Maternal Immunization Knowledge, Attitudes, and Practices on Tetanus Toxoid Vaccination Among Pregnant Teenagers
Ma. Chaela A. Alvarez | Marshall Jeanne L. Lumaguey | Pauline Erika B. Mimay | Alyana M. Cruz | Marc Lester F. Quintana | Vivian P. Lajara
Discipline: health studies
Abstract:
Tetanus toxoid vaccination is a key maternal immunization
intervention for preventing maternal and neonatal tetanus, a highly fatal yet
preventable condition. Despite free provision by the Philippine Department of
Health, vaccination uptake among pregnant teenagers remains inconsistent.
However, there is limited local evidence examining the knowledge, attitudes,
and practices related to tetanus toxoid vaccination among pregnant
adolescents, particularly in community-based settings. This study assessed
levels of knowledge, attitudes, and practices regarding tetanus toxoid
vaccination among pregnant teenagers in San Pablo City, Laguna, and
examined differences by selected socio-demographic characteristics. A
descriptive-comparative quantitative design was utilized, involving 65
pregnant teenagers selected through purposive sampling from barangays with
high teenage pregnancy prevalence. Data were collected using a validated and
reliability-tested questionnaire. Statistical analyses included frequency and
percentage, mean and standard deviation, and the Mann–Whitney U test and
Kruskal–Wallis test. Findings indicated moderate knowledge, positive
attitudes, and generally adequate but inconsistent vaccination practices.
Significant differences in knowledge were observed across age and educational
attainment groups, whereas attitudes differed significantly by civil status. No
significant differences were found in practices across socio-demographic
variables. These findings emphasize the need for adolescent-centered maternal
immunization education, early engagement in antenatal care, and supportive
vaccination counseling. As a practical output, a Personalized Tetanus Toxoid
Immunization Journal was developed to enhance dose monitoring, awareness,
and vaccination compliance among pregnant teenagers. Strengthening youthfocused
maternal immunization initiatives may help reduce the risk of maternal
and neonatal tetanus at the community level.
References:
- Albrecht, M., & Arck, P.C. (2020). Vertically transferred immunity in neonates: Mothers, mechanisms, and mediators. Frontiers in Immunology, 11, Article 555. https://doi.org/10.3389/fimmu.2020.00555
- Alghamdi, R.S., & Tayyib, N.A.-G.H. (2023). Knowledge, attitude, and awareness on (tetanus, diphtheria, and acellular pertussis) vaccination during pregnancy in the Kingdom of Saudi Arabia. Nursing Communications, 7, e2023022. https://doi.org/10.53388/IN2023022
- Altaş, Z.M., Abdulhaq, B., Sezerol, M.A., & Karabey, S. (2025). Tetanus vaccine knowledge, beliefs, and attitudes among Syrian pregnant women in Türkiye: A qualitative study. Healthcare (Basel, Switzerland), 13(3), 302. https://doi.org/10.3390/healthcare13030302
- Alzboon, G., & Vural, G. (2021). The experience of healthy pregnancy in high parity women: A phenomenological study in North Jordan. Medicina, 57(8), 853. https://doi.org/10.3390/medicina57080853
- Amoak, D., Osei Kye, N., Anfaara, F.W., Sano, Y., & Antabe, R. (2022). Maternal tetanus toxoid vaccination in Benin: Evidence from the demographic and health survey. Vaccines, 11(1), 77. https://doi.org/10.3390/vaccines11010077
- Assefa, E.M. (2019). Knowledge, attitude and practice (KAP) of health providers towards safe abortion provision in Addis Ababa health centers. BMC Women’s Health, 19(1), 138. https://doi.org/10.1186/s12905-019-0835-x
- Aswad, T.H., & Abdul-Sahib, H.M. (2025). Knowledge and attitude of tetanus–diphtheria vaccine in pregnant women. Iraqi Journal of Community Medicine, 38(1), Jan–Jun 2025. https://doi.org/10.4103/IRJCM.IRJCM_27_24
- Awosan, K.J., & Hassan, M. (2020). Perception and utilization of tetanus toxoid immunization among pregnant women attending a tertiary centre in North-West Nigeria. Journal of Drug Delivery and Therapeutics, 8(6), 23-29
