Fatores associados à vacinação contra o tétano em gestantes

Abstract

The administration of a vaccine containing tetanus toxoid in pregnant women is the most effective way to prevent neonatal and maternal tetanus (NMT). Several factors are involved in the success of maternal immunization; some factors are organizational, for access, in addition to individual - related to pregnant women. The objective was to analyze the factors associated with tetanus vaccination in pregnant women. Methods: This is a systematic literature review and meta-analysis, and epidemiological study with a cross-sectional design. Regarding the systematic review, the search strategy was carried out on the basis of EMBASE and MEDLINE. The selection included: pregnant women; cohort or cross-sectional studies; studies with data on the rate of vaccination against tetanus and related risk factors. The fixed effects and random effects models were applied, using the model according to the methodological heterogeneity between the studies. For the epidemiological study, data from 481 mothers who participated in the research were used: “Born in Belo Horizonte: Survey on delivery and birth”. Data collection took place in 11 public and private maternity hospitals in Belo Horizonte, Minas Gerais. The presence of at least two doses of the tetanus vaccine in the prenatal booklet was used as an indirect measure of the pregnant woman's immunization and considered as an outcome. To assess the association between the factors that influence the tetanus vaccination of pregnant women, Poisson regression with robust variance was performed. Results: In the systematic review, the initial search strategy generated 14,349original articles, 31 studies met all inclusion criteria and 20 articles were included in the meta-analysis. The grouped and subgroup analyses showed a significant association between tetanus vaccination and the following factors: higher number of prenatal visits (OR: 2.00; 95% CI: 1.17 - 3.42, I2: 53% ), higher maternal age (OR: 1.24, 95% CI: 1.02 - 1.50, I2: 64%), having received professional guidance (OR: 9.00; 95% CI: 1.81 - 44.75, I2: 92%) and having received the influenza vaccine (OR: 5.87; 95% CI: 1.39 - 24.73, I2: 98%). In the epidemiological study, the prevalence of puerperal women who received at least two doses of the tetanus vaccine was 59.2%. Adjusted analyses showed that: not living with a partner increased, on average, 1.58 times the prevalence among women in not receiving the vaccine; each prenatal consultation reduced, on average, 0.65 times the prevalence among women in not receiving the vaccine and the performance of prenatal consultations with the nurse reduced, on average, 0, 52 times the prevalence among women in not receiving immunobiologicals against tetanus. Regarding the spatial distribution of the prevalence of vaccine registration against tetanus in pregnant women, according to the AA-UBS, the prevalence of absence of registration of the vaccine against tetanus in pregnant women was 39.62%, the prevalence of presence of registration vaccine was 60.38%. Conclusion: The identification of factors associated with tetanus vaccination in a group with specific characteristics of the population and which requires greater attention by health professionals, especially nurses, is essential for the implementation and expansion preventive actions. Despite advances in public health policies, there are challenges to expanding vaccination coverage and, consequently, strengthening the National Immunization Program, in order to increase vaccination rates in groups, such as pregnant women.