DEBREMARKOS UNIVERSTY

COLLEGE OF HEALTH SCIENCE

DEPARTMENT OF MIDWIFERY
TETANUS TOXOID VACCINE UTILIZATION AND
ASSOCCIATED FACTORS AMONG CHILD BEARING
WOMEN IN DANGILA TAWON AMHARA REGION NORTH
WEST ETHIOPIA 2018.
By ID.NO
 AGERU TESFIE 1191/07
 YALEW MEKONEN 1226/07
 MEAZA SHITAYE 1212/07
 AMANUEL MULATIE 1194/07
 YESHIWORK ENDALEW 1227/07
ADVISORS
 MR BELSTI TEMESGEN (BSC MSC)
 MR NAKACHEW MEKONEN (BSC, MPH in health education)
Research submitted to Debre Markos University College of health science for
partial fulfillment of the requirement of the degree of Bachelor of Science in
midwifery.
March, 2018

Debre Markos, Ethiopia

i
 AKNOWLEDMENT
 First and for most we would like to express our deepest gratitude and appreciation to our
advisors MR Belsti T (BSC, MSC) & MR Nakachew M (BSC, MSC in PH) for their
unreserved all rounded, support and enriching comment throughout the study period.
 Our special tank goes to Debremarkos University College of medicine and health
sciences, and Department of midwifery for giving this chance to conduct the study in our
carrier by selecting such an interesting researchable title and providing material support.
 We also would like to tank Dangila town culture and tourism office for giving
information about Dangila town population.
 Finally we would like to thank the study participants for their willingness to provide
important information during the study period.

ii
Abbreviations/ Acronyms
ANC- Ante Natal Care
EDHS- Ethiopian Demographic and Health Survey
HEP- Health Extension Program
MDG- Millennium Development Goal
MNT- Maternal and Neonatal Tetanus
FMOH- Federal Ministry Of Health
MOH- Ministry Of Health
NNT- Neo-Natal Tetanus
SNNPR- South Nation Nationalities and Peoples Representative
SPSS- Statistical Package Social Software
TT- Tetanus Toxoid
TTI- Tetanus Toxoid Immunization
UNICEF- United Nation International Children’s Education Fund
UNFPA- United Nations Population Fund
MCH- Maternal and Child Health
WHO- World Health Organization

iii
 Tables of contents
Contents page numbe

r
AKNOWLEDMENT..................................................................................................................... ii
Abbreviations/ Acronyms............................................................................................................. iii
List of tables............................................................................................................................... v
List of figures............................................................................................................................. 1
Abstract......................................................................................................................................... 2
1. INTRODUCTION..................................................................................................................... 3
1.1 Background.......................................................................................................................... 3
1.2. Statement of the Problem.................................................................................................... 5
1.3. Significance of the study.....................................................................................................7
2. Literature Review...................................................................................................................... 8
2.1 Magnitude of Maternal and neonatal tetanus........................................................................8
2.2 Factors influencing Tetanus toxoid coverage.....................................................................10
3 Objectives................................................................................................................................. 12
4. Methods and materials.............................................................................................................13
4.1. Study area and period........................................................................................................13
4.2. Study design......................................................................................................................13
4.3 Population.............................................................................................................................. 13
4.4. Inclusion and exclusion criteria.........................................................................................13
4.5 Sampling method............................................................................................................... 14
4.6. Study variables......................................................................................................................15
4.7. Operational Definitions.........................................................................................................16
4.8. Data processing and analysis.............................................................................................16
4.9. Data quality assurance.......................................................................................................16
4.10. Ethical consideration.......................................................................................................17
4.11. Dissemination of results..................................................................................................17
6. Discussion................................................................................................................................29
7. Conclusion............................................................................................................................... 30
8. Recommendation..................................................................................................................... 31
9. References............................................................................................................................... 32

VI
10. Annexes................................................................................................................................. 35

List of tables

Table 1 Socio-demographic characteristics of the participant in Dangila Town, Amhara region

North West Ethiopia march, 2018................................................................................................18
Table 2 Obstetric characteristics of the respondent in Dangila town, amhara region, North West
Ethiopia, march 2018...................................................................................................................20
Table 3 Participants’ information on TT vaccine immunization in Dangila town Amhara region
north west Ethiopia march, 2018................................................................................................. 22
Table 5 Institution to home distance determinant factors in Dangila town, Amhara region, north
West Ethiopia march, 2018..........................................................................................................26
Table 6 cross tabulation and association between family monthly income, having ANC visit,
knowing the importance of getting TT vaccine and heard about TT vaccine among study
participants in Dangila Town, Amhara Region, North west Ethiopia, 2018 (P value<0.05 is
considered to be statistically significant).....................................................................................27

v
List of figures
Figure 1 Conceptual framework for TT vaccine utilization and associated factors among child
bearing age women...................................................................................................................... 11
Figure 2 Prevalence of TT vaccine utilization among child bearing (15-49 years) age women in
Dangila town, Amhara region North West Ethiopia, march 2018................................................21
Figure 3 Participants information on who is supposed to take TT vaccine in Dangila town,
Amhara region North West Ethiopia, March 2018......................................................................24
Figure 4 Reasons for not receiving tetanus toxoid vaccination in Dangila town, Amhara region
North West Ethiopia, 2018.......................................................................................................... 25

1
 Abstract

Introduction- Tetanus is a sever disease which is responsible for 5% of maternal deaths and
14% of neonatal death. To reduce and prevent deaths due to tetanus, tetanus toxoid vaccine
should be given to women of child bearing age. Globally maternal and neonatal tetanus persist as
a public health problem in many countries especially in Africa and Asia. Although the
effectiveness of tetanus toxoid immunization during pregnancy in preventing maternal and
neonatal tetanus is well established, in many developing countries, tetanus toxoid immunization
programs are underutilized.

Objective- The objective of this study is to assess the prevalence of tetanus toxoid vaccine
utilization and associated factors among child bearing age women in Dangila town, Amhara
region, Ethiopia 2018.

Methods – community based cross-sectional study design with systematic sampling technique
was conducted from March 1-30/2018 to select the sample of 312 reproductive age women in
Dangila town. The data was collected through face to face interview. Data was entered to Epi-
data 3.1 and exported to SPSS version 23 soft ware for analysis. Frequency distribution, charts,
figures and tables were used to present the results. Bivariate and multivariate logistic regression
analysis was done. After analysis by multivariate logistic regression, p-value <0.05 at 95%CI
were used to declare statistically significant association.

Result:-The study showed that the prevalence of tetanus toxoid immunization is 70.5% of which
15.5% take tetanus toxoid vaccine five times and 7.7% once. Having ante natal follow up(AOR:
8.734, P value: 0.040, 95% CI: 01.083-30.369), monthly family income (AOR: 2.329, P
value:0.018, 95% CI:1.153-4.705), knowing the purpose of tetanus toxoid vaccine injection
(AOR: 8.608, P value: 0.004, 95%CI:1.974-37.539) and heard about tetanus toxoid vaccine
(AOR 8.458, P value: 0.000, CI: 3.313-21.592), were found to be significantly associated with
the utilization of tetanus toxoid immunization.

Conclusion and Recommendation:-there is low Tetanus toxoid vaccine immunization in the

study area compared to national and global target. Demographic and socio cultural factors were
found to be barriers to utilization of tetanus toxoid immunization services. Provide
supplementary immunization activities, strengthening routine tetanus toxoid vaccination and
increase community awareness can increase tetanus toxoid vaccine immunization.

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 1. INTRODUCTION
1.1 Background

Tetanus is underreported notifiable vaccine preventable infectious disease characterized by

muscle spasms that is caused by the toxin-producing anaerobe, Clostridium tetani, which exists
worldwide in soil and in animal intestinal tracts, and as such can contaminate many surfaces and
substances (1). Ones the disease is contracted, the fatality rate can be as high as 100% without
hospital care and between 10%-60% with hospital care. The true extent of the tetanus death is
not known as many new born and mothers die at home and neither the birth nor the death is
reported (2). Since the 1980s, TT has been part of routine immunization programs, especially in
developing countries, to protect pregnant women and their future newborns from tetanus (3).