- Bahabadi, F.J., Estebsari, F., Rohani, C., Kandi, Z.R., Sefidkar, R., & Mostafaei, D. (2020). Predictors of health-promoting lifestyle in pregnant women based on Pender’s health promotion model. International Journal of Women’s Health, 12, 71–77. https://doi.org/10.2147/IJWH.S235169
- Bernstein, H., Cleary, S., Chi, V., Sherin, M., Rosenberg, A., & Spino, C. (2024). Maternal recall of obstetric office-based activities that promote antepartum tetanus-diphtheria-acellular-pertussis vaccination. Journal of Women’s Health. https://pubmed.ncbi.nlm.nih.gov/38629392
- Bizuneh, K.F., & Mustofa, M.S. (2024). Uptake of protective tetanus toxoid vaccine doses and maternal associated factors during pregnancy in armed conflict zone, hospital-based cross-sectional study. Frontiers in Reproductive Health, 6, 1353699. https://doi.org/10.3389/frph.2024.1353699
- Bonvicini, L., Sileo, F.G., Riboldi, B., Bisaccia, E., Tamelli, M., Bertani, D., Cilloni, S., Ghirotto, L., & Rossi, P.G. (2025). The Tdap vaccination in pregnancy: Results of a healthy equity audit on coverage trends and their determinants in the Reggio Emilia Province (Italy). Vaccines, 13(3), 251. https://doi.org/10.3390/vaccines13030251
- Chamangasht, M., Kamrani, M.A., & Farid, M. (2021). Efficacy of an early self-care-based education program on the self-evaluation of primiparous postpartum mothers: A randomized controlled clinical trial. Shiraz E-Med J. 2021; 22(9):e108132. https://doi.org/10.5812/semj.108132
- Dasa, T.T., Okunlola, M., & Dessie, G. (2022). Effect of grand multiparity on adverse maternal outcomes: A prospective cohort study. Frontiers in Public Health, 10, 959633. https://doi.org/10.3389/fpubh.2022.959633
- El-Adham, A.F., El-Nagar, A.E., & Hashem, S.M. (2022). Determinants of tetanus toxoid vaccination use among pregnant women. Tanta Scientific Nursing Journal, 27(4), 30-52.
- El-shrqawy, E.H., Elnemer, A., & Elsayed, H.M. (2024). Effect of antenatal education on pregnant women’s knowledge, attitude and preferences of delivery mode. BMC Pregnancy and Childbirth, 24, 740. https://doi.org/10.1186/s12884-024-06922-0
- Faria, A.P.V., da Silva, T.P.R., Duarte, C.K., Mendes, L.L., Santos, F.B.O., & Matozinhos, F.P. (2021). Tetanus vaccination in pregnant women: A systematic review and meta-analysis of the global literature. Public health, 196, 43–51. https://doi.org/10.1016/j.puhe.2021.04.019
- Gebretsadik, S., Girma, B., Molla, A., & Mareg, M. (2022). Tetanus toxoid vaccination coverage and associated factors among childbearing women in Ethiopia: A systematic review and meta-analysis. BioMed Research International, 2021, 5529315. https://doi.org/10.1155/2021/5529315
- Gelaw, T., Ayalew, S., & Eyene, K. (2022). Knowledge and uptake of tetanus toxoid vaccine and associated factors among reproductive age group women in Hayk Town South Wollo, Ethiopia: Cross-sectional study. medRxiv.
- Gembe, M., Wosenyeleh, T., & Gezimu, W. (2024). Protective doses of tetanus toxoid immunization and its associated factors among mothers in Southern Ethiopia. Human Vaccines & Immunotherapeutics, 20(1), 2320501. https://doi.org/10.1080/21645515.2024.2320501
- Hernandez, J., & O'Connor, T. (2020). Factors influencing vaccination practices: A survey of healthcare workers and the general public. Journal of Immunization Practices, 12(2), 145–152.
- Ibrahim, Z., Sabahelzain, M., Elhadi, Y.A.M., Malande, O.O., & Babiker, S. (2023). Predictors of tetanus vaccine uptake among pregnant women in Khartoum State, Sudan: A hospital-based cross-sectional study. Vaccines, 11(7), 1268. https://pubmed.ncbi.nlm.nih.gov/37515083/
- Iqbal, S., Ali, I., Ekmekcioglu, C., & Kundi, M. (2020). Increasing frequency of antenatal care visits may improve tetanus toxoid vaccination coverage in pregnant women in Pakistan. Human Vaccines & Immunotherapeutics, 16(7), 1–4. (ResearchGate record in your list.)
