Level and Predictors of Knowledge and Willingness to Receive Tetanus Vaccination among Rural Female Secondary School Students in a Suburban North-Central Nigeria

Level and Predictors of Knowledge and Willingness to Receive Tetanus Vaccination among Rural Female Secondary School Students in a Suburban North-Central Nigeria | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Level and Predictors of Knowledge and Willingness to Receive Tetanus Vaccination among Rural Female Secondary School Students in a Suburban North-Central Nigeria Philip Adewale Adeoye, Schola Longpoe, Franca Tongjap Dabang, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7373382/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective This study assessed the level and predictors of knowledge of and willingness to receive tetanus vaccination among rural female secondary school students in suburban North Central Nigeria. Methods This study employed a cross-sectional design, and data were collected through a semistructured, self-administered questionnaire. Factors associated with knowledge and willingness to receive or boost vaccination were determined by chi-square and binary logistic regression, respectively. Predictors of knowledge and willingness to receive or boost vaccination were determined via multivariable logistic regression. Results Only 30.6% demonstrated good knowledge of tetanus infection and prevention. Only 21.1% have received adequate doses of tetanus toxoid, with 79.6% willing to receive or boost vaccination soon. Prevention of tetanus is the most common reason for receiving vaccination, whereas cost and ignorance are the most common reasons for not receiving tetanus toxoid vaccination. A significant predictor of good knowledge was being in senior classes (OR: 4.68 [95% CI: 1.88, 11.60]; p = 0.000). A significant predictor of willingness to receive or boost vaccination (Model I) includes living at least 30 minutes away from the nearest health facility (OR: 2.98 [95% CI: 1.06, 8.40]; p = 0.038) and the maternal secondary level of education (OR: 0.19 [95% CI: 0.04, 0.97]; p = 0.046). Cost is not a predictor of willingness to receive or boost vaccination (Model II). Conclusion Although the majority of respondents reside close to health facilities, a majority still have poor knowledge and uptake but are willing to vaccinate against tetanus infection. More school-based outreach campaigns should be implemented by health facilities and local government health authorities to increase the demand for health activities, such as vaccination, among adolescents. The prevention of disease should be incorporated into early childhood curricula to aid in the promotion of healthful and healthy behavioral practices as children grow into adulthood. Epidemiology Obstetrics & Gynecology Infectious Diseases Sexual & Reproductive Medicine Preventive Medicine Statistical Epidemiology knowledge willingness to vaccinate or boost female students tetanus infection rural Nigeria Figures Figure 1 Figure 2 Figure 3 Highlights Compared with those reported in previous studies, the level of knowledge and completion of TT vaccination remain low. However, there is a high level of enthusiasm for receiving or boosting TT vaccination among the study population. The leading motivation is prevention of disease, and the leading barrier is ignorance. Being in the senior class is a significant predictor of good knowledge about tetanus infection and prevention. Deviates from most previous studies by showing that home proximity to health facilities and attainment of secondary education are not positive predictors of willingness to vaccinate. Introduction Maternal and neonatal tetanus is a disease of public health importance, with a fatality rate of 80%-100% among those with inadequately vaccinated mothers following unsafe deliveries/abortion and cord care in low- and middle-income countries (LMICs) [ 1 , 2 ]. As countries achieve maternal and neonatal tetanus elimination (MNTE), neonatal deaths as a result of neonatal tetanus declined, decreasing by 92% between 2000 and 2019 [ 2 ]. One of the important three-pronged strategies is robust immunization of women of reproductive age with the tetanus toxoid vaccine (TT) [ 3 ]. Overall, progress has been made between 1999 and 2020, with overall coverage increasing from 13.79–65.27%, protection at birth increasing from 12–88%, and the global coverage of the third dose of dPT more than doubled, with an 88% reduction in neonatal deaths due to neonatal tetanus [ 1 ]. However, the goal of MNTE, even after 4 deadlines are missed, has yet to be achieved, as 12 countries have yet to demystify this invisible killer, of which Nigeria is among [ 1 – 3 ]. Nigeria is a class C country in which the number of high-risk districts is > 50%, with TT coverage being < 50%, and will require an extended number of years to achieve MNTE [ 1 ]. These have been said to be due to regional/political crises, insecurity, vaccine hesitancy, vaccination coverage inequities, overreliance on foreign donors, poverty, illiteracy, poor knowledge and risk perception of the disease and its prevention, inaccessible populations, and competing priorities of governments and have made the MNTE an unrealistic endeavour in Nigeria [ 1 – 3 ]. Despite these challenges, the southeastern and southwestern regions of Nigeria have attained validation for MNTE [ 1 , 2 , 4 ]. To the best of our knowledge, studies among rural secondary school female students assessing the willingness to receive or boost vaccination in northern Nigeria are limited. Thus, this study assessed the level and predictors of knowledge and willingness to receive tetanus vaccination among rural female secondary school students in suburban North Central Nigeria. Methods Study design This is a cross-sectional study of rural female secondary students in a suburban community in the Jos North Local Government Area (LGA) in Northcentral Nigeria. Setting This was carried out in 2019 in Government Secondary School located in Gwafan district, Jos North LGA, Plateau state, Nigeria, which serves rural communities such as Itsitsa, Gwash, Nupkis, Gwafan, and Lamingo. The LGA has the largest population and is the most cosmopolitan in the state, with Jos as the capital of the state [ 5 ]. It has 72 health facilities: 56 primary health centers, 12 secondary health facilities, and four tertiary hospitals [ 6 ]. Sampling The study site was purposely selected because it was the site of a community diagnosis of sexual and reproductive health among female secondary school students. All eligible secondary school students who consented and/or were accustomed to participating were recruited. For adolescents who were less than the age of consent, we obtained consent from the parents for participation in the study and reception of TT vaccine prophylaxis after a letter detailing the essence, ethics, and vaccination campaign following the research was well outlined. All students whose parents refused consent were excluded from the study. Variables The primary outcome was the willingness to receive or boost TT vaccination, with the secondary outcome being knowledge about tetanus infection and prevention. The independent variables included sociodemographic characteristics, knowledge of tetanus infection and prevention, and uptake patterns. Sample size Cochran’s formula was used for sample size determination: Z 2 pq/d 2 [ 7 ]. where z = standard normal deviation (1.960 at the 95% confidence level); q = willingness to receive the vaccine from a prior study = 0.42 [ 8 ]; q = 1-p = alternate probability of the outcome = 0.58; d = precision = 0.05; and the calculated sample size = 374. However, because the number of female secondary school students did not reach 374 at the time of the study, sample size correction for a finite population was performed via the Slovin formula (n/1 + ne 2 ). where n = calculated sample size and e = error margin = 0.05. The