{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T18:12:15Z","timestamp":1789409535379,"version":"build-2803163510"},"reference-count":38,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2022,3,24]],"date-time":"2022-03-24T00:00:00Z","timestamp":1648080000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Background<\/jats:title><jats:p>Tetanus is a deadly bacterial infection caused by Clostridium tetani wound contamination characterized muscular spasms and autonomic nervous system dysfunction. Maternal and neonatal tetanus occurs under improper hygiene practices during childbirth. Globally, an estimated 3.3 million newborn deaths occur every year, and about 9,000 babies die every day in the first 28 days of life. This study sought to identify risk factors associated with the immunization of rural women against tetanus in rural areas in ten East African countries.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Method<\/jats:title><jats:p>The data used in this study were taken from the Demographic and Health Survey (DHS) of ten East African countries (Ethiopia, Burundi, Comoros, Zimbabwe, Kenya, Malawi, Ruanda, Tanzania, Uganda and, Zambia). Multivariable binary logistic regression is used to determine the risk factors associated with tetanus-protected women in east Africa.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Results<\/jats:title><jats:p>The weighted total samples of 73735 rural women were included in the analysis. The combined prevalence of tetanus immunization among protected rural women in ten East African countries was 50.4%. Those women with age of 24\u201334 (AOR = 0.778; 95%CI: 0.702\u20130.861), higher educational level (AOR = 4.010; 95%CI: 2.10\u20135.670), rich women (AOR = 3.097;95%CI: 2.680\u20133.583), mass media coverage<jats:bold>(<\/jats:bold>AOR = 1.143; 95%CI: 1.030\u20131.269<jats:bold>),<\/jats:bold>having above three antenatal care follow up (AOR = 1.550; 95% CI: 1.424\u20131.687), big problem of distance to health facility (AOR = 0.676; CI: 0.482\u20130.978) and place of delivery health facility (AOR = 1.103; 95% CI: 1.005\u20131.210) had a significant effect on women\u2019s protected from tetanus.<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Conclusion<\/jats:title><jats:p>The coverage of tetanus immunization in East Africa was very low. Public health programs target rural mothers who are uneducated, poor households, longer distances from health facilities, mothers who have the problem of media exposure, and mothers who have not used maternal health care services to promote TT immunization.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0265906","type":"journal-article","created":{"date-parts":[[2022,3,24]],"date-time":"2022-03-24T21:54:03Z","timestamp":1648158843000},"page":"e0265906","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":23,"title":["Prevalence and risk factors associated with rural women\u2019s protected against tetanus in East Africa: Evidence from demographic and health surveys of ten East African countries"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1102-9621","authenticated-orcid":true,"given":"Alebachew Taye","family":"Belay","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4006-3455","authenticated-orcid":true,"given":"Setegn Much","family":"Fenta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Setegn Bayabil","family":"Agegn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2413-8026","authenticated-orcid":true,"given":"Mitiku Wale","family":"Muluneh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,3,24]]},"reference":[{"issue":"suppl_1","key":"pone.0265906.ref001","doi-asserted-by":"crossref","first-page":"i102","DOI":"10.1093\/ije\/dyq027","article-title":"Tetanus toxoid immunization to reduce mortality from neonatal tetanus","volume":"39","author":"H. Blencowe","year":"2010","journal-title":"International journal of epidemiology"},{"issue":"15","key":"pone.0265906.ref002","doi-asserted-by":"crossref","first-page":"103","DOI":"10.29245\/2578-3009\/2018\/si.1115","article-title":"Maternal and neonatal tetanus elimination (MNTE) in the WHO African region","author":"E.S. Messeret","year":"2018","journal-title":"Journal of immunological sciences"},{"issue":"10077","key":"pone.0265906.ref003","doi-asserted-by":"crossref","first-page":"1380","DOI":"10.1016\/S0140-6736(17)30635-9","article-title":"Eliminating maternal and neonatal tetanus and closing the immunity gap","volume":"389","author":"C. Burgess","year":"2017","journal-title":"The Lancet"},{"issue":"1","key":"pone.0265906.ref004","first-page":"1","article-title":"Knowledge and health beliefs of reproductive-age women in Alexandria about tetanus toxoid immunization","volume":"95","author":"A. Mehanna","year":"2020","journal-title":"Journal of the Egyptian Public Health Association"},{"issue":"18","key":"pone.0265906.ref005","first-page":"173","article-title":"Progress towards maternal and neonatal tetanus elimination\u2014worldwide, 2000-2018\/Progres accomplis en vue de l\u2019elimination du tetanus maternel et neonatal dans le monde, 2000\u20132018","volume":"95","author":"H.N. Njuguna","year":"2020","journal-title":"Weekly Epidemiological Record"},{"issue":"3\u20134","key":"pone.0265906.ref006","first-page":"e151","article-title":"Elimination of maternal and neonatal tetanus: a 21st-century challenge","volume":"5","author":"S. Owusu-Darko","year":"2012","journal-title":"Reviews in Obstetrics and Gynecology"},{"key":"pone.0265906.ref007","unstructured":"Organization, W.H., Maternal and neonatal tetanus elimination by 2005: strategies for achieving and maintaining elimination, 2002, World Health Organization."