Maternal and neonatal tetanus (MNT) represents a triple failure of public health in terms of
routine vaccination, antenatal care and clean delivery/umbilical cord care services. Therefore, to
reduce and prevent deaths due to maternal neonatal tetanus (MNT) tetanus toxoid (TT) vaccine
should be given to women of child bearing age (4). Females are more exposed to the risk of
tetanus, especially during unsafe home delivery or abortion by untrained birth attendance and
suffer from puerperal tetanus thus, tetanus toxoid (TT) is administered to women of reproductive
age (15-49 years) groups to protect them and their new born babies from tetanus (3,5). The
vaccine was first produced in1924 but become commercially available in 1938 and was
successfully and extensively used during the Second World War in late 1940(6). The worldwide
deaths estimated from tetanus round the globe are about 213,000 in 2002 and 198,000 of them
were children under five years of age including neonatal tetanus (7).

In 2012 the WHO revealed that around 1.5 million children worldwide died from vaccine‒
preventable diseases (8). It is also estimated that neonatal tetanus is a leading cause of neonatal
mortality in poorest part of the world and responsible for 14% of neonatal death and accounts for
up to 25% in some African countries, while maternal tetanus is responsible at least for 5% of
maternal deaths (9).

By the end of 2015, over 140 million women of reproductive age had been reached by
Supplementary immunization activities with at least two protective doses of tetanus vaccine.
However, there are still an estimated 72 million women of reproductive age remaining who have
not yet been targeted with SIAs for immunization with TT vaccine in the remaining 18 countries
at risk (10).

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In Ethiopia only 10% of deliveries are assisted by trained health workers, NNT is highly
prevalent as most deliveries are unprotected and take place at home. Only 30% of the pregnant
mothers have received TT2+ in 2000, as a result of this about 17,900 NT cases with 13,400
neonatal deaths occur every year. It is estimated that 2000 mothers die every year due to
maternal tetanus infection. The elimination of maternal neonatal tetanus is the priority of the
MOH of Ethiopia which in collaboration with partner organization, TT supplemental
immunization campaigns in selected high risk zones has been conducted since 1999. In 2004 TT
supplemental immunization campaign were conducted in nine high risk zones targeting 2.7
million child bearing age women(11).

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1.2. Statement of the Problem

Globally, maternal tetanus is responsible for at least 5% of maternal deaths, approximately

30,000 deaths and 180,000neonates (1) about 5% of all neonatal deaths annually and 40 million
pregnant women remained in need of immunization against maternal tetanus room 1999-2006,
number of women living in high-risk areas protected with at least two doses of tetanus toxoid
vaccine given during Supplementary Immunization (5, 9). As of June 2010, most of the countries
had achieved maternal and neonatal tetanus (MNT) elimination leaving 40 countries that still
have not eliminated the disease (12).

In any community mothers and children constitute a priority group; as they comprise
approximately 70% of the population of developing countries (1). The majority of mothers and
new born dying of tetanus live in Africa and Southern and East Asia, generally in areas scarred
by poverty, poor medical infrastructure or humanitarian crises, as well, where women are poor,
have little access to health care, and have little information about safe delivery practices (13).

Despite availability of low-cost vaccines against tetanus, a significant number of mothers die due
to maternal tetanus every year and almost all cases are in developing countries, one newborn
baby dies due to tetanus every nine minutes and several thousand mothers also die due to this
easily preventable disease (9).The incidence tetanus is higher in tropical countries and under
poor hygienic conditions. In these countries, tetanus in newborns takes a very important route. In
most of such cases, use of dirty, rusty scissors to cut the umbilical string of the newborn causes
sepsis in navel. An estimated one million infants die due to tetanus in developing countries each
year because of poor hygiene (14). Low-income countries face many health and development
challenges. In response to these challenges, world leaders have taken counter action and
formulated the Millennium Development Goals (MDGs), of which (MDG4 and MDG5) are to
reduce the mortality of children younger than 5 years and the mortality of mothers by two thirds
by 2015. In Ethiopia, under-5 mortality was 166 deaths per 1000 live births in 2000, one of the
highest in the world. The achievement of MDG4 and MDG5 in Ethiopia proofed that tailored
health and health-related interventions and strategies implemented in poorly resourced settings
(15).

Ethiopia is included in countries where more than 50% of the districts are at high risk for
Maternal Neonatal Tetanus (MNT) because of the limited health infrastructure which is indicated
by less than 50% tetanus toxoid vaccination (16). In 2012, the World Health Organization
estimated that vaccination prevents 2.5 million deaths each year (17). If there is 100%
immunization, and 100% efficacy of the vaccines, one out of seven deaths among young children
could be prevented, mostly in developing countries, making this an important global health issue
(18).

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Immunization coverage in Ethiopia varies significantly from region to region, ranging from only
9% of children fully vaccinated in Affar region to 79% in Addis Ababa. Over 90% of age one
child in Southern Nations Nationalities Peoples’ Region (SNNPR) is immunized with DPT3
while the figure dramatically drops to less than 50% in Somali, Afar, and Gambella regions (19)

6
1.3. Significance of the study

This academic research is basically aimed at measuring the utilization of TT vaccine and it
identifies associated factors among child bearing age women in Dangila town and it will also
highlight problems/issues faced by the women and suggest few measures for the removal of
these problems/issues and immunization is also presented as a key strategy to achieve the
sustainable development goal specially to reduce maternal and neonatal mortality. In any
community mothers and children constitute a priority group; as they comprise approximately
70% of the population of developing countries, therefore, to reduce and prevent deaths due to
maternal and neonatal tetanus, TT vaccine should be given to women of child bearing age. It
will also help researchers as a base line for further investigation. In addition, it will also help to
track MNT elimination progress at the study area. Hence, this study is timely, and the result of
the study will also help to inform program mangers to consider the important contributing factors
for TT vaccine utilization and associated factors while planning to improve vaccination program.

7
2. Literature Review
2.1 Magnitude of Maternal and neonatal tetanus

Worldwide, the Coverage for the first three doses of tetanus toxoid vaccine was estimated to
84% in 2013 (20). Because of almost universal vaccination of children with tetanus toxoid in
developed countries, the incidence of tetanus in these regions has dropped dramatically and
steadily since 1940. In contrast to developed nations where tetanus is rare, tetanus remains
endemic in the developing world, and the incidence often increases following natural disasters.
Approximately one million cases of tetanus are estimated to occur worldwide each year, with
300,000 to 500,000 deaths (14). According to WHO/UNICEF Global immunization data, report
of 2008, the unprotected children under one year of age who did not receive DPT3 were 26.3
million in 2005 seventy five percent of these children live in ten countries-Ethiopia, India,
Nigeria, Indonesia, China, Pakistan, Democratic Republic of Congo, Bangladesh, Angola, and
Niger (21).

In Indonesia the coverage result showed that with card/history criterion 55.6% received first dose
of TT 40.8% received second dose of TT and 11.2% received third dose of TT while 44.4% were
not immunized (22).

Another study conducted in Bangladesh revealed that only 11% of women of reproductive age
had obtained the complete series of five TT immunizations and only 52% of women of
reproductive age had received one or more TT immunizations (23).

A cross sectional Study conducted in Pakistan, Peshawar showed that the vaccination coverage
for all doses of TT vaccination was 55.6% completely vaccinated 22.4% incompletely vaccinated
22.0% never vaccinated.(24)

Research conducted in Nigeria showed that most of the mothers had no tetanus immunization
(66.7%). Only 29.4% of the mothers attended ante-natal care (ANC) while majority of the
patients were delivered at home (94.1%). Half of the neonates presented with the severe form of
the disease (51.0%) (25). Among deaths due to diseases preventable by vaccines currently
recommended by WHO tetanus accounts for 10% (213,000) and 13% (18,000) of mortality in all
age group and neonates respectively (7).