final sample size was 193. Statistical analysis The data were entered into Microsoft Excel 2010, and the raw data were stored. The data were subsequently exported into SPSS V25.0 (IBM, Armonk, NY, USA) and were thereafter checked for inconsistencies, and errors were consequently cleaned. Descriptive analyses were performed, and quantitative data are presented as summary measures (means ± standard deviations; unless the data are skewed), whereas qualitative data are presented as frequencies and proportions. Bivariate analysis (chi-square and binary logistic regression) was performed to determine the factors associated with knowledge of tetanus infection and prevention and willingness to receive or boost vaccination. All variables were subsequently loaded into the multivariable analysis, except those that were highly correlated or not correlated at all, to reduce noise in the model. The results of the multivariable analysis revealed the predictors of knowledge and willingness to receive or boost vaccination. The level of statistical significance was set at p < 0.05. Ethics Ethical approval was obtained from the JUTH Health Research Ethics Committee (JUTH/DCS/IREC/127/XXXI/3070), and permission was obtained from the education board of the Plateau State Ministry of Education. Permission was obtained from the school principal. The principal was informed about the justification for the study, its aim, and subsequent vaccination. Then, an appointment was made for a date and time for data collection. The respondents were informed about the essence of the study. They were assured of confidentiality. All consents obtained were written informed consent. They were also given a health talk about tetanus infection. They were subsequently given TT vaccine prophylaxis. Subsequent appointments for further doses were explained to the participants. Results This study achieved a 94.8% response rate: nonresponses were due to parental nonconsent or the nonavailability of students during the study. Table 1 (below) shows that approximately half are between the ages of 10 and 14 years (average: 14.5 years), with the majority being of the indigenous population and two-thirds being in the junior classes. Most of the respondents were Christian; most possessed television; approximately one-third had mothers with a tertiary level of education; and more than half lived within 30 minutes of the nearest health facility. Table 1 Sociodemographic characteristics of the study participants Variable Frequency % Age (years) 10–14 yrs 93 50.8 ≥ 15 90 49.2 Mean (± SD) 14.5 ± 2.2 Tribe Indigenous 154 84.2 Nonindigenous 29 15.8 Class Junior Secondary School 121 66.1 Senior Secondary School 62 33.9 Religion Christianity 181 98.9 Islam 2 1.1 TV possession Yes 170 92.9 No 13 7.1 Mother’s level of education (180) Nil formal education 30 16.7 Primary 29 16.1 Secondary 56 31.1 Tertiary 65 36.1 Distance to the nearest health facility (172) 1 hour 46 26.7 Figure 1 (above) shows that more than two-thirds of the participants had poor knowledge of tetanus infection and prevention, with the majority having poor knowledge across most knowledge items. The respondent responses to the knowledge items and the proportions of correct answers are presented in the supplementary information. Health facilities are the most common source of information and peers. ( Supplementary information 1 and 2 ). Table 2 Tetanus vaccine uptake pattern among study respondents among study respondents Variable Frequency % Doses received (114) Inadequate 90 78.9 Adequate 24 21.1 Median [IQR] 1.00 [4.0–1.0] Willingness to receive or boost vaccination(n = 183) Yes 144 79.6 No 37 20.4 Cost as a barrier (n = 178) Yes 88 49.4 No 90 50.6 When latest dose was collected (n = 69) 1 year ago 29 42.0 1 month ago 21 30.4 5 years ago 15 21.7 10 years ago 4 5.8 IQR = interquartile range Table 2 (above) shows that only one-fifth (20.4%) of the respondents received adequate doses of TT, with the latest dose received only recently by one-third of the respondents. When specifically asked, almost half reported that cost is a barrier to receiving the tetanus vaccine. The majority are willing to receive or boost their TT vaccinations. Figure 2 (below) shows that the most common reason for receiving the tetanus vaccine among the study respondents was to prevent tetanus infection. Figure 3 (below) shows that the commonest possible reasons for not receiving or boosting vaccination are financial challenges and ignorance. Table 3 (below) shows that a greater proportion of older respondents (≥ 15 years) have significantly better knowledge than younger respondents do. Additionally, a greater proportion of those in the senior classes than in the junior classes have significantly good knowledge. On multivariable regression, only class significantly predicts knowledge, with those in the senior classes significantly having almost five times the odds of good knowledge compared with those in the junior classes. Table 3 Predictors of good Tetanus infection and prevention knowledge among study participants Variable Poor Good P-value β aOR (95% CI) P-value Age (years) ≥ 15 54 (60.0) 36 (40.0) 0.007* 0.066 1.068 (0.869,1.314) 0.531 10–14 (ref) 73 (78.5) 20 (21.5) 1 Tribe Indigenous 106 (68.8) 48 (31.2) 0.701 0.114 1.120 (0.405,3.101) 0.827 Non-indigenous (ref) 21 (72.4) 8 (27.6) 1 Class SSS 28 (45.2) 34 (54.8) 0.000* 1.542 4.676 (1.884,11.604) 0.000* JSS (ref) 99 (81.8) 22(18.2) 1 Religion Islam 1 (50.0) 1 (50.0) 0.520 f - - - Christianity (ref) 126 (69.6) 55 (30.4) TV possession Yes 118 (69.4) 52 (30.6) 1.000 - - - No (ref) 9 (69.2) 4 (30.8) Mother’s level of education Primary 19 (65.5) 10 (34.5) 0.459 0.667 1.949 (0.476,7.980) 0.353 Secondary 43 (76.8) 13 (23.2) 0.331 1.392 (0.365,5.305) 0.628 Tertiary 42 (64.6) 23 (35.4) 0.699 2.011 (0.560,7.226) 0.284 No formal education (ref) 22 (73.3) 8 (26.7) 1 Distance to the nearest health facility > 30 mins 51 (68.9) 23 (31.1) 0.721 0.130 1.138 (0.538,2.409) 0.735 ≤ 30 mins (ref) 70 (71.4) 28 (28.6) 1 Model characteristics: Overall percentage accuracy = 77.1%; Hosmer-Lemeshow’s p-value = 0.402; Cos & Snell R 2 = 0.149; Nagelkerke R 2 = 0.214; -2log likelihood = 176.665. ref = reference group; SSS = Senior Secondary School; JSS = Junior Secondary School; aOR = adjusted odds ratio Table 4 (below) shows that only distance and costs are significantly associated with the willingness to receive or boost tetanus vaccination. According to the multivariable regression analysis (Model 1), distance and mothers’ secondary level of education significantly predict willingness to receive or boost tetanus vaccination. Those living more than 30 minutes away from the nearest health facility are significantly three times more likely to receive or boost tetanus vaccination than those living within 30 minutes of the nearest health facility. Additionally, students whose mothers have a secondary level of education are 80.7% less likely to be willing to receive or boost TT vaccination than those whose mothers have no formal education. Further introduction of cost into the multivariable analysis in Model 2 (Table 5 : Supplementary information 3 ) reveals that none of the variables significantly predict willingness to vaccinate or boost vaccination among the study population. Table 4 Predictors of willingness to receive or boost Tetanus vaccination among study participants Model 1 \(\:\varvec{\beta\:}\) cOR(95% CI) P-value \(\:\varvec{\beta\:}\) aOR (95% CI) P-value Age 0.085 1.089 (0.924, 1.283) 0.308 -0.039 0.962(0.725, 1.277) 0.789 Tribe Indigenous 0.480 1.616 (0.651, 4.011) 0.301 -0.514 0.598(0.162, 2.201) 0.439 Non-indigenous (ref) 1 1 Class SSS 0.342 1.407 (0.669, 2.958) 0.368 0.310 1.364(0.376, 4.943) 0.637 JSS (ref) 1 1 TV possession No 0.168 1.182 (0.308, 4.533) 0.807 1.576 4.836(0.822, 28.459) 0.081 Yes (ref) 1 1 Mother's level of education Primary -0.470 0.625 (0.172, 2.267) 0.475 -0.871 0.419 (0.074, 2.357) 0.323 