Coverage and factors associated with tetanus toxoid vaccinations status among females of Reproductive age in Peshawar Pakistan./

Date of Award


Document Type


Degree Name

Master of Science in Epidemiology & Biostatistics (MSc Epidemiology & Biostats)


Community Health Sciences


Vaccination of females against tetanus confers immunity not only to females but also to their newborns. It is a cost effective and economical strategy. According to the World Health Organization (WHO), worldwide around 30,000 women 200,000 children die annually due to tetanus. Tetanus is a vaccine preventable disease but unfortunately people are still dying of it. In Pakistan coverage of tetanus toxoid (TT) vaccination of females is low as compared to the neighboring countries; India and Bangladesh. Pakistan is placed in class C category of countries by WHO regarding TT vaccination of females. In Peshawar mostly married females are allowed to get themselves TT vaccination during pregnancy but it is not considered to be essential for the unmarried females. Because of the structure of society females do have difficulty in seeking medical help. The objectives of this study were to estimate the prevalence of TT vaccination among females of reproductive age in Peshawar and to identify the factors associated with TT vaccination status. A community based cross sectional survey was conducted in district Peshawar from July 2002 through September 2002. A total of 646 eligible females of reproductive age were interviewed using a structured questionnaire. Vaccination status of the females was determined, those females who stated that they received at least two TT vaccinations were classified as vaccinated and those who stated that they received either no TT vaccination or one TT vaccination were classified as unvaccinated. According to World Health Organization one vaccination of TT does not confer any protection against tetanus. Overall 65% of the females in district Peshawar were vaccinated against tetanus. The response rate was 99.5%. Two models were built one based on all females and the other m married females. Due to cultural reasons it was not possible to ask some of the questions from unmarried females. The important determinants both for all females and married females were knowledge regarding TT vaccination, source of information and visits of Lady Health Worker (LHw) to a household together with marital status for all females and an interaction between antenatal care visits and knowledge regarding TT vaccination for married female. Among females who did not know that TT vaccination was necessary and had no antenatal care visits were 11 times more likely to be unvaccinated (95% C I: 10.0, 12.1) than those who had at least four antenatal care visits during pregnancy- Females having no source of information as compared to those having source of information through health care staff were more likely to be unvaccinated and females living in households where LHw paid no visit were also more likely to be unvaccinated. It is recommended that LHW programme should be strengthened and health care staff should encourage females to have antenatal care visits and unmarried females to get themselves TT vaccinated. TT vaccination cards should be properly maintained.

This document is available in the relevant AKU library