},{"issue":"6","key":"pone.0265906.ref008","first-page":"53","article-title":"Tetanus vaccines: WHO position paper\u2013February 2017","volume":"92","author":"W.H. Organization","year":"2017","journal-title":"Wkly Epidemiol Rec"},{"key":"pone.0265906.ref009","first-page":"171","article-title":"Maternal and neonatal tetanus elimination: from protecting women and newborns to protecting all","volume":"7","author":"R. Khan","year":"2015","journal-title":"International journal of women\u2019s health"},{"issue":"3","key":"pone.0265906.ref010","first-page":"233","article-title":"Tetanus toxoid immunization coverage among mothers of below one year of age in difficult-to-reach area of Lagos Metropolis","volume":"6","author":"A. Adeiga","year":"2005","journal-title":"African Journal of Clinical and Experimental Microbiology"},{"key":"pone.0265906.ref011","author":"P. Unicef","year":"2010","journal-title":"Maternal and neonatal tetanus elimination initiative pampers UNICEF 2010 campaign launch"},{"key":"pone.0265906.ref012","doi-asserted-by":"crossref","DOI":"10.1155\/2018\/2839579","article-title":"Tetanus toxoid immunization status and associated factors among mothers in Damboya Woreda, Kembata Tembaro zone, SNNP, Ethiopia","volume":"2018","author":"M. Dubale Mamoro","year":"2018","journal-title":"Journal of nutrition and metabolism"},{"issue":"12","key":"pone.0265906.ref013","doi-asserted-by":"crossref","first-page":"e0243071","DOI":"10.1371\/journal.pone.0243071","article-title":"Determinants of births protected against neonatal tetanus in Ethiopia: A multilevel analysis using EDHS 2016 data","volume":"15","author":"A.B. Teshale","year":"2020","journal-title":"PloS one"},{"issue":"1","key":"pone.0265906.ref014","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1824-7288-40-29","article-title":"Prevalence and socio-demographic factors associated with non-protective immunity against tetanus among high school adolescents girls in Nigeria","volume":"40","author":"A.E. Orimadegun","year":"2014","journal-title":"Italian journal of pediatrics"},{"issue":"3","key":"pone.0265906.ref015","first-page":"153","article-title":"Factors influencing TT immunization coverage and protection at birth coverage in Tselemti District, Ethiopia","volume":"18","author":"T. Kidane","year":"2004","journal-title":"Ethiopian Journal of Health Development"},{"key":"pone.0265906.ref016","article-title":"Determinants of the utilization of the tetanus toxoid (TT) vaccination coverage in Bangladesh: evidence from a Bangladesh demographic health survey 2004","volume":"8","author":"M. Mohammad","year":"2008","journal-title":"The Internet Journal of Health"},{"issue":"3","key":"pone.0265906.ref017","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1007\/s10900-012-9638-9","article-title":"Determinants of utilization of sufficient tetanus toxoid immunization during pregnancy: evidence from the Kenya demographic and health survey, 2008\u20132009","volume":"38","author":"Z.T. Haile","year":"2013","journal-title":"Journal of community health"},{"issue":"1","key":"pone.0265906.ref018","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12914-018-0168-0","article-title":"Determinants and perceptions of the utilization of tetanus toxoid immunization among reproductive-age women in Dukem Town, Eastern Ethiopia: a community-based cross-sectional study","volume":"18","author":"M.D. Anatea","year":"2018","journal-title":"BMC international health and human rights"},{"key":"pone.0265906.ref019","doi-asserted-by":"crossref","DOI":"10.1016\/j.vaccine.2015.07.084","volume-title":"Maternal immunization\u2013Promises and concerns","author":"J.A. Englund","year":"2015"},{"issue":"7","key":"pone.0265906.ref020","doi-asserted-by":"crossref","first-page":"e197","DOI":"10.1016\/S1473-3099(17)30229-3","article-title":"Maternal immunisation: collaborating with mother nature","volume":"17","author":"A. Marchant","year":"2017","journal-title":"The lancet infectious diseases"},{"issue":"6","key":"pone.0265906.ref021","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1097\/MOP.0000000000000553","article-title":"Vaccination during pregnancy: first line of defense for expecting mothers and vulnerable young infants","volume":"29","author":"C.