Path Analysis on Factors Associated with Tetanus Toxoid Immunization Utilization among Pregnant Women

Tiara Yumafita1), Setyo Sri Rahardjo2), Rita Benya Adriani3)


1)Masters Program in Public Health, Universitas Sebelas Maret

2)Departement of Public Health, Faculty of Medicine, Universitas Sebelas Maret

3)Shcool of Health Polytechnics, Surakarta



Background: Maternal and neonatal tetanus (MNT) are important causes of maternal and neo­natal mortality, claiming about 180,000 lives worldwide annually, mostly in developing coun­tries. Despite its ease of prevention bymaternal immunization with tetanus toxoid vaccine, and aseptic obstetric and postnatal umbilical-cord careprac­tices, MNT persist as public-health pro­blems in 48 countries, mainly in Asia andAfrica. This study aimed to examine factors asso­ciated with tetanus toxoid immu­nization utilization among pregnant women using path analysis model.

Subjects And Method: A cross-sectional study was conducted at 25 community health centers in Boyolali, Central Java, from November to December 2018. A sample of 200 pregnant women was selected for this study by simple random sampling. The dependent variable was TT im­mu­ni­za­tion uptake. The independent variables were knowledge, education, influence of midwife pri­vate practice, parity, income, intention, atti­­­tude, perceived behavior control, and social norm. The data on immunization uptake was obtained from the medical record. Theother data were collected by ques­tion­naire. The data were analyzed by path analysis.

Results: TT immunization uptakewas directly associated with midwife private practice influence (b= 1.67; SE= 0.58; p= 0.004), parity ≥2 (b= 1.78; SE= 0.58; p= 0.002), high income (b= 2.13; SE= 0.58; p<0.001), intention (b= 1.54; SE= 0.56; p= 0.006), attitude (b= 1.82; SE= 0.60; p= 0.002), perceived behavior control (b= 3.23; SE= 0.70; p<0.001), andsocial norm (b= 1.80; SE= 0.62; p= 0.004). It was indirectly associated with knowledge and education.

Conclusion: TT immunization uptakeis directly associated with midwife private prac­tice inf­luence, parity ≥2, high income, intention, attitude, perceived behavior control, andsocial norm. It is indirectly associated with knowledge and education.

Keywords:TT immunization uptake, TPB, path analysis

Correspondence: Tiara Yumafita. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: Tiarayumafi­ +6281230492658


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