{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T20:25:09Z","timestamp":1791404709107,"version":"4.3.3"},"reference-count":40,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T00:00:00Z","timestamp":1759104000000},"content-version":"unspecified","delay-in-days":90,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2025,9,8]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Although neonatal tetanus (NNT) has been eliminated in most countries, it remains prevalent in settings where poor hygiene during delivery and low maternal tetanus immunisation coverage persist. Protection against NNT requires at least two doses of tetanus\u2013diphtheria vaccine (Td2+) during pregnancy. In Ghana, despite ongoing elimination efforts, 82 cases of NNT were reported in 2023, highlighting the need to address emerging gaps in surveillance and coverage. This study aimed to determine the prevalence and factors associated with Td2+ uptake among pregnant women in Pru East Municipality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A hospital-based cross-sectional study was conducted among 456 pregnant women from 22nd January to 15th April 2024. Data were collected using structured questionnaires, with Td2+ uptake verified from ANC cards. Descriptive statistics, chi-square tests, and logistic regression were performed in STATA 14. Variables with p \u2264 0.25 were adjusted in the multivariate model with 95% confidence intervals (CIs). Adjusted odds ratios (AORs) were calculated to estimate the strength of association between explanatory variables and Td2+ uptake after controlling for potential confounders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, uptake of Td2+ was 70.2% (95% CI: 66.01\u201374.4). Uptake was linked to early ANC visits [1st (AOR = 2.95) and 2nd (AOR = 2.54)], listening to the radio daily (AOR = 9.23) or weekly (AOR = 4.65), watching television daily (AOR = 1.71) or once a day (AOR = 17.13), frequent internet use (AOR = 1.47), long distance to health facility (AOR = 1.57), high (AOR = 2.47) or moderate (AOR = 3.44) knowledge, good (AOR = 2.26) or fair (AOR = 3.37) attitude, rural residence (AOR = 1.85), being married (AOR = 2.85), formal education (AOR = 2.23), and employment (AOR = 4.27).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The 70.2% uptake of Td2+ was below the 80% target for every district. Achieving the recommended coverage target requires strengthening community outreach, improving health education and improving maternal service accessibility.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2025-003200","type":"journal-article","created":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T11:20:21Z","timestamp":1759144821000},"page":"e003200","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Maternal immunisation towards prevention of neonatal tetanus: insights from a cross-sectional study in Pru East Municipality, Ghana"],"prefix":"10.1136","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1869-7761","authenticated-orcid":false,"given":"Dennis","family":"Bardoe","sequence":"first","affiliation":[{"name":"Department of Public Health Education, Akenten Appiah-Menka University of Skills Training and Entrepreneurial Development, Mampong, Ashanti Region, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Hayford","sequence":"additional","affiliation":[{"name":"Department of Integrated Science Education, Akenten Appiah-Menka University of Skills Training and Entrepreneurial Development, Mampong, Ashanti Region, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isaac","family":"Owusu-Mensah","sequence":"additional","affiliation":[{"name":"Department of Integrated Science Education, Akenten Appiah-Menka University of Skills Training and Entrepreneurial Development, Mampong, Ashanti Region, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert Bagngmen","family":"Bio","sequence":"additional","affiliation":[{"name":"Department of Public Health Education, Akenten Appiah-Menka University of Skills Training and Entrepreneurial Development, Mampong, Ashanti Region, Ghana"},{"name":"Department of Disease Control and Epidemiology, College of Health and Well-Being, Kintampo, Bono East Region, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,9,29]]},"reference":[{"key":"2026010703070113000_3.2.e003200.1","doi-asserted-by":"crossref","first-page":"77","DOI":"10.3390\/vaccines11010077","article-title":"Maternal Tetanus Toxoid Vaccination in Benin: Evidence from the Demographic and Health Survey","volume":"11","author":"Amoak","year":"2023","journal-title":"Vaccines (Basel)"},{"key":"2026010703070113000_3.2.e003200.2","unstructured":"WHO . Tetanus. 