8
According to EDHS 2016 49% of women received sufficient dose of tetanus toxoid to protect
their last birth against neonatal tetanus. The percentage of women whose last birth was protected
from tetanus is higher in urban than rural areas (72% versus 46%), and ranges from 30% in Afar
to 82% in Addis Ababa. The percentage increases with women education and wealth.41% of
women with no education report that their last live birth was protected against neonatal tetanus
compared to 83% of women with more than a secondary education .The proportion of women
whose live birth was protected against tetanus was similar to that reported in the 2011 EDHS
(48%) (26).

A cross sectional study conducted in ambo showed that from a total of child bearing age women
in the study area only 32% of mother immunized for valid Tetanus toxoid dose and only 28 % of
children were protected at birth against neonatal tetanus as evidenced by card alone(27).

Similarly EPI coverage survey conducted in 2006, in Ethiopia revealed that, the weighted
national TT2+ coverage was 41.5% by card only and 75.6% by card plus history. Mothers able to
read and write had higher TT2+ coverage by card plus history than those who could not read or
write (81.0% versus 73.3%). Similarly urban mothers of 0-11 months of infants had higher TT2+
coverage than their rural counterparts (83.3% versus 73.6%) (28). Similar study also showed in
Oromia Region TT2+ coverage was 41.0% by card only 72.6% by card plus history (8).

9
 2.2 Factors influencing Tetanus toxoid coverage

Characteristics associated with TT immunization status includes: educational level of the

woman, distance from the nearest immunization centre, and level of contact with Health workers
and relationships to the health workers. Additional characteristics that influence women's
Tetanus toxoid immunization status include age, marital and working status, number of children,
and attitude towards TT toxoid (29).

Research conducted in Pakistan showed that reasons for not vaccinating were no
awareness/didn't know importance 40.5% , busyness/family problems 18.1% , center to far
18.1% , wrong ideas /sterility 10.8% , fear of reactions 4.3% ,and others 8.3%. Vaccination cards
were present with 59.3% while 46.1% were memory recall. Urban population was (54.3%) while
rural population was 45.7%. Women who had access to televisions or radio had greater
complete immunization rates (58.8%) than women who hadn't access to televisions or radio
(10.3%) (24).

Another study conducted in India showed that woman’s education is an important determinant of
health-seeking behavior and positively influenced the likelihood of TT vaccination. In the study,
it was shown that higher education levels were associated with higher up take of TT
immunization and complete TT vaccine when compared to those with no education (30).

A cross sectional study in Kenya showed that there is significant association between having
health information and tetanus toxoid immunization status. Concerning the source of TT
immunization information, 33.6% participants heard from health workers, 30.9% from school,
13.8% from mass media, 8.2% from both mass media and family members and the remaining
6.2% heard from family members alone(10). Additionally, the DHS 2011 of Ethiopia showed
that women age of 20-34 years was found to be more likely to have received two or more tetanus
injections than women under the age of 20 or 35-49 (31).

Another Study conducted in SNNPR showed that the level of TT immunization missed
opportunity was three times higher in rural areas as compared to urban area, which is 12.9% in
rural as compared to only 4.3% in the urban part of the study area. Those women who received
antenatal care through outreach programs are less likely to miss tetanus immunization as
opposed to women who received ante natal care in health facilities (7.5% versus 13.3%). Over
37% of those women who had only one visit during the whole course their pregnancy did not
take TT immunization. Mothers able to read and write had higher TT2+ coverage than those who
could not read or write (81.0% versus 73.3%). Similarly urban mothers of 0-11 months of infants
had higher TT2+ coverage than their rural counterparts (83.3% versus 73.6%) (32).

10
2.3 Conceptual framework

Socio Demographic factors Institutional/ Health related

(age, educational status of the factors
mother and husband, husband TT vaccine utilization
(Number of ANC visit,
occupation, maternal
gravidity, parity, Distance to
occupation, marital status,
health facility, Amount of
ethnicity, religion, family
money you paid for
income, family size).
transportation, Transportation
problem)

Behavioral factors
(awareness and
attitude of the mother
and her family about
tetanus toxoid vaccine)

Figure 1 Conceptual framework for TT vaccine utilization and associated factors among child bearing age women
Developed from different literatures, 2018.

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3 Objectives
3.1 General objective

To assess the prevalence and associated factors of TT vaccine utilization, among child bearing
women, in Dangila town, Amhara Region Northwestern Ethiopia in 2018.

3.2 Specific objectives

1. To determine prevalence of TT vaccine utilization among reproductive age group in the study
area in 2018.

2. To identify factors influencing to TT vaccine utilization among reproductive age group in the
study area in 2018.

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4. Methods and materials
4.1. Study area and period

The Study was conducted in Dangila town on women of child bearing age. Dangila is a district
town in Awi zone, Amhara region, Northwestern part of the country. It is located 475km from
Addis Ababa, the capital city of Ethiopia and far from Bahir Dar by 78 km the capital city of
Amhara region and by 37km from the capital city Awi zone. According to 2018, population and
housing census report, the total population size of Dangila town administration is 39,058, among
these 21,219 are females. Among 21,219 females 14,202 are child bearing age (15 years to 49
years) women (33). The study was conducted from March/1/ 2018 to April/1/2018.

4.2. Study design

Community based cross-sectional study design was conducted.

4.3 Population

4.3.1. Source population

The source population were all women of child bearing age group (15-49 years old), who are
residents in Dangila town.

4.3.2 Study population

The study population was all women of child bearing age group (15-49 years old), in Dangila
town, that fulfill the inclusion criteria during the study period.

4.4. Inclusion and exclusion criteria

4.4.1. Inclusion criteria

- Women who are 15 to 49 years of age group.

4.4.2. Exclusion criteria

- Critically sick (unable to speak) and mentally ill women.

- Residence period less than 6 month.

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4.5 Sampling method

4.5.1 Sample size determination

The sample size was determined by using systematic random sampling by using the formula for
estimation of single population proportion with the assumption of 95 % confidence interval, a
margin error of 5 % and taking 75.6%TT vaccine utilization prevalence (28). To compensate
contingency of the non-response rate, 10 % of the determined sample will be added up on the
calculated sample size. The final sample size calculated using

n = [(Za2)2 p (1-p)] / w2

P=75.6%

W=5%

n=1.96*1.96*0.756*(1_.756)/ (.05)2=1.96*1.96*.756*(0.244)/0.0025=283.17
n=283.41

Non respondent=10% by adding 10% of non response rate the final sample size will
be 312. NF = 283.41+28.34

Total sample size is 312.

4.5.2 Sampling procedure

The study conducted by simple random sampling technique for selection of kebeles from the 5
kebeles then three kebeles was selected by using lottery method. From each kebele samples are
selected proportionally to ensure representation. To take these samples, systematic sampling
technique was done for selecting women and the household. The total number of sample is 312.
We get the sampling interval ten [10]. Individual house was chosen at regular interval (every 10
units) and put special identification mark by marker on their house then data collection was done.

14
4.5.3 Data collection tool and technique

The data was collected by using structured questionnaire by moving from house to house through
face to face interviewing of child bearing age women in the selected kebele in Dangila town. The
questionnaires was prepared in English, translated into Amharic (regional language), and then
retranslated back to English languages to maintain the consistency of the questionnaire. Data
collectors was 4th year midwifery students. Training was given for data collectors on the aim of
the research, content of the questionnaire, and how to conduct questionnaire interview.

4.6. Study variables

4.6.1. Dependent variable

TT vaccine utilization

4.6.2. Independent variables

Socio-demographic factors (age, level of maternal education, level of husband education,

husband occupation, distance from health facility, maternal occupation, marital status, Ethnicity,
religion).
Economic factors (family income, family size, Amount of money you paid for transportation)
Knowledge and attitude of mothers/family on vaccination and vaccination services
traveling time to reach the nearest health institution
ANC follow up

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4.7. Operational Definitions

Immunization- Protection of susceptible individuals from communicable disease by

administration of a live modified agent (as in yellow fever), a suspension of killed organisms (as
in whooping cough) or an inactivated toxin (as in tetanus).

