Tetanus Toxoid Vaccine Uptake and Associated Factors Among Reproductive Age Women in Mogadishu, Somalia: A Cross-Sectional Study

TL;DR

Tetanus vaccine coverage is low in Mogadishu, with older women, those with planned pregnancies, and those receiving health worker support more likely to be protected.

Contribution

Identifies key factors influencing TT vaccine uptake in reproductive-age women in Mogadishu, Somalia.

Findings

Only 19.7% of women received two or more TT vaccine doses during their last pregnancy.

Older women (36-49 years) were 6.62 times more likely to be protected than younger women (15-25 years).

Households with a monthly income below $57 were significantly less likely to be protected.

Abstract

•Tetanus toxoid vaccine coverage in Mogadishu is low (19.7% received ≥2 doses).•Older women and those with planned pregnancies were more protected.•Visits by health extension workers greatly increased protection.•Antenatal care attendance and respectful health worker behavior boosted uptake.•Low-income women were much less likely to be protected.

Tetanus toxoid vaccine coverage in Mogadishu is low (19.7% received ≥2 doses).

Older women and those with planned pregnancies were more protected.

Visits by health extension workers greatly increased protection.

Antenatal care attendance and respectful health worker behavior boosted uptake.

Low-income women were much less likely to be protected.

Maternal and neonatal tetanus (MNT) remains a major public health concern in Somalia, where health infrastructure is still recovering. Despite the availability of a safe and effective tetanus toxoid (TT) vaccine, coverage remains low. This study aimed to identify factors influencing TT vaccine uptake among reproductive-age women in Mogadishu, Somalia.

A community-based cross-sectional study was conducted from June to August 2025 in Mogadishu, Somalia. A two-stage cluster sampling technique combined with systematic random sampling was used to select 350 households. Data were collected using a structured, interviewer-administered questionnaire, and the primary outcome was adherence to at least two doses of the TT vaccine during pregnancy. Data were analyzed using bivariate and multivariable logistic regression to identify independent predictors of TT vaccine uptake.

A total of 350 women participated in the study. Coverage of the TT vaccine was low, with only 19.7% receiving two or more doses during their last pregnancy. Multivariate analysis showed that women aged 36-49 years were more likely to be protected compared to those aged 15-25 years (AOR = 6.62; 95% confidence interval [CI]: 1.74-25.21; P = 0.006). Planned pregnancy was associated with higher protection (AOR = 8.35; 95% CI: 3.25-21.45; P <0.001). Attendance at health centers for antenatal care (AOR = 0.35; 95% CI: 0.18-0.69; P = 0.002), visits by health extension workers (AOR = 8.13; 95% CI: 4.35-15.22; P <0.001), and good behavior of health workers (AOR = 3.48; 95% CI: 1.15-10.46; P = 0.027) were positively associated with TT protection. Women from households with a monthly income below 57 US$ were significantly less likely to be protected (AOR = 0.04; 95% CI: 0.01-0.22; P <0.001).

TT vaccination coverage among women was low. Older age, planned pregnancy, antenatal care at health centers, visits by health extension workers, and good behavior of health workers were associated with higher protection, while low household income was linked to lower uptake. Strengthening targeted interventions is needed to improve TT coverage.

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