Exploring Coverage and Determinants of Two or More Doses of Tetanus Toxoid Containing Vaccine Immunization among Pregnant Women in Somalia: Evidence from SDHS Data 2020

Abstract Background Tetanus remains a significant public health challenge in low-resource settings, particularly among pregnant women. Immunization with the tetanus toxoid-containing vaccine (TTCV) is critical for preventing maternal and neonatal tetanus. This study aims to explore the coverage and determinants of satisfactory TTCV immunization (defined as receiving two or more doses) among pregnant women in Somalia using data from the 2020 Somalia Demographic and Health Survey (SDHS). Methods The study utilized a sample of 6,411 pregnant women aged 15–49 years with complete data on key variables from the 2020 SDHS. Bivariate and multivariable logistic regression analysis were conducted to identify factors associated with satisfactory TTCV immunization. Results The results revealed that only 20.20% of pregnant women received two or more doses of tetanus toxoid containing vaccine (TTCV), while 79.80% received fewer than two doses. Multivariable logistic regression analysis indicated several significant predictors of satisfactory TTCV immunization. Regarding region of residence, women in Waqooyi-galbeed (OAR: .487, 95% CI: .342-.693) had significantly lower odds of receiving two or more doses compared to those in Awdal (reference group). In terms of place of residence, nomadic women (AOR: 1.897, 95% CI: 1.591–2.262) were more likely to receive adequate doses than rural women (reference group). Additionally, women with a higher wealth index (AOR: 2.756, 95% CI: 2.097–3.62) were positively associated with immunization. Other significant factors included higher educational attainment (AOR: 1.28, 95% CI: 0.746–2.196), receiving antenatal care less than once a week (AOR: 1.495, 95% CI: 1.004–2.227), and having 6–10 antenatal visits during pregnancy (AOR: 2.675, 95% CI: 0.808–3.958) compared to their respective reference groups. Conclusion A study in Somalia reveals significant disparities in tetanus toxoid-containing vaccine (TTCV) immunization among pregnant women. These disparities are driven by a complex interplay of factors, including region, place of residence, socioeconomic status, and access to healthcare. Coverage is lower in certain areas, particularly rural regions, highlighting the need for targeted interventions. Mobile health strategies have proven effective in reaching nomadic populations, but socioeconomic factors, such as wealth and education levels, strongly influence immunization rates, emphasizing the need for empowerment programs and targeted interventions for less educated and poorer women. Strengthening antenatal care services is crucial for increasing coverage and promoting consistent prenatal care, which has proven to be vital for boosting immunization rates. To improve maternal and neonatal health outcomes, urgent action is needed to increase TTCV coverage, including targeted interventions, strengthening antenatal care services, promoting health education, implementing empowerment programs, and expanding mobile health strategies.