Secondary -0.554 0.574 (0.189, 1.750) 0.329 -1.647 0.193 (0.038, 0.970) 0.046* Tertiary -0.105 0.900 (0.321, 2.526) 0.841 -0.482 0.618 (0.149, 2.560) 0.507 No Formal education (ref) 1 1 Distance to nearest health facility > 30 mins 0.799 2.222 (1.035, 4.770) 0.040* 1.093 2.984 (1.060, 8.399) 0.038* ≤ 30 mins (ref) 1 1 Knowledge -0.025 0.995 (0.978, 1.012) 0.551 -0.020 0.980 (0.955, 1.006) 0.128 Doses received -0.036 0.964 (0.750, 1.239 0.776 -0.037 0.964 (0.704, 1.321) 0.819 Cost No 0.921 2.512 (1.145, 5.15) 0.022* - - - Yes (ref) 1 Model characteristics: Overall percentage accuracy = 75.5%; Hosmer-Lemeshow’s p-value = 0.645; Cos & Snell R 2 = 0.121; Nagelkerke R 2 = 0.177; -2log likelihood = 108.705. (r) = reference group; SSS = Senior Secondary School; JSS = Junior Secondary School; aOR = adjusted odds ratio Table 5 Predictors of willingness to receive or boost Tetanus vaccination among study participants (Model 2) Model 2 \(\:\varvec{\beta\:}\) aOR 95% CI P-value Age -0.034 0.966 (0.721, 1.296) 0.820 Tribe Indigenous -0.0323 0.724 (0.195, 2.694) 0.630 Non-indigenous (ref) 1 Class SSS 0.378 1.460 (0.379, 5.620) 0.582 JSS (ref) 1 TV possession No 1.752 5.764 (0.892, 37.266) 0.066 Yes (ref) 1 Mother's level of education Primary -0.767 0.465 (0.074, 2.929) 0.414 Secondary -1.317 0.268 (0.046, 1.549) 0.141 Tertiary -0.173 0.841 (0.180, 3.937) 0.826 No Formal education (ref) 1 Distance to nearest health facility > 30 minutes 0.960 2.612 (0.905, 7.535) 0.076 ≤ 30 minutes (ref) 1 Knowledge -0.017 0.983 (0.957, 1.009) 0.202 Doses received -0.041 0.960 (0.691, 1.335) 0.810 Cost No -0.936 0.392 (0.135, 1.138) 0.085 Yes (ref) 1 Model characteristics: Overall percentage accuracy = 76.0%; Hosmer-Lemeshow’s p-value = 0.843; Cos & Snell R 2 = 0.132; Nagelkerke R 2 = 0.194; -2log likelihood = 104.375. SSS = Senior Secondary School; JSS = Junior Secondary School; ref = reference group; aOR = adjusted odds ratio Discussion Only approximately one-third demonstrated good knowledge of tetanus infection and prevention. Only one-fifth have received adequate doses of TT, with more than three-quarters willing to receive or boost vaccination shortly. Prevention of tetanus is the most common reason for receiving vaccination, whereas cost and ignorance are the most common reasons for not receiving TT vaccination. A significant predictor of good knowledge is being in senior classes. Significant predictors of willingness to receive or boost vaccination include living at least 30 minutes away from the nearest health facility and a maternal secondary level of education. This study revealed that only a third demonstrated good knowledge of tetanus infection and prevention. This is similar to the similar population in Ibadan and relatively older students of higher education in Ile-Ife (southwest-Nigeria, respectively) [ 8 , 9 ]. This demonstrates that the educational sector has been neglected in vaccination promotion campaigns over the years. Although adolescent girls have the potential to pass the right information about tetanus infection and prevention to communities and future generations, school children are often neglected in the promotion of vaccination health among many populations. This study revealed that one-fifth of the study population received adequate doses of TT, which is higher than those obtained among relatively older students with higher education in Ile-Ife (southwest-Nigeria), Port-Harcourt (southsouth-Nigeria), and women of reproductive age in the Kwarbai ward (northwest-Nigeria) [ 8 , 10 , 11 ]. This finding shows that despite the higher proportion reported in this study, the use of the TT vaccine is generally low among women of reproductive age, irrespective of their place of residence, as most of the studies cited were conducted in urban centers rather than in rural populations. More than three-quarters are willing to receive or boost vaccination in the near future to this study. This figure is higher than those obtained among students of higher education in Ile-Ife (Nigeria) and among basketball players in Italy [ 8 , 12 ]. Vaccine hesitancy has become an issue of public health importance—even before the advent of COVID-19 [ 13 ]—with high hesitancy among nursing students being accentuated by misinformation about COVID-19 vaccines and uncoordinated government policies, as seen in Texas, USA [ 14 ], and greater acceptance when there is a coordinated response, as seen among secondary school students, as seen in rural Bangladesh [ 15 ]. According to this study, the most common reason for vaccination is to prevent tetanus infection, which is similar to that reported among Italian amateur basketball players [ 12 ]. A similar phenomenon has also been reported for COVID-19 among nursing students in Texas, USA [ 14 ]. This might be due to increased risk perception among young people with infectious diseases, which might make them less likely to access more information about diseases, develop vaccination intentions, and eventually achieve adequate uptake of the vaccine [ 16 ]. However, according to this study, ignorance was reported as the most common reason for not receiving vaccination, which is similar to that reported among female nursing students at government universities in Khartoum State, Sudan [ 17 ]. Other commonly expressed concerns include no particular reason among undergraduates in Port-Harcourt, Nigeria, and the fear of side effects expressed by basketball players [ 12 ]. This is, however, different from the reasons for COVID-19 vaccine hesitancy observed among similar populations, which are mainly concerns about development and approval concerns, safety, side effects and injection anxiety [ 14 , 15 ]. Being in senior classes is a significant predictor of good knowledge of tetanus infection and prevention, according to this study. This finding is similar to that observed among female undergraduates in Port-Harcourt (Nigeria), where increasing years of study are associated with an increasing proportion of students with good knowledge [ 10 ]. Vaccine literacy strongly predicts vaccination intention, whereas vaccination uptake is blunted. Thus, more studies are needed to establish the role of vaccine knowledge in the vaccination decision-making process [ 16 ]. There is also a need for innovative methods, such as the use of educational videos, which has been shown to significantly improve accuracy/knowledge among similar populations [ 18 ]. According to this study, living at least 30 minutes away from the nearest healthcare facility is a significant predictor of willingness to receive or boost vaccination and, by extension, eventual vaccination. This finding is similar to that of a study in Northwest Ethiopia, where those who lived within 30 minutes' distance were less likely to be fully immunized than those who lived more than 30 minutes away from the nearest vaccination site [ 19 ]. This is contrary to most studies measuring distance and vaccination, where every increase in distance leads to a decrease in vaccination demand [ 20 ]. This might be due to proximity to functional proximity rather than home proximity to health facilities, which has been shown to improve the probability of vaccination among populations [ 21 ]. Additionally, the sociodemographic characteristics, access to information, and geographical proximity to the city center of those farther from the study site might have also been responsible for these unexpected results [ 22 ]. This study also revealed that students whose mothers have a secondary level of education are 80.7% less likely to be willing to receive or boost TT vaccination than those whose mothers have no formal education. This is contrary to reports in low- and middle-income countries (LMICs), where increasing maternal education increases the probability of vaccination of children [ 23 ]. Evidence has shown that if all women (after controlling for household wealth and average community education) in