• Mohammad Naeem
  • Muhammad Zia-Ul-Islam Khan
  • Syed Hussain Abbas
  • Muhammad Adil
  • Ayasha Khan
  • Syeda Maria Naz
  • Muhammad Usman Khan


Background: Pakistan has one of the highest maternal mortality rates in the world, with widelyprevalent maternal and neonatal tetanus. The purpose of this study was to estimate the coverage anddetermine the factors associated with tetanus toxoid vaccination status among females of reproductiveage in Peshawar. Methods: A Cross-sectional study was conducted in Peshawar, Pakistan, from 9 Juneto 19 June 2010. A total of 304 females of reproductive age (17‒45) years were selected from bothurban and rural areas of Peshawar through random sampling. A pre-tested structured questionnaire wasadministered to females. Questions about demographics, income, education of husband, occupation,accessibility to health centres and frequency of visits from health workers was inquired. Knowledgeand views on immunization were also asked. Results: Overall 55.6% were vaccinated. Urbanpopulation was 54.3% while rural population was 45.7%. Reasons for not vaccinating were: Noawareness (38.4%), being busy (18.1%), centre too far (18.1%), misconceptions (10.86%), and fear ofreactions (4.3%). Most of the females thought immunization was effective (89.5%). Husbandeducation, females’ knowledge and views on immunization, income, distance, frequency of healthvisits were the main factors associated with immunization status. Conclusion: Majority of females arenot vaccinated. Effective media campaigns on maternal tetanus vaccination should be carried. Ladyhealth workers should be mobilised effectively to increase the vaccination coverage.Keywords: Tetanus toxoid, immunization, EPI Pakistan


Elimination of Maternal and Neonatal Tetanus. [online][cited 10

September 2010]; Available from:


Maternal and Neonatal Tetanus Elimination by 2005-UNICEF.

[online][cited 10 September 2010]; Available from:

Afridi NK, Hatcher J, Mahmud S, Nanan D. Coverage and

factors associated with tetanus toxoid vaccination status among

females of reproductive age in Peshawar. J Coll Physicians Surg

Pak 2005;15:391–5.

Hasnain S, Sheikh NH. Causes of low tetanus toxoid vaccination

coverage in pregnant women in Lahore district, Pakistan. East

Mediterr Health J 2007;13:1142–52.

WHO vaccine-preventable diseases: monitoring system 2010

global Estimates. [online][cited 10 September 2010]; Available



Siddiqi N, Khan A, Nisar N, Siddiqi AE. Assessment of EPI

(expanded program of immunization) vaccine coverage in a periurban area. J Pak Med Assoc 2007;57:391–5.

Rahman MM. Determinants Of The Utilization Of The Tetanus

Toxoid (TT) Vaccination Coverage In Bangladesh: Evidence

From A Bangladesh Demographic Health Survey 2004. Int J

Health 2009;8(2).

Rahman M. Tetanus toxoid vaccination coverage and differential

between urban and rural areas of Bangladesh. East Afr J Public

Health 2009;6(1):26–31.

Gupta RS, Gupta A, Gupta HO, Venkatesh S, Lal S. Mother and

child service coverage: reproductive and child health programme in

Alwar district, Rajasthan state. J Commun Dis 2006;38(1):79–87.

Torun SD, Bakırcı N. Vaccination coverage and reasons for nonvaccination in a district of Istanbul. BMC Public Health


Mansuri FA, Baig LA. Assessment of immunization service in

perspective of both the recipients and the providers: a reflection

from focus group discussions. J Ayub Med Coll Abbottabad


Kidane T. Factors influencing TT immunization coverage and

protection at birth coverage in Tselemti District, Ethiopia. Ethiop

J Health Dev 2004;18(3):153–8.

J Ayub Med Coll Abbottabad 2010;22(3)

Gokhale MK, Rao SS, Garole VR. Infant mortality in India: use

of maternal and child health services in relation to literacy status.

J Health Popul Nutr 2002;20(2):138–47.

Inakci HI, Simsek Z, Koruk I, Koruk ST. Coverage of Tetanus

Vaccine after National Tetanus Vaccination Campaign and Basic

Determinants in Sanliurfa. TAF Prev Med Bull 2009;8(6):453–8.

Gupta SD, Keyl PM. Effectiveness of prenatal tetanus toxoid

immunization against neonatal tetanus in a rural area in India.

Pediatr Infect Dis J 1998;17:316–21.

Ahmad N, Akhtar T, Roghani MT, Ilyas HM, Ahmad M.

Immunization coverage in three districts of North West Frontier

Province (NWFP). J Pak Med Assoc 1999;49:301–5.

Anand S, Bärnighausen T. Health workers and vaccination

coverage in developing countries: an econometric analysis.

Lancet 2007;369:1277–85.

Perry H, Weierbach R, Hossain I, Islam R. Tetanus toxoid

immunization coverage among women in zone 3 of Dhaka city:

the challenge of reaching all women of reproductive age in urban

Bangladesh. Bull World Health Organ 1998;76:449–57.

Atkinson SJ, Cheyne J. Immunization in urban areas: issues and

strategies. Bull World Health Organ 1994;72(2):183–94.

Nisar N, Mirza M, Qadri MH. Knowledge, attitude and practices

of mothers regarding immunization of one year old child at

Mawatch Goth, Kemari Town, Karachi. Pakistan. J Med Sci




Most read articles by the same author(s)