https://orcid.org/0000-0002-5919-9670
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ABSTRACT
Neonatal tetanus persists as a public health problem in many developing countries including Ethiopia. Maternal tetanus toxoid vaccination is a cornerstone to prevent neonatal tetanus. However, its prevalence is low in Ethiopia, and little has been devoted to its spatial epidemiology and associated factors. Hence, this study aimed to explore the spatial pattern and factors affecting tetanus-unprotected births in Ethiopia. A further analysis of the 2016 Ethiopia Demographic and Health Survey data was conducted, and a weighted sample of 7590 women was used for analysis. Spatial analysis was done using ArcGIS and SaTScan software. A binary logistic regression model was fitted to identify factors and variables with a p-value <.05 were considered as statistically significant. About 54.13% (95% CI: 53.01, 55.25) of births were not protected against neonatal tetanus, and spatial clustering of tetanus unprotected births was observed (Moran’s I = 0.144, p-value = .028). The primary and secondary SaTScan clusters were detected in Northeastern Tigray, Eastern Amhara, and almost the entire Afar (RR = 1.34 & LLR = 66.5, p < .01), and in the Somali region, and the western border of Gambela (RR = 1.44 & LLR = 31.3, p < .01), respectively. Tetanus unprotected births were higher among women without formal education (AOR = 1.63; 95% CI: 1.29, 2.04), came from poor households (AOR = 1.27; 95% CI: 1.12, 1.45), who had no ANC contact (AOR = 6.97; 95% CI: 6.21, 7.88), and who were not exposed to the media (AOR = 1.26; 95% CI: 1.09, 1.47). Hence, tetanus-unprotected birth hotspots require priority interventions, and it is good if the targeted interventions consider the identified factors.
Abbreviations
| AOR | = | Adjusted Odds Ratio |
| AIC | = | Akaike’s Information Criterion |
| COR | = | Crude Odds Ratio |
| EDHS | = | Ethiopian Demographic and Health Survey |
| GWR | = | Geographically Weighted Regressions |
| LLR | = | Log Likelihood Ratio |
| MNT | = | Maternal and Neonatal Tetanus |
| OLS | = | Ordinary Least Squares |
| PCA | = | Principal Component Analysis |
| RR | = | Relative Risk |
| SNNPR | = | Southern Nations Nationalities and People Region |
| SSA | = | Sub-Saharan Africa |
| SIAs | = | Supplementary Immunization Activities |
| TT | = | Tetanus Toxoid |
| UNICEF | = | United Nations Children’s Fund |
| WHA | = | World Health Assembly |
| WHO | = | World Health Organization |
Acknowledgments
We would like to thank the measure DHS program for the on-request open access to its dataset.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Data availability statement
The managed raw data supporting the conclusions of this article will be made available upon reasonable request by the corresponding authors without undue reservation.
Authors’ contribution
All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.
Ethical approval and consent to participate
Ethical approval and participant consent were not necessary since it was a secondary data analysis of publicly available survey data from the measure DHS program. However, the proposal was acknowledged and given full approval by the research and community service coordinator of the College of Health Science, Debre Tabor University (Ref. No: CHS/1951/2023). In addition, we requested DHS Program data archivists and permission be granted to download and use the data for this study from www.measuredhs.com. At all, all the methods were performed in accordance with Helsinki Declaration of 1975.