LMICs are to attain at least basic education, the probability of a child receiving diphtheria, pertussis, and tetanus vaccines will increase by 43% [ 24 , 25 ]. This deviation might be due to the inability of those attaining secondary school education to differentiate between vaccine-related myths and facts despite better access to health information. Additionally, access to vaccine-related disabilities among children reported in a northern Nigerian state might have heightened vaccine hesitancy among those with basic education who might have had access to the news [ 26 ]. However, less educated women with positive cultural attitudes toward child health, with access to health information from government-subsidized health facilities, are more likely to be willing to vaccinate their wards [ 25 ]. This study is, however, limited because generalizability to the whole local government might be difficult. This study might also be affected by recall bias. However, this study revealed the state of willingness and uptake of the TT vaccine among rural women of reproductive age who were educated in a suburban secondary school. Conclusion This study revealed that the level of knowledge and completion of TT vaccination remain low compared with those reported in previous studies. However, there is a great level of enthusiasm to receive or boost TT vaccination among the study population, with the leading motivation being prevention of disease and the leading barrier being ignorance. This study also deviates from most previous studies by showing that home proximity to health facilities and attainment of secondary education are not positive predictors of willingness to vaccinate. Despite the increased number of vaccination campaigns, the young people in this study had a low level of knowledge about tetanus infection and prevention. Therefore, there is a need for health authorities to increase the dissemination of vaccination information via media (such as social media, the internet, and peer-to-peer mentoring), with strong youth appeal to improve vaccination knowledge. There should be more school-based outreach campaigns instituted by ministries of health and education, local government health authorities, and health facilities to increase the demand for health activities such as vaccination among adolescents. The prevention of disease should be incorporated into early childhood curricula by the Ministry of Education to aid in the improvement of healthful and healthy behavioral practices as children grow into adulthood. Declarations Aknowledgement We would like to acknowledge the school principal and parents who permitted us and gave consent, respectively, for us to be able to conduct the study and administer the TT vaccine during the school vaccine campaign. We would also like to thank the staff of the Family Health Clinic of the Department of Community Medicine, Jos University Teaching Hospital, for participating in the vaccination campaign. Author contribution Conceptualization: PAA, SL,FTD, MB, HAA; Data curation: PAA, SL,FTD, MB, HAA; Formal analysis: PAA; Methodology: PAA, SL,FTD, MB, HAA; Resources: PAA, SL,FTD, MB, HAA; Visualization: PAA; Writing-original draft: PAA; Review and Editing: PAA, SL,FTD, MB, HAA Funding Nil Conflict of interest None References Dhir SK, Dewan P, Gupta P. Maternal and Neonatal Tetanus Elimination: Where are We Now? Res Rep Trop Med [Internet] 2021;12:247–61. https://doi.org/10.2147/RRTM.S201989 Kanu FA, Yusuf N, Kassogue M, Ahmed B, Tohme RA. Progress Toward Achieving and Sustaining Maternal and Neonatal Tetanus Elimination - Worldwide, 2000-2020. MMWR Morb Mortal Wkly Rep [Internet] 2022;71(11):406–11. https://doi.org/10.15585/mmwr.mm7111a2 World Health Organization. Protecting all against tetanus: guide to sustaining maternal and neonatal tetanus elimination (MNTE) and broadening tetanus protection for all populations [Internet]. 2019;152. 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Lancet Glob Heal [Internet] 2021;9(11):e1610–7. https://doi.org/10.1016/S2214-109X(21)00338-7 Forshaw J, Gerver SM, Gill M, Cooper E, Manikam L, Ward H. The global effect of maternal education on complete childhood vaccination: a systematic review and meta-analysis. BMC Infect Dis [Internet] 2017;17(1):801. https://doi.org/10.1186/s12879-017-2890-y United Nations Educational Scientific and Cultural Organization, Education for All Global Monitoring Report, Global Education First Initiative. Sustainable Development Begins with Education: How Education can contribuate to the proposed post-2015 goals [Internet]. 2014;24. Available from: https://unesdoc.unesco.org/ark:/48223/pf0000230508/PDF/230508eng.pdf.multi British Broadcasting Corporation. 100 Women: Is child vaccination boosted by educating mothers? [Internet]. News. 2017 [cited 2019 Aug 6];3. Available from: https://www.bbc.com/news/health-41280113 Archibong B, Annan F. What do Pfizers 1996 drug trials in Nigeria teach us about vaccine hesitancy? [Internet]. Brookings. 2021 [cited 2023 Sep 10];4. Available from: https://www.brookings.edu/articles/what-do-pfizers-1996-drug-trials-in-nigeria-teach-us-about-vaccine-hesitancy/ Additional Declarations The authors declare no competing interests. Supplementary Files Supplementarytable1StudyparticipantsresponsestoknowledgeitemsonTetanusinfectionandprevention.docx Supplementary table 1: Study participants’ responses to knowledge items on Tetanus infection and prevention Supplementarytable2Patternofcorrectknowledgescoresamongstudyparticipants.docx Supplementary table 2: Pattern of correct knowledge scores among study participants rsquestionnaire.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7373382","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":500505743,"identity":"5a942b06-9a1f-4d77-97f7-b8a654673d1a","order_by":0,"name":"Philip Adewale Adeoye","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9UlEQVRIiWNgGAWjYDACCcbGAwkMDIwNIM4HIGZjJ6ylAa6FcQZICzNBLQwMBxigWph5QCKEtJhLNzcceLjDTrafvcfwsc2vbfJ8zAyMHz7m4NZiOedgw4HEM8nGM3vOGBvn9t02bGNmYJacuQ23FoMbiUAtbcyJG27kmEnn9txmBGphY+YlrKU+cf+NHPPflj237YnVcjhxg0SOGTPDj9uJBLVYzgBpOXPceMaZY8WSvQ23k9uYGZvx+sVcIv3hw587qmX725s3fvjx57bt/Pbmgx8+4nMYiIBEPYcBA2MbgkuMFvYHDAx/8CoeBaNgFIyCEQoAIlhbls/X+3gAAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0003-1801-6302","institution":"Department of Community Medicine, Jos University Teaching Hospital, Jos, Plateau State, Nigeria","correspondingAuthor":true,"prefix":"","firstName":"Philip","middleName":"Adewale","lastName":"Adeoye","suffix":""},{"id":500505744,"identity":"d7f444ed-0ff7-4f4b-a38e-ac576c1d5b9e","order_by":1,"name":"Schola Longpoe","email":"","orcid":"","institution":"Department of Community Medicine, Jos University Teaching Hospital, Jos, Plateau State, Nigeria.","correspondingAuthor":false,"prefix":"","firstName":"Schola","middleName":"","lastName":"Longpoe","suffix":""},{"id":500505745,"identity":"f2414a7a-78a0-4332-ad20-c844a179d787","order_by":2,"name":"Franca Tongjap Dabang","email":"","orcid":"","institution":"Department of Community Medicine, Jos University Teaching Hospital, Jos, Plateau State, Nigeria.","correspondingAuthor":false,"prefix":"","firstName":"Franca","middleName":"Tongjap","lastName":"Dabang","suffix":""},{"id":500505746,"identity":"d0b60638-4f12-450b-8b24-e9d511a9e50b","order_by":3,"name":"Mehana Braimah","email":"","orcid":"","institution":"Department of Community Medicine, Jos University Teaching Hospital, Jos, Plateau State, Nigeria","correspondingAuthor":false,"prefix":"","firstName":"Mehana","middleName":"","lastName":"Braimah","suffix":""},{"id":500505747,"identity":"386de4df-c56e-40a0-87ef-5c8a8c36dc3a","order_by":4,"name":"Hadiza Abigail Agbo","email":"","orcid":"https://orcid.org/0000-0003-0024-2803","institution":"Department of Community Medicine, University of Jos, Jos, Plateau State, Nigeria / Department of Community Medicine, Jos University Teaching Hospital, Jos, Plateau