Peer-reviewed article
Determinants of the Number of Tetanus‐Toxoid Injections Before Birth Among Pregnant Women in Somalia: A Multilevel Analysis
Jama Mohamed, Hamse Mohamed Amoud, Ahmed Ismail Mohamed, Abdisalam Hassan Muse, Azizur Rahman et al. ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5This study looked at why so few pregnant women in Somalia receive tetanus vaccinations, which protect both mothers and newborns from a dangerous but preventable infection. Using national survey data from over 4,800 pregnant women, the researchers found that only about a third had received any tetanus vaccine before giving birth. Women who were older, wealthier, employed, had health insurance, or attended more antenatal visits were more likely to be vaccinated. Nomadic women, those delivering at home, and those with less-educated husbands were more likely to have received no vaccine at all.
Key points
- Only 32.6% of pregnant women received at least one tetanus-toxoid injection; 67.4% received none
- Health insurance was linked to much higher vaccine uptake (IRR = 5.24)
- Nomadic women were more likely to have zero vaccine uptake (AOR = 1.40)
- More antenatal care visits were linked to higher vaccination (IRR = 1.02 per visit)
- Home delivery and lack of phone ownership were linked to higher odds of no vaccination
Limitations
The study is based on a cross-sectional survey, so it cannot show whether these factors directly cause low vaccination, only that they are statistically associated with it.
Abstract
Background: Maternal and neonatal tetanus remains a major public health concern in Somalia, where low immunization coverage contributes to preventable mortality. Despite global progress, Somalia continues to report suboptimal tetanus-toxoid (TT) vaccine uptake due to conflict, weak health systems, and socioeconomic barriers. This study examined multilevel factors associated with the number of TT injections before birth among Somali women. Methods: We analyzed data from the Somali Health and Demographic Survey (2020), including 4841 pregnant women aged 15-49. A mixed-effects negative binomial regression model addressed overdispersion, excess zeros, and hierarchical structure (region and residence). Model fit was assessed using Akaike (AIC) and Bayesian (BIC) information criteria. Results: Only 32.6% of women received at least one TT injection, whereas 67.4% received none. Higher TT uptake was associated with older age (IRR = 1.62; 95% CI = 1.09-2.42), higher wealth (IRR = 1.49; 95% CI = 1.01-2.18), prior vaccination (IRR = 1.76; 95% CI = 1.44-2.16), antenatal care visits (IRR = 1.02; 95% CI = 1.01-1.04), employment (IRR = 1.41; 95% CI = 1.00-1.97), clinic deliveries (IRR = 1.23; 95% CI = 1.01-1.50), and health insurance (IRR = 5.24; 95% CI = 1.04-26.47). Conversely, zero uptake was more likely among nomadic women (AOR = 1.40; 95% CI = 1.06-1.85), those with no prior vaccination (AOR = 3.64; 95% CI = 2.76-4.80), home deliveries (AOR = 1.42; 95% CI = 1.18-1.71), no phone ownership (AOR = 1.31; 95% CI = 1.02-1.68), and women whose husbands lacked education (AOR = 1.27; 95% CI = 1.02-1.58). Conclusion: TT vaccine coverage among pregnant women in Somalia remains critically low and is shaped by socioeconomic inequities, healthcare access, and household decision-making. Strengthening antenatal care integration, targeted outreach for nomadic populations, economic empowerment, health education, and expanding insurance coverage are essential to improve maternal immunization and eliminate neonatal tetanus.