Maternal tetanus: - tetanus that strikes women during pregnancy or within six weeks of the
termination of pregnancy.

Neonatal tetanus: - the diseases usually occur in newborn between 3-28 days after birth
through introduction of tetanus spores via the umbilical cord during delivery by cutting
the cord with an unclean material.

TT vaccine utilization: - the proportion of women who had received 2 or more doses of
TT vaccine.
Neonatal Tetanus elimination: - an incidence of less than one NT case per 1,000 live
births in a district or similar administrative unit in a year.

4.8. Data processing and analysis

Data was entered to Epi Data 3.1 and then exported to SPSS version 23 for analysis.
Descriptive statistics, including frequencies, percent, mean and standard deviation were
computed. Statically significant test was applied to find out the strength of association
between variables by using odds ratio. Data was presented in tables, graphs, and
frequency percentage of different variables. Bivariate and multivariate logistic
regression analysis was done to identify the association between independent and
dependent variables. Variables with p value < 0.2 in bivariate analysis were included in
multivariate analysis to identify factors associated with TT vaccine utilization at
significance level of P-value < 0.05. After analysis by multivariate logistic regression, p-
value <0.05 with 95%CI were used to declare statistically significant association.

4.9. Data quality assurance

The quality of data was ensured through data quality training of data collectors, close
supervision by our advisor and by each other’s, reviewing each of completed data. One
week prior to the actual data collection period, pre-test was conducted to test the
instrument and strategies on 5% of women’s of reproductive age group in Addiss kidam
town. A close supervision was applied during the three days of data collection period to
make sure the data collectors, how to fill the questioners. Cleaning, coding and entering
of the data were carried out carefully.

16
4.10. Ethical consideration

Data collection and processing was done after gating an ethical clearance letter from
Debremarkos University College of health science ethical review committee and Dangila town
health office gave a permission letter for each Keble then oral consent was done from
respondents. We also explain to the respondents that the target of the study and the information
we obtain was kept confidentially and used for research purpose only. Participants were
informed about their full right not to be participating at all or to stop at any time while the data
collection is going on.

4.11. Dissemination of results

The finding of this study was submitted and presented to Debremarkos University College of
health science department of midwifery. Moreover the result of this study also will be
disseminated to the relevant organization including district health office and health institution.
Further attempts will be made to publish it on national and international journals.

17
5. RESULT
In total, 312 respondents have participated on the study out of 312 intended samples making the
response rate 100%. The study showed that majority 180(57.5%) of the respondents were
between the age of 15-25, while 93(29.7%) were between 26-35 years of age and 40 (12.8%)
were between 36-49 years, with mean age of 26.25(±7.506). similarly 291 (93.6%) were belong
to Amhara followed by 9(2.9%), Tigray), 6(1.9%) Oromo and 5 (1.6%) Gumuz. 254(81.4% and
37(11.9%) of the participants were orthodox and Muslim by their religion respectively. The
study also showed that 139(44.6%) of the respondents were college and above, 92 (29.5%)
secondary school, 35(11.2%) primary education, 20 (6.4%) only read and write and 26(8.3%)
were never been at school.

SOCIODEMOGRAPHIC CARACTERSTICS OF THE RESPONDENT

Table 1 Socio-demographic
characteristics of the participant in Dangila Town, Amhara region
North West Ethiopia march, 2018.

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Variable Variable category Frequency Percent
Age 15-25 180 57.5
26-35 93 29.7
36-49 40 12.8
Ethnicity Amhara 292 93.6
Oromo 6 1.9
Tigray 9 2.9
Gumuz 5 1.6

Religion Orthodox 254 81.4

muslim 37 11.9
protestant 21 6.7

Marital married 198 63.4

status divorce 8 2.6
widowed 5 1.6
unmarried 101 32.4

Maternal Never been at school 26 8.3

level of Only read and write 20 6.4
education Primary education 35 11.2
Secondary education 92 29.5
College and above 139 44.6
Maternal Housewife 147 47.2
occupation House worker 18 5.8
Civil servant 117 37.5
Merchant 30 9.6

Family <2000 167 53.4

income 2000-5000 119 38.0
>5000 27 8.6

Husband Only read and write 19 9.4

education Primary education 35 17.2
Secondary education 25 12.3
College and above 124 61.1

Husband Teacher 49 24.1

occupation Health worker 45 22.2
Merchant 43 21.2
Farmer 17 8.4
Carpenter 49 24.1

Family size 1-3 141 49.5

4-6 120 42.1
>6 24 8.4
19
20
 Obstetrical characteristics of the respondent

This study showed that 51(16.3%) of the participants have had three and more pregnancies,
45(14.4%) got pregnancy two times, 63(20.2%) got pregnancy ones, and 153 (49.0%) have not
got pregnancy. Among participants who have got pregnancy 160 (51.3%) have antenatal follow
up. From participants having antenatal follow up 112 (70.0%) has four and more ANC visit
and .7(4.4%) have only have one ANC visit.

Table 2 Obstetric characteristics of the respondent in Dangila town, amhara region, North West Ethiopia,
march 2018.

Variables Variable categories Frequency Percent

Number of pregnancies have you None 153 49.0

had one 63 20.2
two 45 14.4
three and more 51 16.4
How many times have you get None 158 50.6
birth One 69 22.2
Two 39 12.5
Three and more 46 14.7
Was the pregnancy planned for Yes 148 47.4
the No 164 52.6
recent child
ANC follow up during your Yes 160 51.3
pregnancy period No 152 48.7

Total number of ANC One 7 4.4

visits for the recent child being two 11 6.9
assessed three 30 18.7
four and more 112 70.0

21
Prevalence of TT vaccine

The study showed that the prevalence of tetanus toxoid vaccine utilization among reproductive
age group of Dangila town was 70.5% among which 88 (23.4%) was for TT5, and 85.6% of the
study participants have heard about TT immunization among these, majority 144(53.9%) heard
from health workers followed by 44 (16.5%), from community members. As to the place where
the participants got the immunization, 42.6% at health center, 23.3% school, 22.5% hospital,
5.9% health post and 5.6% at outreach sites. Concerning the knowledge of time interval between
each TT injection, only 38 (9.3%) of the study participants responded correctly.

29.5%
women who received two or
more TT vaccine
women who received only one
TT or not take TT vaccine at all
70.5%

From

Figure 2 Prevalence of TT vaccine utilization among child bearing (15-49 years) age women
in Dangila town, Amhara region North West Ethiopia, march 2018.

22
Information on TT vaccine utilization

Regarding the source of information patterns on immunization 267(85.6%) of the respondents

have heard about TT vaccination, among these 150 (56.2%) heard from health workers, 50
(18.6%) from community members, 26(9.7%) from kebele administrators, 23(8.6%) from radio,
16(6%) from television and 2(0.7%) heard from news paper. 220(70.5%) had received TT
vaccine, of which 107(47.9%) vaccinated from health center, 62(28.3%) vaccinated from home
or outreach, 37(16.9%) from hospital and 13(5.9%) vaccinated from health post.

Table 3 Participants’ information on TT vaccine immunization in Dangila town Amhara

region north west Ethiopia march, 2018

Variables Variable category Frequency Percent

Heard about vaccination Yes 267 85.6
No 45 14.4

From where have you Community members 50 18.7

heard Kebele administrators 26 9.7
Health extension workers 150 56.2
Radio 23 8.6
Television 16 6.1
News paper 2 0.7

Have you ever had Yes 220 70.5

received TT vaccination No 92 29.5

How many times you Once 45 20.5

get vaccination Twice 53 24.4
Three times 60 27.4
four times 27 12.2
five times 3 15.5

Where you get TT Hospital 37 16.9

vaccine injection Health center 107 47.9
Health post 13 5.9
Home/outreach 62 28.3

Reasons for not Not aware 44 47.3

vaccination Nobody advise me 9 9.7
Service area too far 8 8.6
Fear of side effect 9 9.7
No problem experienced 23 24.7

23
Purpose of taking TT To prevent mother from 94 30.1
vaccine tetanus 41 13.2
To prevent child from tetanus 128 41.0
To prevent both mother and
child from tetanus 49 15.7
Don’t know
Who is supposed to All men and women 71 22.8
receive TT All women of child bearing 117 54.4
Immunization age 14 4.5
only children 57 18.3
don’t know
How many TT One injection 24 7.7
injections is the Two injections 26 8.3
woman supposed to Three injections 49 15.7
receive to be Four injections 32 10.7
fully protected in life Five injections 73 23.4
Don’t know 108 34.6

24
Participant information on who is supposed to take TT vaccine
The study shows that among the participants 117(54.4%) responded at all men and women,
71(22.8%) only child bearing age women, 57(18.3%), and 14(4.5%) don’t know who is supposed
to take TT vaccine.

