Tetanus toxoid immunization coverage among women in Zone 3 of Dhaka City: the challenge of reaching all women of reproductive age in urban Bangladesh

Neonatal tetanus is still an important public health problem in both urban and rural Bangladesh, with an estimated 41000 cases occurring annually. Thi s article analyses the coverage of tetanus toroid (TT) immunizations among women of reproductive age in Zone 3 of Dhaka City in 1995. Although 85% of women with a child under 1 year of age had received two TT immunizations, o nly 85% of women of reproductive age had obtained the complete series of fi ve TT immunizations and only 52% of women of reproductive age had received one or more TT immunizations. Access to TT immunization, as defined by havi ng had at least one such immunization, was lower among women aged over 30 y ears and also among those aged under 20 years, especially those who were no t yet married or who had not yet become pregnant. Characteristics associated with TT immunization status included the followi ng: educational level of the woman, distance from the nearest immunization centre, and level of contact with family planning field workers. Additional characteristics that influenced women's TT immunization status included ag e, marital and working status, recency of migration from rural to urban are a, and number of children. The relationships were complex and Varied depend ing on the number of TT immunizations received (one or two) and on the type of analysis being carried out (bivariate or multivariate). The findings point to the need for a broad-based campaign to promote access to TT immunization as well as to promote the completion of all five TT dos es in Bangladesh. Reducing missed opportunities for promotion of immunizati on as well as targeting home visitation of women in need of additional immu nizations constitute further approaches to improving coverage. Although Tr coverage rates were only marginally lower among women in slum households, s uch women were more likely than those in non-slum households to be pregnant and hence more likely to bear a baby at risk of neonatal tetanus. Furtherm ore, the environment of slum households, where deliveries normally take pla ce, is more conducive to the development of neonatal tetanus among unprotec ted neonates; a strategy of focusing on slum households is therefore also n eeded.