- Jasim, R.M., thanoon, S.R., Alzaidy, Z.F., & Sulaiman, N.K. (2021). Assessment knowledge of pregnant women about tetanus toxoid vaccination in Mosul City. Systematic Reviews in Pharmacy. https://tinyurl.com/yc2h2jak
- Johm, P., Nkoum, N., Ceesay, A., Mbaye, E.H., Larson, H., & Kampmann, B. (2021). Factors influencing acceptance of vaccination during pregnancy in The Gambia and Senegal. Vaccine, 39(29), 3926–3934. https://doi.org/10.1016/j.vaccine.2021.05.068
- Johns, N., Cata-Preta, B., Kirkby, K., Arroyave, L., Bergen, N., Danovaro-Holliday, M.C., Santos, T., Yusuf, N., Barros, A., & Hosseinpoor, A.R. (2023). Inequalities in immunization against maternal and neonatal tetanus: A cross-sectional analysis of protection at birth coverage using household health survey data from 76 countries. Vaccines, 11(4), 752. https://doi.org/10.3390/vaccines11040752
- Jones, C., Yusuf, N., Ahmed, B., Kassogue, M., Wasley, A., & Kanu, F. (2024). Progress toward achieving and sustaining maternal and neonatal tetanus elimination—Worldwide, 2000–2022. MMWR Morbidity and Mortality Weekly Report, 73, 614–621. https://doi.org/10.15585/mmwr.mm7328a1
- Kanu, F., Yusuf, N., Ahmed, B., Kassogue, M., & Tohme, R. (2022). Progress toward achieving and sustaining maternal and neonatal tetanus elimination—Worldwide, 2000–2020. MMWR Morbidity and Mortality Weekly Report, 71(12), 406–411. https://doi.org/10.15585/mmwr.mm7111a2
- Kuye-kuku, T.O., Akinlusi, F.M., Olalere, F.D.H., Chionuma, J.O., Oshodi, Y.A., & Ottun, T.A. (2022). Awareness, adherence, and determinant factors among pregnant mothers on lifelong tetanus toxoid vaccination as part of the national immunization scheme. Journal of Advances in Medicine and Medical Research, 34(8), 27–34. https://doi.org/10.9734/JAMMR/2022/v34i831338
- Lanuza, P.D., Garcia, J.J., Turalde, C.W., & Prado, M., Jr. (2024). Clinical profile and outcomes of tetanus patients in a tertiary hospital in the Philippines: A ten-year retrospective study. BMC Infectious Diseases, 24, 142. https://doi.org/10.1186/s12879-024-09037-1
- Lee, S., Adam, E., Kanyike, A.M., Wani, S., Kasibante, S., Mukunya, D., & Nantale, R. (2024). Compliance with the WHO recommended 8+ antenatal care contacts schedule among postpartum mothers in Eastern Uganda: A cross-sectional study. PLOS One, 19(12), e0314769. https://doi.org/10.1371/journal.pone.0314769
- Leo, C.L., Sinaga, M., & Wijaya, R.P.C. (2023). Factors associated with the utilization of tetanus toxoid immunization services among pregnant women in Oepoi Health Center, Kupang, East Nusa Tenggara. Journal of Health Promotion and Behavior, 8(1), 58–64. https://www.thejhpb.com/index.php/thejhpb/article/view/407
- Liyew, A.M., & Ayalew, H.G. (2021). Individual and community-level determinants of poor tetanus toxoid immunization among pregnant women in Ethiopia using data from the 2016 Ethiopian Demographic and Health Survey. Archives of Public Health, 79(1), 92.
