Factors associated with maternal tetanus vaccination in Myanmar: An analysis of Demographic and Health Survey data

Background: Tetanus toxoid vaccination is a life-saving maternal and child health intervention. Understanding gaps in maternal vaccination coverage is key to informing progress towards universal health coverage. We assessed maternal tetanus vaccination coverage in Myanmar and investigated factors associated with being unvaccinated. Method: We analysed 2015-16 Demographic and Health Survey data including women aged 15-49 years with at least one childbirth in the last five years. The outcome was self-reported receipt of tetanus vaccine at least once during the last pregnancy. We used logistic regression models to assess factors associated with being unvaccinated. Results: Overall maternal tetanus vaccination coverage was 85.7%. Sub-national coverage was lowest in the predominantly ethnic minority states of Shan, Kayin, and Chin at 69.6%, 77.4%, and 79.9%, respectively. Factors associated with a lack of vaccination were: not receiving antenatal care (odds ratio (OR): 18.99, 95% confidence interval (CI): 14.21, 25.39); receiving antenatal care at home (OR: 2.05, 95% CI: 1.46, 2.88), private and non-governmental organization clinics (OR: 2.88, 95% CI: 1.81, 4.58, compared to public facilities); and not wanting to go to a health facility alone (OR: 1.53, 95% CI: 1.14, 2.06). Higher educational attainment was associated with lower odds of being unvaccinated (OR: 0.48, 95% CI: 0.32, 0.70 for secondary relative to no education). Interpretation: We identified regional, structural, and individual differences in maternal tetanus vaccination coverage. Achieving universal coverage of maternal tetanus vaccination will largely depend on the ability to provide accessible antenatal care to most women who do not currently receive it.