Residential differentials in prevalence and factors associated with tetanus toxoid uptake among women of reproductive age in Nigeria: a Multiple Indicator Cluster Survey analysis (MICS 2021)

Tetanus remains a preventable cause of maternal and neonatal deaths, yet uptake of tetanus toxoid (TT) among Nigerian women of reproductive age is low and unevenly distributed across residential settings. This study aimed to assess residential differential (urban-rural residence) in prevalence and factors associated with tetanus toxoid uptake among women of reproductive age. The 2021 Nigeria Multiple Indicator Cluster Survey (MICS) was employed for the study. A weighted sample size of 25,063 women of reproductive age was analysed using STATA SE Version 17. Descriptive statistics (frequency distribution table and chart) were used to gain an understanding of the characteristics of the study population. Inferential statistics (Pearson’s Chi-square test of association) were performed to establish the association between the socio-demographic characteristics of respondents, obstetric factors and tetanus toxoid uptake. All explanatory variables with significant evidence of no collinearity were selected and used in the multilevel mixed-effects binary logistic regression models to examine the factors influencing residential variation in tetanus toxoid uptake at a p < 0.05 level of significance. The study 8found persistent low utilisation of tetanus toxoid across rural and urban areas, with prevalence ranging from 22.1% in rural areas to 26.2% in urban areas. The odds of utilising tetanus toxoid were significantly higher among women with age 24–29 years [AOR: 1.319, 95% CI (1.006–1.732)], primary [AOR: 1.526, 95% CI (1.252–1.861)], secondary [AOR: 1.985, 95% CI (1.620–2.433)], higher education [AOR: 1.709, 95% CI (1.238–2.361)], south eastern region [AOR: 1.853, 95% CI (0.999–3.435)], middle [AOR: 1.539, 95% CI (1.269–1.867)] and rich wealth index [AOR: 1.599, 95% CI (1.254–2.037)], moderate [AOR: 1.388, 95% (1.124–1.714)] and high media exposure [AOR: 1.816, 95% CI (1.114–2.962)], more than 8 ANC visits [AOR: 4.979, 95% CI (3.779–6.561)], health facility delivery [AOR: 4.516, 95% CI (3.636–5.609)] than their counterparts who are not. The study provides compelling evidence of low utilisation of tetanus toxoid across rural-urban areas of Nigeria. This underscores the imperative for targeted policy interventions for each residential area. Therefore, a one-size-fits-all approach is unlikely to be effective, and policymakers must consider the distinct characteristics and challenges of each residential areas when designing interventions aimed at improving tetanus toxoid uptake in Nigeria.