Knowledge, attitudes and practices related to tetanus toxoid vaccination in women of childbearing age: A cross-sectional study in peri-urban settlements of Karachi, Pakistan

Backgound: A higher incidence of neonatal tetanus implies failure of the vaccination program in Pakistan. Objectives: The objective of this study was to assess knowledge, attitudes and practices related to tetanus toxoid (TT) vaccine in women of childbearing age. Methods: We performed a cross-sectional survey in peri-urban Karachi, Pakistan, among women of childbearing age, stratified into three mutually exclusive groups as: married pregnant; married non-pregnant; and unmarried. Descriptive and inferential analyses were performed to estimate vaccine coverage and knowledge attributes. Results: A total of 450 women participated, of which the largest proportion were married and non-pregnant (n = 185/450, 41%). Over 50% of women (n = 258/450) had not received TT vaccine. Most unmarried women (n = 139, 97%) were unvaccinated. Non-vaccination predictors included: women aged <25 years without any formal education (adjusted odds ratio [OR], 2.1; 95% confidence interval [CI], 1.0–4.4), lack of knowledge about free vaccination (adjusted OR, 4.0; 95% CI, 1.64–10.20), poor knowledge of tetanus disease/vaccination (adjusted OR, 4.6; 95%, 2.2–9.6), living with extended family (adjusted OR, 2.0; 95% CI, 1.04–3.96); family non-supporting vaccination (adjusted OR, 5.7; 95% CI, 2.3–13.9); and husband/other family member deciding upon issues related to women’s health (adjusted OR, 2.9; 95% CI, 1.3–6.6). Conclusion: Low coverage of TT vaccine is largely influenced by poor knowledge, family structure and family decision-making in the local communities of Pakistan.