State, Nigeria.","correspondingAuthor":false,"prefix":"","firstName":"Hadiza","middleName":"Abigail","lastName":"Agbo","suffix":""}],"badges":[],"createdAt":"2025-08-14 11:31:55","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-7373382/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7373382/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89273918,"identity":"cdb5fe33-af0d-44e1-be81-39c75ce8be16","added_by":"auto","created_at":"2025-08-18 09:11:37","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":3227,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eLevel of knowledge of tetanus infection and prevention among the study respondents\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7373382/v1/f3496f9074e4053abef1e3ed.png"},{"id":89274352,"identity":"edb86018-6a4e-4810-a944-7b883667b571","added_by":"auto","created_at":"2025-08-18 09:19:37","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":9169,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eReasons for receiving the tetanus vaccine among study respondents\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7373382/v1/d1e97fe196f0ec90df21b789.png"},{"id":89273922,"identity":"18d6cf96-7b03-48b6-a349-b55cdb2dcaf2","added_by":"auto","created_at":"2025-08-18 09:11:37","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":9973,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eReasons for not receiving or boosting the tetanus vaccine\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7373382/v1/45fe118b29ae21118841c402.png"},{"id":89276518,"identity":"94121df1-d1e2-487e-9888-9ad3d440ba72","added_by":"auto","created_at":"2025-08-18 09:35:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1299852,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7373382/v1/b7f55074-bff8-46af-836d-35f4457121e5.pdf"},{"id":89274350,"identity":"61620e8c-b7cb-4d64-a2db-15b776b0cbe5","added_by":"auto","created_at":"2025-08-18 09:19:37","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":16192,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSupplementary table 1: Study participants’ responses to knowledge items on Tetanus infection and prevention\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Supplementarytable1StudyparticipantsresponsestoknowledgeitemsonTetanusinfectionandprevention.docx","url":"https://assets-eu.researchsquare.com/files/rs-7373382/v1/54aa11c3944f5fa7b9c63039.docx"},{"id":89275973,"identity":"96d5c6e4-a3bd-4a23-b2d4-b5f0e7861e4a","added_by":"auto","created_at":"2025-08-18 09:27:37","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":13635,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSupplementary table 2: Pattern of correct knowledge scores among study participants\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Supplementarytable2Patternofcorrectknowledgescoresamongstudyparticipants.docx","url":"https://assets-eu.researchsquare.com/files/rs-7373382/v1/aee6ea01c754bc9d39b05967.docx"},{"id":89274354,"identity":"c131d7f3-8c1e-48c2-86bc-1f2689206e68","added_by":"auto","created_at":"2025-08-18 09:19:38","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":17745,"visible":true,"origin":"","legend":"","description":"","filename":"rsquestionnaire.docx","url":"https://assets-eu.researchsquare.com/files/rs-7373382/v1/78b282273957dafd12029fa5.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eLevel and Predictors of Knowledge and Willingness to Receive Tetanus Vaccination among Rural Female Secondary School Students in a Suburban North-Central Nigeria\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Highlights","content":"\u003cul\u003e\u003cli\u003e\u003cp\u003eCompared with those reported in previous studies, the level of knowledge and completion of TT vaccination remain low.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eHowever, there is a high level of enthusiasm for receiving or boosting TT vaccination among the study population.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eThe leading motivation is prevention of disease, and the leading barrier is ignorance.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eBeing in the senior class is a significant predictor of good knowledge about tetanus infection and prevention.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eDeviates from most previous studies by showing that home proximity to health facilities and attainment of secondary education are not positive predictors of willingness to vaccinate.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e"},{"header":"Introduction","content":"\u003cp\u003eMaternal and neonatal tetanus is a disease of public health importance, with a fatality rate of 80%-100% among those with inadequately vaccinated mothers following unsafe deliveries/abortion and cord care in low- and middle-income countries (LMICs) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. As countries achieve maternal and neonatal tetanus elimination (MNTE), neonatal deaths as a result of neonatal tetanus declined, decreasing by 92% between 2000 and 2019 [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOne of the important three-pronged strategies is robust immunization of women of reproductive age with the tetanus toxoid vaccine (TT) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Overall, progress has been made between 1999 and 2020, with overall coverage increasing from 13.79\u0026ndash;65.27%, protection at birth increasing from 12\u0026ndash;88%, and the global coverage of the third dose of dPT more than doubled, with an 88% reduction in neonatal deaths due to neonatal tetanus [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. However, the goal of MNTE, even after 4 deadlines are missed, has yet to be achieved, as 12 countries have yet to demystify this invisible killer, of which Nigeria is among [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eNigeria is a class C country in which the number of high-risk districts is \u0026gt;\u0026thinsp;50%, with TT coverage being \u0026lt;\u0026thinsp;50%, and will require an extended number of years to achieve MNTE [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. These have been said to be due to regional/political crises, insecurity, vaccine hesitancy, vaccination coverage inequities, overreliance on foreign donors, poverty, illiteracy, poor knowledge and risk perception of the disease and its prevention, inaccessible populations, and competing priorities of governments and have made the MNTE an unrealistic endeavour in Nigeria [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Despite these challenges, the southeastern and southwestern regions of Nigeria have attained validation for MNTE [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. To the best of our knowledge, studies among rural secondary school female students assessing the willingness to receive or boost vaccination in northern Nigeria are limited.\u003c/p\u003e\u003cp\u003eThus, this study assessed the level and predictors of knowledge and willingness to receive tetanus vaccination among rural female secondary school students in suburban North Central Nigeria.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design\u003c/h2\u003e\u003cp\u003eThis is a cross-sectional study of rural female secondary students in a suburban community in the Jos North Local Government Area (LGA) in Northcentral Nigeria.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSetting\u003c/h3\u003e\n\u003cp\u003eThis was carried out in 2019 in Government Secondary School located in Gwafan district, Jos North LGA, Plateau state, Nigeria, which serves rural communities such as Itsitsa, Gwash, Nupkis, Gwafan, and Lamingo. The LGA has the largest population and is the most cosmopolitan in the state, with Jos as the capital of the state [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. It has 72 health facilities: 56 primary health centers, 12 secondary health facilities, and four tertiary hospitals [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eSampling\u003c/h3\u003e\n\u003cp\u003eThe study site was purposely selected because it was the site of a community diagnosis of sexual and reproductive health among female secondary school students.