology at Social Insurance Hospital, Ankara, Turkey The objectives of this study were to determine the tetanus vaccination status for pregnant women, and to examine the effects of various factors on tetanus toxoid (TT) vaccination coverage during pregnancy in reproductive-age women. Four-hundred and ninety-three postpartum women who had live births at a hospital in Ankara were interviewed and information was collected on the mothers’ sociodemographic characteristics, TT vaccination history, and prenatal care during the pregnancy studied. The rates for no vaccination, one-dose vaccination, and two-dose vaccination were 53.3%, 18.9%, and 27.8%, respectively. The vaccinated women (with at least one dose) were significantly younger, of lower parity, and had attended more prenatal care visits than the unvaccinated women. Of the women who attended at least one prenatal care check-up, only about half were vaccinated. Significantly more rural women were vaccinated against tetanus than urban women. Current vaccination rates with TT during pregnancy were found to be well below universal levels. Turkey needs to launch effective mass media campaigns that target urban and suburban populations, and inform and motivate women to request vaccination against tetanus. Public Health (2001) 115, 359–364. Keywords: pregnant women; tetanus vaccination status Introduction Although tetanus vaccine has been available for years, neonatal tetanus (NT) remains one of the leading causes of infant mortality in many developing countries. 1,2 The disease has been virtually eliminated in the more indus- trialized nations through widespread childhood vaccination and improved conditions at delivery. In the past decade, there has been only one reported case of NT in the United States. 3 In 1989, the World Health Organization (WHO) set a target of eliminating NT by 1995 to 2000; 4 however, unfortunately, this disease still causes an estimated 400 000 deaths annually throughout the world 5 and accounts for 23 – 73% of all neonatal deaths in developing countries. 5–8 Successful control of NT hinges on both improved obstetric and postnatal care, and active immunization of women with tetanus toxoid (TT) before or during preg- nancy. A number of studies done in developing nations have demonstrated the efficacy of TT vaccination of pregnant women in decreasing deaths due to NT. 8 – 11 The WHO guidelines for immunizing primarily nonimmunized or partially immunized women in developing countries recommend administration of five doses of TT during reproductive age to guarantee long-term immunity. 11 In Turkey, although the incidence of NT has been on the decline, the disease continues to be a significant public health problem, especially in regions where home delivery is common, such as the southeast. 12 In 1992, Yalcin et al 13 reported on 43 cases of NT that were seen between 1982 and 1989 at a university hospital in Istanbul, a metropolitan centre that offers a broad spectrum of health facilities and services. They noted that even some people that live in the more prosperous parts of the country, the so-called ‘urban poor’, remain at high risk of contracting this preventable disease. In 1994, in an effort to eliminate NT as a public health issue, the Turkish Ministry of Health implemented a vaccination schedule for immunizing pregnant women against tetanus, in accordance with the WHO guidelines. 14 To achieve adequate immunization, the schedule recom- mends that every nonimmunized pregnant woman be vac- cinated with two doses of TT; however, if a woman has been vaccinated during the last 5 y, one dose of TT should be adequate. In practice, if the previous vaccination history can not be documented, each woman should receive two injections of TT during pregnancy. *Correspondence: I Maral, 12.Sok 17=6 Dadak Apt. Bahcelievler, 06490, Ankara, Turkey. E-mail: maral@med.gazi.edu.tr Accepted 25 April 2001 Public Health (2001) 115, 359–364 ß R.I.P.H.H. 2001 www.nature.com/ph