-N. Bethancourt","year":"2017","journal-title":"Current opinion in pediatrics"},{"issue":"14","key":"pone.0265906.ref022","doi-asserted-by":"crossref","first-page":"R713","DOI":"10.1016\/j.cub.2017.05.064","article-title":"Animal communication: when i\u2019m calling you, will you answer too?","volume":"27","author":"N.J. Vickers","year":"2017","journal-title":"Current biology"},{"issue":"1","key":"pone.0265906.ref023","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18488\/journal.107.2013.11.1.14","article-title":"Maternal health-care in India: the case of tetanus toxoid vaccination","volume":"1","author":"R.E.A. Khan","year":"2013","journal-title":"Asian Development Policy Review"},{"issue":"9603","key":"pone.0265906.ref024","doi-asserted-by":"crossref","first-page":"1947","DOI":"10.1016\/S0140-6736(07)61261-6","article-title":"Maternal and neonatal tetanus","volume":"370","author":"M.H. Roper","year":"2007","journal-title":"The Lancet"},{"key":"pone.0265906.ref025","first-page":"130","volume-title":"World Bank. State of the world\u2019s vaccines and immunization","author":"U. Who","year":"2009"},{"key":"pone.0265906.ref026","volume-title":"Guide to DHS statistics, DHS-7. The Demographic and health surveys program","author":"T.N. Croft","year":"2018"},{"key":"pone.0265906.ref027","article-title":"Binary logistic regression","volume":"20","author":"M. Tranmer","year":"2008","journal-title":"Cathie Marsh for census and survey research, paper"},{"key":"pone.0265906.ref028","doi-asserted-by":"crossref","DOI":"10.1155\/2020\/4023031","article-title":"Tetanus toxoid vaccination uptake and associated factors among mothers who gave birth in the last 12 months in Errer District, Somali regional state, Eastern Ethiopia","volume":"2020","author":"T.S. Gebremedhin","year":"2020","journal-title":"BioMed Research International"},{"issue":"1","key":"pone.0265906.ref029","doi-asserted-by":"crossref","DOI":"10.4314\/ejhd.v24i1.62953","article-title":"Maternal mortality trend in Ethiopia","volume":"24","author":"A. Abdella","year":"2010","journal-title":"Ethiopian Journal of Health Development"},{"key":"pone.0265906.ref030","doi-asserted-by":"crossref","first-page":"57","DOI":"10.30541\/v40i1pp.57-70","article-title":"Factors affecting childhood immunisation in Bangladesh","author":"S.C. Biswas","year":"2001","journal-title":"The Pakistan development review"},{"issue":"1","key":"pone.0265906.ref031","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12889-015-2315-z","article-title":"Individual and community level determinants of childhood full immunization in Ethiopia: a multilevel analysis","volume":"15","author":"S.A. Abadura","year":"2015","journal-title":"BMC public health"},{"issue":"6","key":"pone.0265906.ref032","doi-asserted-by":"crossref","first-page":"e0253126","DOI":"10.1371\/journal.pone.0253126","article-title":"Factors associated with births protected against neonatal tetanus in Africa: Evidences from Demographic and health surveys of five African countries","volume":"16","author":"Y. Yeshaw","year":"2021","journal-title":"Plos one"},{"issue":"22","key":"pone.0265906.ref033","doi-asserted-by":"crossref","first-page":"2543","DOI":"10.1016\/j.vaccine.2013.04.023","article-title":"Teenagers\u2019 understandings of and attitudes towards vaccines and vaccine-preventable diseases: a qualitative study","volume":"31","author":"S. Hilton","year":"2013","journal-title":"Vaccine"},{"issue":"4","key":"pone.0265906.ref034","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1007\/s00431-019-03511-8","article-title":"Experts\u2019 opinion for improving global adolescent vaccination rates: a call to action","volume":"179","author":"C. Azzari","year":"2020","journal-title":"European journal of pediatrics"},{"issue":"1","key":"pone.0265906.ref035","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13690-021-00622-3","article-title":"Individual and community-level determinants of poor tetanus toxoid immunization among pregnant women in Ethiopia using data from 2016 Ethiopian demographic and health survey; multilevel analysis","volume":"79","author":"A.M. Liyew","year":"2021","journal-title":"Archives of Public Health"},{"issue":"1","key":"pone.0265906.ref036","first-page":"91","article-title":"Factors associated with TT (tetanus toxoid) immunization among pregnant women, in Saparua, Maluku, Indonesia","volume":"31","author":"B. Roosihermiatie","year":"2000","journal-title":"Southeast Asian Journal of tropical medicine and public health"},{"issue":"5","key":"pone.0265906.ref037","first-page":"359","article-title":"Tetanus immunization in pregnant women: evaluation of maternal tetanus vaccination status and factors affecting rate of vaccination coverage","volume":"115","author":"I. Maral","year":"2001","journal-title":"Public health"},{"key":"pone.0265906.ref038","doi-asserted-by":"crossref","first-page":"1","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":"S. Yaya","year":"2020","journal-title":"BMC public health"}],"updated-by":[{"DOI":"10.1371\/journal.pone.0315193","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2024,12,4]],"date-time":"2024-12-04T00:00:00Z","timestamp":1733270400000}}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0265906","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,20]],"date-time":"2024-09-20T22:55:43Z","timestamp":1726872943000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0265906"}},"subtitle":[],"editor":[{"given":"Jos\u00e9 Antonio","family":"Ortega","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,3,24]]},"references-count":38,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,3,24]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0265906","relation":{"correction":[{"id-type":"doi","id":"10.1371\/journal.pone.0315193","asserted-by":"object"}]},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,24]]}}}