\u003c/p\u003e\u003cp\u003eAll eligible secondary school students who consented and/or were accustomed to participating were recruited. For adolescents who were less than the age of consent, we obtained consent from the parents for participation in the study and reception of TT vaccine prophylaxis after a letter detailing the essence, ethics, and vaccination campaign following the research was well outlined. All students whose parents refused consent were excluded from the study.\u003c/p\u003e\n\u003ch3\u003eVariables\u003c/h3\u003e\n\u003cp\u003eThe primary outcome was the willingness to receive or boost TT vaccination, with the secondary outcome being knowledge about tetanus infection and prevention. The independent variables included sociodemographic characteristics, knowledge of tetanus infection and prevention, and uptake patterns.\u003c/p\u003e\n\u003ch3\u003eSample size\u003c/h3\u003e\n\u003cp\u003eCochran\u0026rsquo;s formula was used for sample size determination: Z\u003csup\u003e2\u003c/sup\u003epq/d\u003csup\u003e2\u003c/sup\u003e [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. where z\u0026thinsp;=\u0026thinsp;standard normal deviation (1.960 at the 95% confidence level); q\u0026thinsp;=\u0026thinsp;willingness to receive the vaccine from a prior study\u0026thinsp;=\u0026thinsp;0.42 [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]; q\u0026thinsp;=\u0026thinsp;1-p\u0026thinsp;=\u0026thinsp;alternate probability of the outcome\u0026thinsp;=\u0026thinsp;0.58; d\u0026thinsp;=\u0026thinsp;precision\u0026thinsp;=\u0026thinsp;0.05; and the calculated sample size\u0026thinsp;=\u0026thinsp;374. However, because the number of female secondary school students did not reach 374 at the time of the study, sample size correction for a finite population was performed via the Slovin formula (n/1\u0026thinsp;+\u0026thinsp;ne\u003csup\u003e2\u003c/sup\u003e). where n\u0026thinsp;=\u0026thinsp;calculated sample size and e\u0026thinsp;=\u0026thinsp;error margin\u0026thinsp;=\u0026thinsp;0.05. The final sample size was 193.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eThe data were entered into Microsoft Excel 2010, and the raw data were stored. The data were subsequently exported into SPSS V25.0 (IBM, Armonk, NY, USA) and were thereafter checked for inconsistencies, and errors were consequently cleaned. Descriptive analyses were performed, and quantitative data are presented as summary measures (means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations; unless the data are skewed), whereas qualitative data are presented as frequencies and proportions. Bivariate analysis (chi-square and binary logistic regression) was performed to determine the factors associated with knowledge of tetanus infection and prevention and willingness to receive or boost vaccination. All variables were subsequently loaded into the multivariable analysis, except those that were highly correlated or not correlated at all, to reduce noise in the model. The results of the multivariable analysis revealed the predictors of knowledge and willingness to receive or boost vaccination. The level of statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEthics\u003c/h3\u003e\n\u003cp\u003eEthical approval was obtained from the JUTH Health Research Ethics Committee (JUTH/DCS/IREC/127/XXXI/3070), and permission was obtained from the education board of the Plateau State Ministry of Education. Permission was obtained from the school principal. The principal was informed about the justification for the study, its aim, and subsequent vaccination. Then, an appointment was made for a date and time for data collection. The respondents were informed about the essence of the study. They were assured of confidentiality. All consents obtained were written informed consent. They were also given a health talk about tetanus infection. They were subsequently given TT vaccine prophylaxis. Subsequent appointments for further doses were explained to the participants.\u003c/p\u003e\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThis study achieved a 94.8% response rate: nonresponses were due to parental nonconsent or the nonavailability of students during the study. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e (below) shows that approximately half are between the ages of 10 and 14 years (average: 14.5 years), with the majority being of the indigenous population and two-thirds being in the junior classes. Most of the respondents were Christian; most possessed television; approximately one-third had mothers with a tertiary level of education; and more than half lived within 30 minutes of the nearest health facility.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSociodemographic characteristics of the study participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u0026ndash;14 yrs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e50.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e49.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMean (\u0026plusmn;\u0026thinsp;SD)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTribe\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndigenous\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e154\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e84.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNonindigenous\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eClass\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJunior Secondary School\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e121\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e66.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSenior Secondary School\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e33.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReligion\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChristianity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e181\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e98.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIslam\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTV possession\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e170\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e92.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMother\u0026rsquo;s level of education (180)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNil formal education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e31.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTertiary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e36.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDistance to the nearest health facility (172)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;15 minutes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e32.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e15\u0026ndash;30 minutes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e31\u0026ndash;60 minutes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;1 hour\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e26.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e (above) shows that more than two-thirds of the participants had poor knowledge of tetanus infection and prevention, with the majority having poor knowledge across most knowledge items. The respondent responses to the knowledge items and the proportions of correct answers are presented in the supplementary information. Health facilities are the most common source of information and peers. (\u003cem\u003eSupplementary information 1 and 2\u003c/em\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eTetanus vaccine uptake pattern among study respondents among study respondents\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDoses received (114)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInadequate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e78.