الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Tetanus is an acute, often fatal, disease caused by an exotoxin produced by the
bacterium clostridium tetani. It is characterized by generalized rigidity and convulsive
spasms of skeletal muscles. The disease can affect any age group and case – fatality rates
are high even, where modern intensive care is available. There is no natural immunity
against tetanus; protection can be provided by active immunization with the tetanus toxoid
(TT) vaccine or by administration of an anti-tetanus antibody.
Maternal and Neonatal tetanus (MNT) are among the most common lethal outcomes
of unclean deliveries and umbilical cord care practices.
Although the TT vaccine has been available for years, neonatal tetanus (NT) still
remains one of the major causes of infant mortality in many developing countries.
According WHO (2016), Tetanus kills an estimated 34.000 neonates (about 1 – 2 %
of all neonatal deaths) worldwide each year.
Global evidence has revealed tetanus as the highest mortality contributor among
children after measles in preventable diseases.
Complete eradication of tetanus is not possible because tetanus spores are
widespread in the soil and stool of people and animals.
However, elimination of maternal and neonatal tetanus (MNT), - reduction of
neonatal tetanus to below one case per thousand live births per year in every district –is
possible when all countries are committed to elimination of (MNT).
The present study was conducted to assess the factors affecting low coverage of TT
vaccine during pregnancy in Alexandria governorate.AS, nine health offices were
randomly selected from four districts of Alexandria governorate. The total study sample
was 700 women who were delivered within six months coming to the health office to
vaccinate their child aged 2, 4 or 6 months. They were interviewed according to a
predesigned questionnaire to collect the necessary data. This questionnaire included:
Data about socio-demographic characteristics of the sample. This included their age,
education, occupation, income and family size as well as reproductive history such as
gravidity, parity, number of abortions, number of living children, antenatal care in
last pregnancy, place of antenatal care, place of last delivery and person attending
this delivery.
Women‘s knowledge about TTV and MNT and source of this knowledge.
Women‘s believe about TTV and MNT using HBM with its components.
Social support from the community to take the vaccine.
Vaccination status of the studied mothers and the factors affecting the level of the
immunity.
The main results of the present study are:
The mean age of the studied mothers was (30 ± 4 years).
Most of the studied mothers were of low and medium socio-economic levels (40%,
53.86%) respectively.
Most of the studied mothers (66.71%) had 2 to 4 pregnancies; all of them received
antenatal care during last pregnancy. The majority of them received their antenatal
care in private sector (90.86%).
The great majority of the studied sample (79%) were aware of TTV and MNT, while
most of them had poor level of knowledge about related information (78.12%).
Family members and friends represent the main source of information about TTV
and MNT (72.69%, 58.95%) respectively, while doctors represent only 21.70% of
source of information.
The majority of the studied sample (67.14%) had high self-efficacy to take the TTV,
while 48% had low perception of susceptibility and 42% had high perception of
severity, 27.85% had high perception of barriers while 86.57% had high perception
of benefits of the vaccine.
The majority of the studied sample trusted the opinion of the doctors to take the
vaccine (98.14%), meanwhile, the doctors specially gynecologists who practice in
hospitals and private clinics don‘t consider TTV to be absolutely necessary during
pregnancy.
The majority of the studied sample (73.43%) had moderate social support, however,
this support had insignificant association with the immunity status of the woman.
The main recommendations are:
Physicians (especially gynecologists) should be provided with information about
MNT elimination program and their role to implement it.
Training of health workers on effective communication with mothers to enhance
their health belief about TTV vaccination (perceived susceptibility, severity,
benefits, barriers, self-efficacy and cues to action) with a special attention to
eliciting and dealing with perceived barriers.
A system for monitoring and supervision of vaccination activities should be
followed including providing women with a vaccination card to be a document for
vaccination activities.
Mass media should participate more as an important source of information about MNT
and TTV. Further research is needed to find out why private physicians usually find it not
important to recommend TTV for pregnant women. Other possible causes for relatively
lower TT vaccination rates need to be investigated as well.