Maternal Immunization Knowledge, Attitudes, and Practices on Tetanus Toxoid Vaccination Among Pregnant Teenagers
DOI:
https://doi.org/10.69569/jip.2025.793Keywords:
Adolescent pregnancy, Immunization, Maternal health, Pregnant teenagers, Tetanus ToxoidAbstract
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 youth focused maternal immunization initiatives may help reduce the risk of maternal and neonatal tetanus at the community level.
Downloads
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
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Journal of Interdisciplinary Perspectives
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