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdequate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e21.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eMedian [IQR]\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.00 [4.0\u0026ndash;1.0]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWillingness to receive or boost vaccination(n\u0026thinsp;=\u0026thinsp;183)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e144\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e79.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCost as a barrier (n\u0026thinsp;=\u0026thinsp;178)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e49.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e50.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWhen latest dose was collected (n\u0026thinsp;=\u0026thinsp;69)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1 year ago\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e42.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1 month ago\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e30.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5 years ago\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e21.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10 years ago\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIQR\u0026thinsp;=\u0026thinsp;interquartile range\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e (above) shows that only one-fifth (20.4%) of the respondents received adequate doses of TT, with the latest dose received only recently by one-third of the respondents. When specifically asked, almost half reported that cost is a barrier to receiving the tetanus vaccine. The majority are willing to receive or boost their TT vaccinations.\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e (below) shows that the most common reason for receiving the tetanus vaccine among the study respondents was to prevent tetanus infection.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e (below) shows that the commonest possible reasons for not receiving or boosting vaccination are financial challenges and ignorance.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e (below) shows that a greater proportion of older respondents (\u0026ge;\u0026thinsp;15 years) have significantly better knowledge than younger respondents do. Additionally, a greater proportion of those in the senior classes than in the junior classes have significantly good knowledge. On multivariable regression, only class significantly predicts knowledge, with those in the senior classes significantly having almost five times the odds of good knowledge compared with those in the junior classes.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePredictors of good Tetanus infection and prevention knowledge among study participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePoor\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eβ\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eaOR (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e54 (60.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36 (40.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.007*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.066\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.068 (0.869,1.314)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003e0.531\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u0026ndash;14 (ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e73 (78.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20 (21.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTribe\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndigenous\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e106 (68.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e48 (31.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003e0.701\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.114\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.120 (0.405,3.101)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003e0.827\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon-indigenous (ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21 (72.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (27.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eClass\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSSS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28 (45.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34 (54.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.542\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.676 (1.884,11.604)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJSS (ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e99 (81.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22(18.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReligion\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIslam\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003e0.520\u003c/em\u003e\u003csup\u003e\u003cem\u003ef\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChristianity (ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e126 (69.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55 (30.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTV possession\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e118 (69.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e52 (30.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003e1.000\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003e-\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo (ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (69.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (30.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMother\u0026rsquo;s level of education\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19 (65.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (34.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003e0.459\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.667\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.949 (0.476,7.980)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003e0.353\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e43 (76.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (23.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.331\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.392 (0.365,5.305)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003e0.628\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTertiary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e42 (64.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23 (35.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.699\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.011 (0.560,7.226)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003e0.284\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo formal education (ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22 (73.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (26.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDistance to the nearest health facility\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;30 mins\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e51 (68.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23 (31.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003e0.721\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.130\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.138 (0.538,2.409)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003e0.735\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;30 mins (ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e70 (71.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28 (28.