54.40%

22.80%
18.30%

4.50%

all men and women only child bearing age only children don’t kow
women

Figure 3 Participants information on who is supposed to take TT vaccine in Dangila town,

Amhara region North West Ethiopia, March 2018.

25
The reasons for not taking TT vaccination:-No awareness (knowing the importance of TT
immunization) (47.3%), no problem experienced before (24.7%), fear of side effect (9.7%), no body
advise me (9.7%), and service area too far to take TT vaccine (8.6%), were the major reasons given by
respondents for not taking TT vaccine injection table 3.

Respondents reason for not receiving vaccination

47.3%

24.7%

9.7% 9.7% 8.6%

ss r ct e fa
r
ne fo ffe m
ar
e be e e ise to
ce
d
sid dv r ea
aw n a
ea
no rie of dy
pe ear bo r vic
f o se
ex n
lem
ob
pr
no

Figure 4 Reasons for not receiving tetanus toxoid vaccination in Dangila town, Amhara
region North West Ethiopia, 2018

26
Institution to home distance determinant factors of the respondent
The study showed that 281 (90.1%) of the participant takes less than twenty (20) minutes to go from their
home to the nearest health institution, 16(5.1%) greater than forty (40) minutes and 15(4.8%) 20-40
minutes on walking. 235 (75.3%) of the participants were go to health institution through walking
followed by 77(24.7%) by tax. 298 (90.1%) of the respondent pay less than ten (10) birr for transportation
to health institution.

Table 4 Institution to home distance determinant factors in Dangila town, Amhara region,
north West Ethiopia march, 2018

Variables Variables category Frequency Percent

Distance to the nearest <20 minute 281 90.1

health institution 20-40 minute 15 4.8
>40 minute 16 5.1
Mode of transport to Walking 235 75.3
health institution By tax 77 24.7
Amount of money paid <10 298 90.1
for transportation to 10-20 14 4.6
health institution 20-30 1 0.3

Is road possible for Yes 281 90.1

transportation No 15 4.8
throughout the year Don’t know 16 5.1

Factors associated with TT vaccine utilization

This study showed that having ANC visit, knowing the purpose of TT vaccine, heard about TT
vaccine and traveling time to health institution of the reproductive age group of women was
associated with TT immunization status. Women who have ANC follow up were 5.7 times more
likely to receive TT immunization when compared to those who doesn’t have ANC follow up
with (AOR: 5.734, P value: 0.040, 5%CI: 1.083-30.369). women who doesn’t know the purpose
of TT vaccine is 7.6 times less likely to use TT vaccine when compared to those of women who
know the purpose of TT vaccine (AOR: 8.608, p-value: 0.004, 95% CI: 1.974-37.539) And
women heard about TT vaccine were 8.5 times more likely to use TT immunization (AOR:
8.458, P value: 0.000, CI: 3.313-21.592)

27
 Cross tabulation, bivariate and multivariate analysis

Table 5cross tabulation and association between family monthly income, having ANC visit,
knowing the importance of getting TT vaccine and heard about TT vaccine among study
participants in Dangila Town, Amhara Region, North west Ethiopia, 2018 (P value<0.05 is
considered to be statistically significant).
Variables Variables Tetanus toxoid COR AOR P-value 95%CI for AOR
category vaccine
utilization Lower Upper
limit limit

Yes No
Age 15-25 115 64 1 - - - -
26-35 74 19 2.18 1.027 0.954 0.415 2.543
36-49 31 9 1.917 0.440 0.236 0.113 1.714
Marital status Married 163 48 2.621 1.029 0.944 0.462 2.295
Unmarried 57 44 1 - - -
Family income <2000 101 65 1 - - -
2000-5000 96 23 2.686 2.329 0.018 1.153 4.705
>5000 23 4 3.700 1.625 0.442 0.472 5.600
Number of pregnancy None 90 63 1 - - -
One 49 14 2.450 2.409 0.512 0.173 33.44
Two 38 7 3.800 3.712 0.495 0.085 161.12
Three & more 43 8 3.762 0.999 0.000 9

Number of birth None 95 63 1 - - -

One 54 15 2.387 0.111 0.090 0.009 1.410
Two 33 6 3.647 0.126 0.307 0.002 6.750
Three & more 38 8 3.150 0.000 0.999 -
Planned pregnancy Yes 125 23 3.947 1.466 0.638 0.299 7.199
No 95 69 1 - - -
ANC visit Yes 135 25 4.256 5.734 0.040 1.083 30.369
No 85 67 1 - - - -
Knowing the Purpose To prevent mother 65 29 3.860 1.714 0.270 0.658 4.464
of TT vaccination from tetanus
To prevent child
from tetanus 36 5 12.400 8.608 0.004 1.974 37.539
To prevent both
mother and child 101 27 6.442 2.959 0.030 1.113 7.866
from tetanus
Don’t know
18 31 1 1 - - -
Heard about tetanus Yes 210 57 12.895 8.458 0.000 3.313 21.592
toxoid vaccination No 10 35 1

28
Who is supposed to All men and 53 18 4.049 2.597 0.054 0.985 6.852
take TT vaccine women
All women of 134 36 5.118 1.933 0.142 0.820 4.660
child bearing age
Only children 9 5 2.475 1.057 0.948 0.205 5.448
don’t know 24 33 1 1

Note: - AOR=adjusted odds ratio, COR= crude odds ratio, CI= confidence interval.

29
6. Discussion
This study was undertaken to evaluate the TT vaccine utilization in Dangila town of Ethiopia and
to understand the factors affecting for tetanus toxoid immunization. The WHO recommends that
90% of the females in high-risk areas should be vaccinated against tetanus while this study
shows that TT vaccine utilization among the reproductive age group of women in Dangila town
is 70.5%. The finding of this study is lower than the figure in Ethiopia, EPI coverage in Addis
Ababa, which accounted (82%) in the year 2006 (29). The probable explanation of this
difference could be related to the difference in socio-demographic characteristics, degree of
awareness, culture and beliefs towards immunization.

This study revealed that low immunization among females were, whose husbands had lower
education status and have not ANC visit as compared to those who have ANC visit and whose
husband educational status is college and above. It was also showed that women who have heard
about immunization and its importance had much greater immunization rates. This clearly shows
the impact of education of both men and women’s knowledge on immunization and attendance at
antenatal care had strong effect on TT vaccine utilization. Studies in Pakistan and other countries
showed similar results (25, 26 &27).

The study showed that respondents having more than 5000 monthly family income are two times
more likely to use tetanus toxoid vaccine injection as compared to those who have less than 2000
birr monthly family income (AOR: 2.329, 95% CI: 1.153-4.705) the finding of this research is
not significant in a research conducted in Pakistan and others, the difference may be due to
socio- demographic deference, educational status difference countries difference study method
difference (24, 31, & 32)

As to the factors associated with TT vaccination, The study showed that mothers who attend
ANC follow up are 5.7 times more likely to use tetanus toxoid vaccine (AOR: 5.734, 95% CI:
1.083-30.369) as compared to women who didn’t have ANC follow up. The finding of this
study is consistent with a Study conducted in India, but high compared to a study conducted in
Kenya. This difference could be due to difference in reproductive health information
dissemination, policy difference, socio demographic factors and sample size (30 & 31).