2024. Available: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/tetanus"},{"key":"2026010703070113000_3.2.e003200.3","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1093\/tropej\/fmz054","article-title":"The Prevalence and Case-Fatality Rates of Post-Neonatal Tetanus in a Population of Hospitalized Nigerian Children: An 8-Year Retrospective Review","volume":"66","author":"Okike","year":"2020","journal-title":"J Trop Pediatr"},{"key":"2026010703070113000_3.2.e003200.4","unstructured":"WHO . Tetanus reported cases and incidence. 2025. Available: https:\/\/immunizationdata.who.int\/global\/wiise-detail-page\/tetanus-reported-cases-and-incidence?CODE=Global&DISEASE=TTETANUS&YEAR="},{"key":"2026010703070113000_3.2.e003200.5","unstructured":"George EK , Jesus O , Tobin EH , et al . Tetanus (clostridium tetani infection). In: StatPearls. Treasure Island: StatPearls, 2025."},{"key":"2026010703070113000_3.2.e003200.6","unstructured":"Bae C , Tetanus BD . StatPearls. Treasure Island (FL): StatPearls Publishing, 2025."},{"key":"2026010703070113000_3.2.e003200.7","unstructured":"WHO . The strategies. 2025. Available: https:\/\/www.who.int\/initiatives\/maternal-and-neonatal-tetanus-elimination-(mnte)\/the-strategies"},{"key":"2026010703070113000_3.2.e003200.8","doi-asserted-by":"crossref","first-page":"42","DOI":"10.60014\/pmjg.v5i1.97","article-title":"Neonatal Tetanus in Northern Region, Ghana \u2013 A Case Report","volume":"5","author":"Abdul-Mumin","year":"2016","journal-title":"pmjg"},{"key":"2026010703070113000_3.2.e003200.9","unstructured":"UNICEF . 6 ways UNICEF is supporting immunisation in Ghana | UNICEF Ghana. 2024. Available: https:\/\/www.unicef.org\/ghana\/stories\/6-ways-unicef-supporting-immunisation-ghana%E2%80%AF"},{"key":"2026010703070113000_3.2.e003200.10","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0010010","article-title":"A ten-year review of neonatal tetanus cases managed at a tertiary health facility in a resource poor setting: The trend, management challenges and outcome","volume":"15","author":"Ogundare","year":"2021","journal-title":"PLoS Negl Trop Dis"},{"key":"2026010703070113000_3.2.e003200.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2021.11.005"},{"key":"2026010703070113000_3.2.e003200.12","unstructured":"Ghana Statistical Service . Pru east (district, Ghana) - population statistics, charts, map and location. 2021. Available: https:\/\/www.citypopulation.de\/en\/ghana\/admin\/bono_east\/1106__pru_east\/"},{"key":"2026010703070113000_3.2.e003200.13","doi-asserted-by":"crossref","DOI":"10.3390\/vaccines10071038","article-title":"Access to Vaccination among Disadvantaged, Isolated and Difficult-to-Reach Communities in the WHO European Region: A Systematic Review","volume":"10","author":"Ekezie","year":"2022","journal-title":"Vaccines (Basel)"},{"key":"2026010703070113000_3.2.e003200.14","unstructured":"Ghana Health Service . Bono east region \u2013 Ghana health service. 2023. Available: https:\/\/ghs.gov.gh\/bono-east\/"},{"key":"2026010703070113000_3.2.e003200.15","doi-asserted-by":"crossref","unstructured":"Bardoe D , Hayford D , Bio RB , et al . Prevalence and Correlates of Hepatitis B in Pregnancy: Evidence From a Cross\u2010Sectional Study in Bono East Region, Ghana. Health Science Reports 2025;8. doi:10.1002\/hsr2.71263","DOI":"10.1002\/hsr2.71263"},{"key":"2026010703070113000_3.2.e003200.16","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-024-11347-8","article-title":"Assessment of expanded programme on immunization routine data quality in the upper east region of Ghana","volume":"24","author":"Piu","year":"2024","journal-title":"BMC Health Serv Res"},{"key":"2026010703070113000_3.2.e003200.17","doi-asserted-by":"crossref","DOI":"10.1177\/25151355241305855","article-title":"Factors associated with tetanus toxoid vaccine utilization among reproductive-age women in Debre Markos town, Ethiopia, 2021: a cross-sectional study","volume":"12","author":"Tamiru","year":"2024","journal-title":"Ther Adv Vaccines Immunother"},{"key":"2026010703070113000_3.2.e003200.18","unstructured":"GSS . Ghana DHS 2022 - final report. 