1) Percentage of women with a live birth in the 2 years preceding the survey receiving two or more injections during the pregnancy for the most recent live birth.
2) Percentage of women with a live birth in the 2 years preceding the survey whose most recent live birth was protected against neonatal tetanus.
Coverage:
Population base: Women who had a live birth in the 2 years preceding the survey (NR file)
Time period: Two years preceding the survey
Numerators:
1) Number of women with a live birth in the 2 years preceding the survey with two or more of tetanus toxoid injections received during the pregnancy of the most recent birth (m1 in 2:7)
2) Number of women with a live birth in the 2 years preceding the survey who received either:
a) two tetanus toxoid injections during the pregnancy for her most recent live birth, or
b) two or more injections (the last within 3 years of the most recent live birth), or
c) three or more injections (the last within 5 years of the most recent live birth), or
d) four or more injections (the last within 10 years of the most recent live birth), or
e) five or more injections at any time prior to the most recent live birth
Denominator: Number of women with a live birth in the last 2 years (m80 = 1 & p19 < 24)
Variables: NR file.
|
m80 |
Pregnancy outcome for this section |
|
p19 |
Months since pregnancy outcome |
|
b19 |
Current age of child in months |
|
m1 |
Number of tetanus injections before birth (during pregnancy) |
|
m1a |
Number of tetanus injections before pregnancy |
|
m1d |
Years ago received last tetanus injection before pregnancy |
|
v005 |
Woman’s individual sample weight |
Numerators:
1) Numbers of women with a live birth in the 2 years preceding the survey with two or more of tetanus toxoid injections received during the pregnancy of the most recent birth (m80 = 1 & m1 in 2:7)
2) For the percentage of women with a live birth in the 2 years preceding the survey whose most recent live birth was protected against neonatal tetanus, the calculation of the numerator requires calculating two intermediate variables – the total number of tetanus injections in the woman’s life (total_tetanus) and the number of years since the last tetanus injection (last_injection). total_tetanus is the sum of the number of injections during the pregnancy (m1) and the number of injections prior to the pregnancy (m1a) if these are in the range 1 to 7 (values of m1 or m1a outside of the range 1 to 7 are counted as 0). last_injection is initialized to a high value (99). If any injection was given during the pregnancy (m1 in 1:7) then last_injection is set to 0. Otherwise if m1d (years ago received last tetanus toxoid injection) is in the range 1 to 20 then last_injection is set to m1d minus the age of the child (or years since birth if died) ( int( b19 / 12 ) ). Using these two intermediate variables, the following conditions are used for the numerator:
a) two tetanus toxoid injections during the pregnancy for her most recent live birth
(m80 = 1 & m1 in 2:7), or
b) two or more injections (the last within 3 years of the most recent live birth)
(m80 = 1 & total_tetanus >= 2 & last_injection < 3), or
c) three or more injections (the last within 5 years of the most recent live birth)
(m80 = 1 & total_tetanus >= 3 & last_injection < 5), or
d) four or more injections (the last within 10 years of the most recent live birth)
(m80 = 1 & total_tetanus >= 4 & last_injection < 10), or
e) five or more injections at any time prior to the most recent live birth
(m80 = 1 & total_tetanus >= 5)
The percentages are calculated as the numerators divided by the denominator, multiplied by 100.
“Don’t know” or missing on the number of tetanus toxoid injections during the pregnancy (m1) or prior to the pregnancy (m1a) are treated as 0 injections in the calculation of total_tetanus. “Don’t know” or missing on the number of years ago received the last tetanus toxoid injection before the pregnancy (m1d) are treated as a large number of years (99) prior to the pregnancy.
Tetanus toxoid injections are given to women during pregnancy to protect infants from neonatal tetanus, an important cause of infant death that is due primarily to unsanitary conditions at childbirth.
In DHS-8, the reference time period for this indicator changed from 5 years to 2 years, reflecting a shorter time period asked about in the women’s questionnaire.
Benova, L., Ö. Tunçalp, A.C. Moran and O.M.R. Campbell, 2018. “Not just a number: examining coverage and content of antenatal care in low-income and middle-income countries.” BMJ Global Health, 3(2), p.e000779. https://gh.bmj.com/content/3/2/e000779
World Health Organization, Department of Making Pregnancy Safer and Department of Reproductive Health and Research. 2007. Standards for Maternal and Neonatal Care: Maternal immunization against tetanus. http://apps.who.int/iris/bitstream/handle/10665/69735/a91272.pdf?sequence=1
World Health Organization. 2017. Tetanus vaccines: WHO position paper – February 2017. Weekly epidemiological record. No 6, 2017, 92, 53–76. https://pubmed.ncbi.nlm.nih.gov/28427847/
DHS-8 Tabulation plan: Table 9.6
API Indicator IDs:
RH_TTIJ_W_TT2, RH_TTIJ_W_PRT
MICS6 Indicator TM.7: Neonatal tetanus protection.