- Maheshwari, M., Khalid, N., Patel, P., Alghareeb, R., & Hussain, A. (2022). Maternal and neonatal outcomes of adolescent pregnancy: A narrative review. Cureus, 14(6), e25921. https://doi.org/10.7759/cureus.25921
- Mathews, S. (2022). Adolescent capacity to consent to participate in research. Laws, 12(1), 2. https://doi.org/10.3390/laws12010002
- Mehanna, A., Ali, M., & Kharboush, I. (2020). Knowledge and health beliefs of reproductive-age women in Alexandria about tetanus toxoid immunization. Journal of the Egyptian Public Health Association, 95(1), 22. https://doi.org/10.1186/s42506-020-00049-8
- Manzoor, I. (2019). Tetanus toxoid vaccination coverage and reasons for non-vaccination among married women in the reproductive age group 15–49 years. ResearchGate. https://tinyurl.com/bdh86sr3
- Mitrogiannis, I., Evangelou, E., Efthymiou, A., Kanavos, T., Birbas, E., Makrydimas, G., & Papatheodorou, S. (2023). Risk factors for preterm birth: An umbrella review of meta-analyses of observational studies. BMC Medicine, 21(1), 494. https://doi.org/10.1186/s12916-023-03171-4
- Modawey, S.H.F. (2019). Knowledge, attitude, and practice of Sudanese women toward tetanus toxoid vaccine during pregnancy in Bahri Teaching Hospital, May 2018. Chronicle of Medicine and Surgery. https://scientiaricerca.com/srcoms/pdf/SRCOMS-03-00056.pdf
- Naha, S.K., Arpon, M.E.I., Siddique, R.T., Ripa, F.R., Hasan, M.N., & Uddin, M.J. (2025). A study of association between maternal tetanus toxoid immunization and neonatal mortality in the context of Bangladesh. PLOS One, 20(1), e0316939. https://doi.org/10.1371/journal.pone.0316939
- Nigussie, J. (2021). Tetanus toxoid vaccination coverage and associated factors among childbearing women in Ethiopia: A systematic review and meta-analysis. Biomed Research International, 2021, Article 5529315. https://doi.org/10.1155/2021/5529315
- Njuguna, H., Yusuf, N., Raza, A.A., Ahmed, B., & Tohme, R. (2020). Progress toward maternal and neonatal tetanus elimination—Worldwide, 2000–2018. MMWR Morbidity and Mortality Weekly Report, 69(17), 515–520. https://doi.org/10.15585/mmwr.mm6917a2
- Nyando, M., Makombe, D., Mboma, A., Mwakilama, E., & Nyirenda, L. (2023). Perceptions of pregnant women on antenatal care visit during their first trimester at Area 25 health centre in Lilongwe, Malawi - A qualitative study. BMC Women’s Health, 23, 646. https://doi.org/10.1186/s12905-023-02800-7
- Olufadewa, I., Adesina, M., Akinniranye, H., Oladele, R., Olufadewa, T., & Obigwe, E. (2024). Determinants of taking adequate tetanus toxoid vaccination among mothers in their last pregnancy in Nigeria. Razi International Medical Journal, 4(1), 25–34. https://doi.org/10.56101/rimj.v4i1.139
- Patel, A., & Kumar, R. (2022). Attitudes toward vaccination and its effect on vaccine uptake: A cross-sectional analysis of community-based surveys. Vaccine, 40(4), 526–532. https://doi.org/10.1016/j.vaccine.2022.01.012
- Pepito, V.C., Amit, A.M., Tang, C., Co, L.M., Aliazas, N.A., De Los Reyes, S., Baquiran, R., & Tanchanco, L.B. (2021). Factors associated with pregnancy among Filipino women aged 15–19: Results from the 2017 Philippine National Demographic and Health Survey. Research Square. https://doi.org/10.21203/rs.3.rs-808908/v1
- Salehe, F., Omari, R., Moshi, F., & Kibusi, S. (2025). Using Health Belief Model to explain the factors associated with postnatal services utilization among post-delivery mothers in Zanzibar: A cross-sectional study. Medicine, 104(1), e41229. https://doi.org/10.1097/MD.0000000000041229
- San Juan, F.G. (2024). Re-examining the measles outbreak in the Philippines: Strengthening the vaccination program through women. International Journal of Women’s Health, 16, 2359808. https://doi.org/10.1080/21645515.2024.2359808
- Sari, A.N., Tini, T., & Lushinta, L. (2023). Analysis of factors related to the completeness of tetanus toxoid immunization in trimester III pregnant women. International Journal of Nursing and Midwifery Science (IJNMS), 7(2A), 80–87.