2024."},{"key":"2026010703070113000_3.2.e003200.19","unstructured":"GSS . Ghana demographic and health survey (GDHS) 2022 report. 2022. Available: https:\/\/www.statsghana.gov.gh\/headlines.php?slidelocks=NjMzMzk0MDg5MC4zNg==\/headlines\/5352088335"},{"key":"2026010703070113000_3.2.e003200.20","doi-asserted-by":"crossref","DOI":"10.1155\/2021\/5529315","article-title":"Tetanus Toxoid Vaccination Coverage and Associated Factors among Childbearing Women in Ethiopia: A Systematic Review and Meta-Analysis","volume":"2021","author":"Nigussie","year":"2021","journal-title":"Biomed Res Int"},{"key":"2026010703070113000_3.2.e003200.21","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0316939","article-title":"A study of association between maternal tetanus toxoid immunization and neonatal mortality in the context of Bangladesh","volume":"20","author":"Naha","year":"2025","journal-title":"PLoS One"},{"key":"2026010703070113000_3.2.e003200.22","doi-asserted-by":"crossref","DOI":"10.3390\/vaccines11071268","article-title":"Predictors of Tetanus Vaccine Uptake among Pregnant Women in Khartoum State, Sudan: A Hospital-Based Cross-Sectional Study","volume":"11","author":"Ibrahim","year":"2023","journal-title":"Vaccines (Basel)"},{"key":"2026010703070113000_3.2.e003200.23","doi-asserted-by":"crossref","first-page":"1911","DOI":"10.2147\/RMHP.S519479","article-title":"Vaccine Hesitancy and Immunization Patterns in Central and Eastern Europe: Sociocultural, Economic, Political, and Digital Influences Across Seven Countries","volume":"18","author":"Kurpas","year":"2025","journal-title":"Risk Manag Healthc Policy"},{"key":"2026010703070113000_3.2.e003200.24","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0004826","article-title":"From need to neglect: Exploring psychological barriers to preventive interventions in pregnancy","volume":"5","author":"Bardoe","year":"2025","journal-title":"PLOS Glob Public Health"},{"key":"2026010703070113000_3.2.e003200.25","doi-asserted-by":"crossref","DOI":"10.1016\/j.heliyon.2025.e43019","article-title":"Towards improved maternal health: Navigating non-compliance with integrated viral hepatitis B and malaria interventions among pregnant women in Bono East, Ghana","volume":"11","author":"Bardoe","year":"2025","journal-title":"Heliyon"},{"key":"2026010703070113000_3.2.e003200.26","doi-asserted-by":"crossref","DOI":"10.1080\/21645515.2024.2411823","article-title":"Facilitators and barriers to maternal immunization and strategies to improve uptake in low-income and lower-middle income countries: A systematic review","volume":"20","author":"Khan","year":"2024","journal-title":"Hum Vaccin Immunother"},{"key":"2026010703070113000_3.2.e003200.27","doi-asserted-by":"crossref","unstructured":"Abah MG , Asuquo OA , Inyangetoh EC . Knowledge and Behaviour Towards Tetanus Toxoid Immunisation in South-South, Nigeria: Findings from Antenatal Clinic Attendees. AJAS 2019;7. doi:10.24203\/ajas.v7i5.5785","DOI":"10.24203\/ajas.v7i5.5785"},{"key":"2026010703070113000_3.2.e003200.28","doi-asserted-by":"crossref","first-page":"154","DOI":"10.4103\/tcmj.tcmj_55_18","article-title":"Knowledge about and preventive practices against neonatal tetanus among young Nigerian women","volume":"31","author":"Adegbenro","year":"2019","journal-title":"Tzu Chi Med J"},{"key":"2026010703070113000_3.2.e003200.29","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-024-84481-2","article-title":"Prevalence and determinants of full vaccination coverage according to the national schedule among children aged 12-35 months in Ghana","volume":"15","author":"Tekeba","year":"2025","journal-title":"Sci Rep"},{"key":"2026010703070113000_3.2.e003200.30","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-019-7847-1","article-title":"Antenatal visits are positively associated with uptake of tetanus toxoid and intermittent preventive treatment in pregnancy in Ivory Coast","volume":"19","author":"Yaya","year":"2019","journal-title":"BMC Public