Peer-reviewed article

Adequate tetanus toxoid immunization and its correlates among married women with a recent live birth in Afghanistan: Insights from a national survey.

Muhammad Haroon Stanikzai, Essa Tawfiq, Zainab Ezadi, Massoma Jafari, Omid Dadras · 2 Sept 2026

Abstract

This study aimed to determine the prevalence and correlates of adequate tetanus toxoid (TT) immunization among married women in Afghanistan. This cross-sectional study analyzed data from the 2022-2023 Afghanistan Multiple Indicator Cluster Survey (MICS), focusing on 12,450 married women aged 15-49y who had a live birth in the two years preceding the survey. Multivariable logistic regression determined the correlates of adequate TT immunization. The prevalence of adequate TT immunization was 49.9% (95% CI 48.2%-51.6%). The odds of adequate TT immunization were higher in women with primary (AOR 1.32) and secondary/higher (AOR 1.57) education, in women who used 1-3 (AOR 3.06) and ≥4 (AOR 4.67) antenatal care (ANC) visits, those living in Central High region (AOR 4.20), those with access to media (AOR 1.29), and in women belonging to second (AOR 1.33), third (AOR 1.25) and fourth (AOR 1.26) household wealth quintiles. On the other hand, the likelihood of adequate TT immunization was lower in women aged 40-49y (AOR 0.76) and those living in the East (AOR 0.76) and West (AOR 0.68) regions of Afghanistan. Only half of married women in Afghanistan had adequate TT immunization, highlighting substantial gaps in coverage. Strengthening health education, improving equitable access to immunization services, and enhancing communication through mass media; particularly targeting older, less-educated, and economically disadvantaged women, are essential to improve TT coverage and progress toward maternal and neonatal tetanus elimination in Afghanistan.