Use of tetanus toxoid for the prevention of neonatal tetanus. 2. Immunization acceptance among pregnant women in rural Bangladesh.

In a rural area of Bangladesh, 2 injections of aluminum phosphate absorbed tetanus toxoid were offered to pregnant women within the context of a maternal-child health and family planning program. Over the first 16 months of the program, only 34.2% of pregnant women identified by fieldworkers accepted full immunization and 4.8% accepted partial immunization. A comparison of acceptors and nonacceptors of immunization showed only small differences between the 2 groups in terms of their sociodemographic characteristics, such as age, religion, education, number of children, and occupation. The main reasons reported for nonacceptance were objection by husbands and mothers-in-law, fear of harming the fetus exacerbated by village rumors, and failure to inform women sufficiently early during pregnancy. The most frequently reported reason for failure to accept the 2nd injection among the partially immunized was the temporary migration of women from the usual residence for confinement in their parents' house. Confusion caused by local names for neonatal tetanus may have adversely affected perception by the community of the effectiveness of the vaccine. The study demonstrated that previous use of injectable and other contraceptives did not decrease subsequent acceptance of tetanus immunization. The families of tetanus immunization acceptors appeared also to adopt home-based oral rehydration therapy for diarrhea more readily than families of nonacceptors. (author's)