Health"},{"key":"2026010703070113000_3.2.e003200.31","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-020-08985-y","article-title":"Prevalence and predictors of taking tetanus toxoid vaccine in pregnancy: a cross-sectional study of 8,722 women in Sierra Leone","volume":"20","author":"Yaya","year":"2020","journal-title":"BMC Public Health"},{"key":"2026010703070113000_3.2.e003200.32","doi-asserted-by":"crossref","DOI":"10.1186\/s41182-023-00519-7","article-title":"Public relations strategies employed by the Ghana Health Service to address COVID-19 vaccine hesitancy: a qualitative inquiry","volume":"51","author":"McCarthy","year":"2023","journal-title":"Trop Med Health"},{"key":"2026010703070113000_3.2.e003200.33","unstructured":"Anlimah J . Media called to action as Ghana pushes for SDG health targets through immunization. 2025. Available: https:\/\/www.gbcghanaonline.com\/news\/health\/media-called-to-action\/2025\/"},{"key":"2026010703070113000_3.2.e003200.34","doi-asserted-by":"crossref","first-page":"e1610","DOI":"10.1016\/S2214-109X(21)00338-7","article-title":"Progress and barriers towards maternal and neonatal tetanus elimination in the remaining 12 countries: a systematic review","volume":"9","author":"Yusuf","year":"2021","journal-title":"Lancet Glob Health"},{"key":"2026010703070113000_3.2.e003200.35","doi-asserted-by":"crossref","DOI":"10.3389\/fgwh.2025.1481771","article-title":"Determinants of tetanus immunization among pregnant women where tetanus has not been eliminated: a multilevel analysis of 6 countries","volume":"6","author":"Tilahun","year":"2025","journal-title":"Front Glob Womens Health"},{"key":"2026010703070113000_3.2.e003200.36","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-024-06747-x","article-title":"Facilitating and limiting factors of cultural norms influencing use of maternal health services in primary health care facilities in Kogi State, Nigeria; a focused ethnographic research on Igala women","volume":"24","author":"Opara","year":"2024","journal-title":"BMC Pregnancy Childbirth"},{"key":"2026010703070113000_3.2.e003200.37","doi-asserted-by":"crossref","DOI":"10.1186\/s12936-024-05120-9","article-title":"Assessing the prevalence, risk factors, and socio-demographic predictors of malaria among pregnant women in the Bono East Region of Ghana: a multicentre hospital-based mixed-method cross-sectional study","volume":"23","author":"Bardoe","year":"2024","journal-title":"Malar J"},{"key":"2026010703070113000_3.2.e003200.38","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0296174","article-title":"Prevalence and correlates of tetanus toxoid uptake among women in sub-Saharan Africa: Multilevel analysis of demographic and health survey data","volume":"18","author":"Aboagye","year":"2023","journal-title":"PLoS One"},{"key":"2026010703070113000_3.2.e003200.39","doi-asserted-by":"crossref","DOI":"10.1080\/21645515.2024.2352905","article-title":"Number of tetanus toxoid injections before birth and associated factors among pregnant women in low and middle income countries: Negative binomial poisson regression","volume":"20","author":"Zegeye","year":"2024","journal-title":"Hum Vaccin Immunother"},{"key":"2026010703070113000_3.2.e003200.40","doi-asserted-by":"crossref","first-page":"1105495","DOI":"10.3389\/fpubh.2023.1105495","article-title":"Implementation of the Community-based Health Planning and Services (CHPS) in rural and urban Ghana: a history and systematic review of what works, for whom and why","volume":"11","author":"Elsey","year":"2023","journal-title":"Front Public Health"}],"container-title":["BMJ Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjph-2025-003200","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T11:09:10Z","timestamp":1767784150000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjpublichealth.bmj.com\/lookup\/doi\/10.1136\/bmjph-2025-003200"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7]]},"references-count":40,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,9,29]]},"published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1136\/bmjph-2025-003200"],"URL":"https:\/\/doi.org\/10.1136\/bmjph-2025-003200","relation":{},"ISSN":["2753-4294"],"issn-type":[{"value":"2753-4294","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7]]}}}