This study also showed that participants who have heard about TT vaccine immunization are 8.5
Times more likely to use TT vaccine immunization as compared to those who have not heard
about tetanus toxoid vaccine injection (AOR: 8.458, CI: 3.313-21.592). The finding of this study
is high as compared with a research conducted in Kenya and Pakistan. This difference could be
due to difference in educational status of participants, reproductive health information
dissemination, policy difference, socio demographic factors and sample size (24 & 31).

30
The study also showed that Women who know the importance of taking tetanus toxoid vaccine
injection are 8.6 times more likely to use tetanus toxoid vaccine (AOR: 8.608, 95%CI: 1.974-
37.539) when compared to those doesn’t know the importance of taking TT vaccine (AOR:
0.077, 95%CI: 0.129-4.465). Knowing the purpose of TT vaccine is not significant in a research
conducted in Nigeria and others, the possible Rational for this difference could be due to socio
demographic, cultural, educational status, reproductive health information dissemination,
and countries policy difference (7. 24, 30& 32).

7. Conclusion
The prevalence of tetanus toxoid vaccination among reproductive age group of women in
Dangila town is low compared to national and global target. The study showed that having ante
natal follow up, Knowing the purpose of TT vaccine, heard about TT vaccine, and Amount of
money paid for transportation were found to be significantly associated with the utilization of TT
immunization.

31
8. Recommendation

Based on the finding of this study the following changes are recommended

For Dangila town reproductive age group women

All reproductive (15-49years) age group women better to receive TT vaccine injection during
campaign and take TT vaccine at health institution through properly spaced rounds of
Supplemental Immunization. Pregnant women should have to visit health institution for ANC
follow up hence ANC follow up improves TT vaccine immunization.

For Dangila town health office

Give emphasis for health education to increase community awareness on TT vaccine

immunization. Encourage health professionals to do Screening of TT immunization status of all
reproductive age group women and administering TT vaccine to all eligible women could
increase TT vaccination.

For Awi zone health department

In collaboration with regional health bureau Increase health institution to have accessible and
sustainable health care and immunization services for all reproductive age group women.

For regional health bureau

Provide Continuous supply of TT vaccines for health institutions as it makes the women to get
tetanus toxoid immunization easily. Provide health information dissemination through mass
media. In collaboration with federal ministry of health offer Vaccination programs in schools,
higher institution and home visits.

For federal ministry of health

Increase health institution and ensure availability and accessibility of health facilities, as health
institution is important to increase ANC visit and reduces traveling time of respondents for
immunization. Developing and implementing country health policy about TT vaccine; providing
training for regional health bureaus and health professionals about TT vaccine immunization.

For other researchers

This study was done on a small scale and so the findings cannot be generalized, so better to
conduct researches regarding tetanus by changing the study design and by increasing sample
size.

32
9. References
1. Vandelaer J, Partridge J, Suvedi BK. Process of neonatal tetanus elimination in Nepal. J Public Health,
2009; 31: 561–565.

2. Federal Ministry of Health [ETHIOPIA]: Ethiopia National Expanded Program on Immunization.

2010, Addis Ababa: Comprehensive Multi-Year Plan 2011-2015

3. WHO Immunization surveillance, assessment and monitoring available from www.Who.int/

immunization/documents/monitoring/en (2015).

4. Who (2008). Immunization surveillance, Assessment and monitoring available from http: // who.int/
immunization/ monitoring/disease/ tetanus/zh/index.

5. WHO (2015) Immunization surveillance, assessment and monitoring.

6. World Health Organization. Immunization surveillance, assessment and monitoring, Available from:
http://www.who.int/immunizationmonitoring/disease/tetanus/zh/index.html 2015.

7. Darmstadt GL, Bhutta ZA, Cousens S, Adam T, Walker N, de Bernis L. Evidence-based, cost effective
interventions: how many newborn babies can we save? Lancet, 2005; 365: 977–988.

8. Rownak Khan, Jos Vandelaer, Ahmadu Yakubu, Azhar Abid Raza,and Flint Zulu,Health Section,
Programme Division, UNICEF, New York, NY, USA Maternal and neonatal tetanus elimination: from
protecting women and newborns to protecting all,int J womens health PMCID februry2015.

9. Mohammad Naeem, Muhammad Zia-Ul-Islam Khan*, Syed Hussain Abbas*, Muhammad Adil*,
Ayasha Khan†, Syeda Maria Naz et al COVERAGE AND FACTORS ASSOCIATED WITH TETANUS
TOXOID VACCINATION AMONG MARRIED WOMEN OF REPRODUCTIVE AGE: J Ayub Med
Coll Abbottabad 2010; 22 (3)

10. World health Organization: Maternal and Neonatal Tetanus Elimination African Region
WHO/UNICEF Five-year Regional Plan of Action 2001- 2005.

11. Http: // www. Researchgate.int/---/7566984-coverage-and-factors-associateddecember, 2017.

12. Belihu KD, Tesso FY, Woldetsadik TD (2017) Dropout Rate of Tetanus Toxoid Immunization and
Associated Factors among Reproductive Age Group of Women in Debrebirhan Town, Amhara Region,
Northern Ethiopia. J Women's Health Care 6: 390. doi: 10.4172/2167-0420.1000390

13. WHO (World health Organization) 2010 neonatal tetanus elimination field guide scientific and
technical publication.

14. World Health Organization. Second and subsequent doses of tetanus toxoid: reported estimates of
TT2+ coverage. 2014.

33
15. Betty Roosihermiate, Midory Nishiyama and Kimihiro Nakae, factors associated with TT (tetanus
toxoid) immunization among pregnant women, in Saparua, Indonesia, Southeast Asian, J TROP MED
PUBLIC HEALTH. March, 2012, Vol 31no.1.

16. Afshar M, Raju M, Ansell D, Bleck TP. Narrative review: tetanus-a health threat after natural
disasters in developing countries. Ann Intern Med 2011; 154:329.

17. Yohannes Adama Melaku, Zumin Shi Adelaide Medical School, The University of Adelaide,
Adelaide, SA 5005, Australia (Y A Melaku, Z Shi); and Institute of Public Health, University of Gondar,
Gondar, Ethiopia (Y A Melaku), Sustainable Development Goals from Ethiopia’s success,
www.thelancet.com/lancetgh Vol 5 November 2017.

18. Elimination of Maternal and Neonatal Tetanus. [Online][Cited 10 September 2010]; Available from:
http://www.unicef.org/health/ index_43509.html

19. UNICEF (2010) Maternal and neonatal tetanus elimination initiative pampers.

20. WHO (2014) Elimination of maternal and neonatal tetanus, July 2014.vol 384 no 9948(1129-1145).

21. WHO/FMOH. Vaccinators Guide for Maternal & Neonatal Tetanus Elimination Campaign: Ethiopia,
2012

22. Adeel Ahmed Khan, Aysha Zahidie, and Fauziah Rabbani, Interventions to reduce neonatal mortality
from neonatal tetanus in low and middle income countries - a systematic review, BMC Public
Health201313:322

23. BDHS. Determinants of the utilization of the neonatal vaccination coverage In Bangladesh evidence
from a Bangladesh DHS 2004.

24. S.Hasnain and N.H.Sheikhcauses of low tetanus toxoid vaccination coverage in pregnant women in
Lahore district, Pakistan, eastern Mediterranean health journal, vol.13No 5. 2010.

25. Alhaji M A, Bello M A, Elechi H A, Akuhwa R T, Bukar F L, Ibrahim H A. Review of Neonatal

tetanus in University of Maiduguri Teaching Hospital, North-eastern Nigeria. Niger Med J 2013; 54: 398-
401, 2013.

26. Ethiopian demographic and health survey 2016,Centeral statistical agency, Addis Ababa , Ethiopia
ICF international Rockville , Maryland , USA ,2016.

27. Meknnen,Y.missed opportunity of tetanus toxoid immunization among pregnant mothers in southern
Ethiopia. J health Dev. 2004; 14(2): 143-148.