- Saso, A., & Kampmann, B. (2020). Maternal immunization: Nature meets nurture. Frontiers in Microbiology, 11, 1499. https://doi.org/10.3389/fmicb.2020.01499
- Shahid, S., Khan, R., & Jamil, N. (2024). Knowledge and determinants of TT awareness among mothers. Journal of Public Health Research, 13(1), 44–52.
- Silva, T.V., Bento, S.F., Katz, L., et al. (2021). “Preterm birth risk, me?” Women risk perception about premature delivery - A qualitative analysis. BMC Pregnancy and Childbirth, 21, 633. https://doi.org/10.1186/s12884-021-04068-x
- Smith, D., Martin, L., & Roberts, P. (2021). Awareness of tetanus vaccination and its role in public health: A review. International Journal of Vaccine Studies, 18(1), 58–64.
- Sultana, R., Ali, N., Islam, S., & Rahman, F. (2023). Child immunization practices by number of siblings. BMC Public Health, 23(1), 1449.
- Tamiru, Y.D., Sendo, E.G., & Deressa, J.T. (2024). Factors associated with tetanus toxoid vaccine utilization among reproductive-age women in Debre Markos Town, Ethiopia, 2021: A cross-sectional study. Therapeutic Advances in Vaccines and Immunotherapy, 12, 25151355241305855. https://doi.org/10.1177/25151355241305855
- Tilahun, W.M., Geremew, H., Abay, L.Y., Kebie, A.B., & Simegn, M.B. (2025). Determinants of tetanus immunization among pregnant women where tetanus has not been eliminated: A multilevel analysis of six countries. Frontiers in Global Women’s Health. https://doi.org/10.3389/fgwh.2025.1481771
- Timsin, N., & Wangpitipanit, S. (2025). The effects of a health literacy promotion program for prevention of preterm birth among pregnant women who received antenatal care services in the hospital-based. Chinese Roots Global Impact. https://doi.org/10.1016/j.wcn.2025.01.003
- United Nations Population Fund (UNFPA). (2024). Philippines – Adolescent pregnancy. United Nations Population Fund. https://tinyurl.com/mrxkbnv4
- Undie, C.-C., & Birungi, H. (2022). What to expect when girls are expecting: Psychosocial support challenges and opportunities in the context and aftermath of teenage pregnancy in Kenya. Reproductive Health 19, 228. https://doi.org/10.1186/s12978-022-01544-1
- World Health Organization. (2019). Immunization, vaccines and biologicals - Tetanus. World Health Organization. https://tinyurl.com/sbtv4vse
- World Health Organization. (2024). Tetanus. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/tetanus
- World Health Organization. (2024). Maternal health. World Health Organization. https://tinyurl.com/yeywfdby
- Yaya, S., Kota, K., Buh, A., & Bishwajit, G. (2020). Prevalence and predictors of taking tetanus toxoid vaccine in pregnancy: A cross-sectional study of 8,722 women in Sierra Leone. BMC Public Health, 20(1), 855. https://doi.org/10.1186/s12889-020-08985-y
- Yusuf, N., Steinglass, R., & Gasse, F. (2022). Sustaining Maternal and Neonatal Tetanus Elimination (MNTE) in countries that have been validated for elimination – Progress and challenges. BMC Public Health, 22, 691. https://doi.org/10.1186/s12889-022-13110-2
- Zaman, A., Şahin, S., & Üstüner, M. (2025). The role of antenatal education on maternal self-efficacy, fear of childbirth, and delivery mode: A systematic review. European Journal of Midwifery. https://tinyurl.com/3ac4r874
- Zhang, J., Wang, P., Fan, W., & Lin, C. (2024). Comparing the prevalence and influencing factors of postpartum depression in primiparous and multiparous women in China. Frontiers in Psychiatry, 15:1479427. https://doi.org/10.3389/fpsyt.2024.1479427
- Zegeye, A.F., Tamir, T.T., Mekonen, E.G., Ali, M.S., Gonete, A.T., Techane, M.A., Wassie, M., Kassie, A.T., Ahmed, M.A., Tsega, S.S., Wassie, Y.A., Tekeba, B., & Workneh, B.S. (2024). Number of tetanus toxoid injections before birth and associated factors among pregnant women in low and middle income countries: Negative binomial poisson regression. Human Vaccines & Immunotherapeutics, 20(1), 2352905. https://doi.org/10.1080/21645515.2024.2352905
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