28. Teklay Kidane, Asnakew Yigzaw, Yodit Sahilemariam, Tesfaye Bulto, Hiwot Mengistu, Tesfanesh
Belay, et al, National EPI coverage Survey report in Ethiopia, EJHD: 2008; 22(2). 148- 157.

29. CHERG Reports March 2015. Http: // www.who.int/ immunization/ diseases/ tetanus/ Lancet-2013-
Global-childmortality.pdf.

34
30. Alikhan RE, Aliraza M (2013) maternal health-care in India: The case of tetanus toxoid vaccination.
Asian Development Policy Review 1: 1-14.

31. Wanjiku MMM (2014) utilization of antenatal tetanus toxoid immunization service among women in
Bahati division, Nakuru country, Kenya.

32. Abel Negussie, Wondewosen Kassahun, Sahilu Assegid, and Ada K. Hagan, Factors associated with
incomplete childhood immunization in Arbegona district, southern Ethiopia, BMC Public Health, 2016;
16: 27.

33. Dangila culture and tourism office January 1/2018

35
10. Annexes
General information sheet

Verbal consent
Hello! My name is _________________. I am a BSC degree midwifery student of Debre Markos
University college of Health sciences.
I am conducting a study on maternal Tetanus toxoid immunization utilization and associated factors in
Dangila town. No information concerning you, as individual will be passed to another individual or
institution without your agreement.
You are kindly invited to be included in the study, which will have importance in improving maternal and
child health services. All information which you are being asked to provide in this questionnaire, will be
kept strictly confidential. And, will be used only for study purposes. Your participation is voluntary and
you have the right to participate or not have been communicated. However, your participation is
important to fulfill the study purpose.

Consent form that certify the respondents agreement before the interview

Do you agree to answer the following questions to the best of your ability?
Yes________________________ No____________________
if your answer is yes, please continue responding to the interview. And if no,
thank and stop interviewing and skip to the next house.
Name of the interviewer _______________ Signature__________
Date of interview____
Name of the supervisor _________________Sign.______ Date_____________

Questionnaire for community based survey on utilization and associated factors influencing utilization of
TT immunization in Dagila town.

001. Questionnaire Code___________

002. Kebele __________

003. House number _____________

004. How long have you been living in this town/Area ____

• Show the answer of the respondent by circling the number and / or writing or marking “√” on the space
provided.
• Time of interview start__________ ended_____________

36
English version questionnaire.

Part I -Questionnaire on socio-demographic characteristics.

S No Questionnaire Alternative choice for responses

101 Age in complete years? Years

102 Ethnicity? 1. Amhara

2. Oromo
3. Tigray
4. Gumuz
5. Others specify

103 Religion? 1. Orthodox

2. Muslim
3. Catholic
4. Protestant
5. Others specify

104 Marital status? 1. Married

2. Divorced
3. Widowed
4. Unmarried
5.separated
105 Maternal Level of education? 1. never been at school
2 .only read and write
3. primary education
4. secondary education
5. college and above
6. others specify

106 Maternal occupation? 1. Housewife

2.house worker
3. Civil servant
4. merchant
5. others specify

37
 107 Family monthly income (in birr)? _______Birr
108 Husband occupation? 1. teacher
2. health worker
3.merchant
4.farmer
5. carpenter
6.Others specify___
109 Husband educational status? 1 only read and write
2 primary education
3 secondary education
4 college and above
5 others specify____
110 Family size? _______

Part II: Questionnaire on Obstetric determinant

201 How many pregnancies have you had? 1. none

2. one

3. two

4. Tree and more

202 How many times have you get birth? 1. no

2. one

3. two

4. Three and more

203 Was the pregnancy planned for the recent child? 1. Yes

2. No

204 Do you have ANC follow up during your pregnancy period? 1. Yes

2. No

38
 205 If your answer for question 204 is yes what was the total 1. Once
number of ANC visits for the recent child being assessed? 2. two times
3. three times
4. Four and more

Part III Questionnaire on tetanus toxoid vaccine immunization

301 Have you ever heard about tetanus 1 yes

toxoid vaccination? 2 no
302 If your answer on question 301 is yes 1 Community members
from where you heard about tetanus 2 kebele administrator
toxoid vaccination? (More than one 3 Health extension workers
answer is possible). 4 Radio
5 television
6 News paper
7 others (specify) ___________
303 Have you ever been given “vaccination 1. Yes
injections” to prevent from getting 2. No
tetanus? 3. Don’t know
304 If your answer on question 301 is yes for 1. once
how many times you get vaccination? 2. Two times
3. Three times
4. Four times
5. Five times
305 If vaccinated, where was TT vaccine 1.Hospital
given? 2.Health center
3.Health post
4.Home/outreach
5. others specify
306 If not vaccinated, what was the reason? 1. Not aware
(More than one answer is possible) 2. Nobody advice me
3. Service area too far
4. Fear of side effects
5. No problem experienced
6. Others specify______
307 What is the purpose of getting TT 1.To prevent mother from tetanus
injection? 2.To prevent child from tetanus
3.To prevent both mother and child from tetanus
4.Don’t know
5. others specify_______
308 Who is supposed to receive TT 1. All men and women

39
 immunization in order to protect the 2. All women of child bearing age
unborn child? 3. Only children
4. don’t know
5. others specify______
309 How many TT injections is the woman 1. One injection
supposed to receive to be fully protected 2. Two injections
in life? 3. Three injections
4. Four injections
5. Five injections
6. Don’t know

Part IV: Questions on institution distance determinants services

401 How long does it take to travel from your home to the nearest ___minute
health institution when walking (in minute)?
402 What is your mode of transport from your home to health 1 walking
institution? 2 bicycle
3 on vehicle
4 others specify___
403 How much do you pay to the nearest health center for ___ Birr
transport (in birr)?
404 Is the road from your home to the nearest health institution 1 yes
possible throughout the year? 2 no
3 don’t know

Thanks for your cooperation!

40
 የአማርኛ ቃለ መጠይቅ

የመንጋጋ ቆልፍ ክትባት ዓጠቃቀምና ተያያዥነት ያሏቸው ጉዳዮች ለማጥናት የተዘጋጀ መጠይቅ
መጋቢት,2010 ዓ.ም

የስምምነት ቅጽ

ጤና ይስጥልኝ ስሜ________እባላለሁ:: በደብረ ማርቆስ ዩኒቨርሲቲ በጤና ሳይንስ ኮሌጅ እየተካሄደ

ባለው ሳይንሳዊ ጥናት ውስት የቡድን አባል ሆኜ የእናቶችን የመንጋጋ ቆልፍ ክትባት አጠቃቀምና
ተያያዥነት ያሏቸው ጉዳዮች የሚወስን የምርምር ስራ እየሰራሁ እገኛለሁ::ለዚህ ስራ የእርስወን
መልካም ድጋፍና ትብብር እፈልጋለሁ የጥናቱ አላማም ለእናቶችና ህጻናት ጤና አገልግሎት ጥራት
ለማሳደግ ይረዳል:: የእርስወን ስም አልጠቅስም ማንኛውንም ከእርስወ የምወስደውን መረጃ ለሌላ
ሶስተኛ ወገን ከእርስወ ፈቃድ ውጭ አሳልፌ የማልሰጥ መሆኑን ከወዲሁ እረጋግጣለሁ：：የምርምር ስራውም
በደብረማርቆስ ዩኒቨርሲቲ ተቀባይነት አግኝቷል ： ： ቃለ መጠይቁን ለመመለስ ፈቃደኛ ከሆኑ ጥያቄየን
እጀምራለሁ ለመሳተፍ ፈቃደኛ ነወት？1 አወ 2 የለም

መልሱ አወ ከሆነ ወደ ሚቀጥሉት ጥያቄወች ወይም የለም ከሆነ አመስግነህ/ሽ ወደሚቀጥለው ቤት እለፍ/ፊ

የመረጃ ሰብሳቢ ስም ፊርማ_________ ቀን

የተቆጣጣሪ ስም ፊርማ ቀን

በደብረ ማርቆስ ዩኒቨርሲቲ የእናቶችን የመንጋጋ ኮልፍ ክትባት ስርጭትና ተዛማጅ ጉዳዮች
በህብረተሰቡ ውስጥ የሚወስን ጥናት

001 የጥያቄዉ መለያ ቁጥር

002 የቤት ቁጥር

003 ለምን ያህል ጊዜ እዚህ ኖረዋል_______

የእናቶችን ትክክለኛ መልስ በተሰጡት የምርጫ ቁጥሮች ላይ በማክበብ ወይም በክፍት ቦታ ላይ በመፃፍ
ወይም ምልክት በማመልከት አሳዩ

ክፍል አንድ ስለ ግልና ማህበራዊ ጉዳዮች የሚመለከቱ ጥያቄወች

ተቁ ጥያቄ አማራጭ { መልስ በመፃፍ ወይም

በማክበብ አሳይ）
101 የእርስዎ እድሜ ስንት ነው በሙሉ አመት አመት

102 የየትኛው ብሔረሰብ አባል ነወት？ 1 አማራ

2 ኦሮሞ

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 3 ትግሬ
4 ጉምዝ
5 ሌላ ካለ ይገለፅ
103 የየትኛው ሀይማኖትተከታይ ነወት？ 1 ኦርቶዶክስ ተዋህዶ
2 እስላም
3 ካቶሊክ
4 ፕሮቴስታንት
5 ሌላ ካለ ይገለፅ
104 የጋብቻ ሁኔታ 1 ያገባች
2 የተፋታች
3 ባል የሞተባት
4 ያላገባች
5 ተለያይተው የሚኖሩ
105 የዕርስዎ የትምህርት ደረጃ？ 1 ያልተማረች
2 ማንበብና መፃፍ ብቻ የምትችል
3 አንደኛ ደረጃ ትምህርት
4 ሁለተኛ ደረጃ ትምህርት
5 ኮሌጅ እና ከሀ 1 ያ በላይ
6 ሌላ ካለ ይገለፅ
106 የዕርስወ የስራ መደብ？ 1 የቤት እመቤት
2 የቤት ሰራተኛ
3 የመስሪያ ቤት ሰራተኛ
4 ነጋዴ
5 ሌላ ካለ ይገለፅ
107 በወር ውስጥ ጠቅላላ የቤተሰብ ገቢ በብር？ ብር
108 የባለቤትወ የስራ መደብ？ 1 መምህር
2 የጤና ባለሙያ
3 ነጋዴ
4 ግብርና
5 አናጺ
5 ሌላ ካለ ይገለጽ

109 የባለቤትወ የት/ት ደረጃ？ 1 ማንበብና መጻፍ ብቻ የሚችል

2 አንደኛ ደረጃ
3 ሁለተኛ ደረጃ
4 ኮሌጅ እና ከሀ 1 ያ በላይ
5 ሌላ ካለ ይገለጽ

110 ጠቅላላ የቤተሰብ ብዛት ስንት ነው？ ———

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ክፍል ሁለት ወሊድና ጤና ነክ ጉዳዮችን ጥናት በተመለከተ

201 ምን ያህል ጊዜ አርግዘው ያዉቃሉ？ 1 ምንም

2 አንድ ጊዜ
3 ሁለት ጊዜ
4 ሶስትና ከዚያ በላይ
202 ስንት ልጆች ወልደዋል？ 1 ምንም
2 አንድ
3 ሁለት
4 ሶስትና ከዚያ በላይ
203 የመጨረሻ ዕርግዝናዎን አቅደው ነበር 1 አወ
ያረገዙት？ 2 የለም
204 በዕርግዝናዎ ወቅት የቅድመ ወሊድ ክትትል 1 አወ
ነበረዎት？ 2 የለም
205 ለጥያቄ ቁጥር 204 መልስዎ አወ ከሆነ ስንት 1 አንድ ጊዜ
ጊዜ ክትትል አደረጉ？ 2 ሁለት ጊዜ
3 ሶስት ጊዜ
4 አራት ጊዜና በላይ

ክፍል ሶስት ተጠያቂዎች በመንጋጋ ቆልፍ በሽታ ክትቫት ላይ ያላቸው መጠይቅ

301 ስለ መንጋጋ ቆልፍ በሽታ ክትቫት ሰምተው 1 አወ

ያዉቃሉ？ 2 አልሰማሁም
302 ለጥያቄ ቁጥር 301 መልስወ አወ ከሆነ የት ነበር 1. ከማህበረሰቡ
የሰሙት？ከአንድ በላይ መልስ መጥቀስ ይቻላል 2. ከቀበሌ አስተዳደር
3. ከጤና ኤክስቴንሽን
ባለሞያወች
4. ከሬዲዮ
5. ከቴሌቭዥን
6. ከጋዜጣ
7. ሌላ ካለ ይገለጽ________
303 የመንጋጋ ቆልፍ በሽታ መከላከያ ክትቫት ዎስደው 1 አወ
ያዉቃሉ？ 2 የለም
3 አላስታዉስም
304 ለጥያቄ ቁጥር 303 መልስዎ አወ ከሆነ ስንት ጊዜ 1 አንድ ጊዜ
ተከተቡ？ 2 ሁለት ጊዜ
3 ሶስት ጊዜ

43
 4 አራት ጊዜ
5 አምስት ጊዜ
305 ክትቫቱን የወሰዱት የት ነበር？ 1 ሆስፒታል
2 ጤና ጣቢያ
3 ጤና ኬላ
4 ከቤትዎ/በዘመቻ
5 ሌላ ካለ ይገለጽ ——
306 ካልተከተቡ ያልተከተቡበት ምክንያት ምን 1 አለማወቅ
ነበር？ከአንድ በላይ መልስ መስጠት ይቻላል 2 የመከረኝ የለም
3 የአገልግሎት መስጫ ርቀት
4 የክትቫት መዘዝ ፍራቻ
5 ችግር አግኝቶኝ አያዉቅም
6 ሌላ ካለ ይገለጽ——
307 የመንጋጋ ቆልፍ ክትቫት ጥቅሙ ምንድን ነው？ 1 ለራስ መከላከያ
2 ለምወልደው ልጅ መከላከያ
3 ለእናትና ለልጅ
（ለሁለቱም）
4 አላውቅም
5 ሌላ ካለ ይገለጽ——
308 የመንጋጋ ቆልፍ ክትቫትለነማን ይሰጣል？ 1 ለሁሉም ወንዶችና ሴቶች
2 ከ 15 እስከ 49 አመት ላሉ
እናቶችና ለህጻናት
3 ለህጻናት ብቻ
4 አላውቅም
5 ሌላ ካለ ይገለጽ——
309 የመንጋጋ ቆልፍ ክትቫት ስንትጊዜ ይሰጣል？ 1 አንድ ጊዜ
2 ሁለት ጊዜ
3 ሶስት ጊዜ
4 አራት ጊዜ
5 አምስት ጊዜ
6 አላውቅም

ክፍል IV የጤና ተቋማትን ቅርበትና ርቀት በተመለከተ

401 ከቤትዎ እስከ ቅርቡ ጤና ተቋም በደቂቃ ምን ያህል ——ደቂቃ

ይወስዳል？
402 ከቤትዎ እስከ ቅርቡ ጤና ተቋም ለመሄድ የሚጠቀሙት 1 በእግር ጉዞ
መጓጓዣ ምንድን ነው？ 2 በብስክሌት
3 በታክሲ
4 ሌላ ካለ ዪገለጽ——

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403 ከቤትዎ እስከ ቅርቡ ጤና ተቋም ለመሄድ ምን ያህል ——ብር
ይከፍላሉ（በብር）？
404 ከቤትዎ እስከ ቅርቡ ጤና ድርጅት ያለው መንገድ 1 አወ ይሰጣል
አመቱን ሙሉ አገልግሎት ይሰጣል？ 2 የለም አይሰጥም
3 አላዉቅም

ስለትብብርዎ እናመሰግናለን！

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