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eModel characteristics: Overall percentage accuracy\u0026thinsp;=\u0026thinsp;77.1%; Hosmer-Lemeshow\u0026rsquo;s p-value\u0026thinsp;=\u0026thinsp;0.402; Cos \u0026amp; Snell R\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;\u003cem\u003e=\u0026thinsp;0.149; Nagelkerke R\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;\u003cem\u003e=\u0026thinsp;0.214; -2log likelihood\u0026thinsp;=\u0026thinsp;176.665. ref\u0026thinsp;=\u0026thinsp;reference group; SSS\u0026thinsp;=\u0026thinsp;Senior Secondary School; JSS\u0026thinsp;=\u0026thinsp;Junior Secondary School; aOR\u0026thinsp;=\u0026thinsp;adjusted odds ratio\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e (below) shows that only distance and costs are significantly associated with the willingness to receive or boost tetanus vaccination. According to the multivariable regression analysis (Model 1), distance and mothers\u0026rsquo; secondary level of education significantly predict willingness to receive or boost tetanus vaccination. Those living more than 30 minutes away from the nearest health facility are significantly three times more likely to receive or boost tetanus vaccination than those living within 30 minutes of the nearest health facility. Additionally, students whose mothers have a secondary level of education are 80.7% less likely to be willing to receive or boost TT vaccination than those whose mothers have no formal education. Further introduction of cost into the multivariable analysis in Model 2 (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e: \u003cem\u003eSupplementary information 3\u003c/em\u003e) reveals that none of the variables significantly predict willingness to vaccinate or boost vaccination among the study population.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePredictors of willingness to receive or boost Tetanus vaccination among study participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e\u003cp\u003e\u003cem\u003eModel 1\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\varvec{\\beta\\:}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003ecOR(95% CI)\u003c/b\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eP-value\u003c/b\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\varvec{\\beta\\:}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003eaOR (95% CI)\u003c/b\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003eP-value\u003c/b\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.085\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.089 (0.924, 1.283)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003e0.308\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.039\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.962(0.725, 1.277)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003e0.789\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTribe\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndigenous\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.480\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.616 (0.651, 4.011)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003e0.301\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.514\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.598(0.162, 2.201)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003e0.439\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon-indigenous (ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eClass\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSSS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.342\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.407 (0.669, 2.958)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003e0.368\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.310\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.364(0.376, 4.943)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003e0.637\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJSS (ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTV possession\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.168\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.182 (0.308, 4.533)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003e0.807\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.576\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.836(0.822, 28.459)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003e0.081\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes (ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMother's level of education\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.470\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.625 (0.172, 2.267)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003e0.475\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.871\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.419 (0.074, 2.357)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003e0.323\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.554\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.574 (0.189, 1.750)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003e0.329\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-1.647\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.193 (0.038, 0.970)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.046*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTertiary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.105\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.900 (0.321, 2.526)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003e0.841\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.482\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.618 (0.149, 2.560)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003e0.507\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo Formal education (ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDistance to nearest health facility\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;30 mins\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.799\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.222 (1.035, 4.770)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.040*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.093\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.984 (1.060, 8.399)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.038*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;30 mins (ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eKnowledge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.025\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.995 (0.978, 1.012)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003e0.551\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.980 (0.955, 1.006)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003e0.128\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDoses received\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.036\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.964 (0.750, 1.239\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003e0.776\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.037\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.964 (0.704, 1.321)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003e0.819\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCost\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.921\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.512 (1.145, 5.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.022*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes (ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eModel characteristics: Overall percentage accuracy\u0026thinsp;=\u0026thinsp;75.5%; Hosmer-Lemeshow\u0026rsquo;s p-value\u0026thinsp;=\u0026thinsp;0.645; Cos \u0026amp; Snell R\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;\u003cem\u003e=\u0026thinsp;0.121; Nagelkerke R\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;\u003cem\u003e=\u0026thinsp;0.177; -2log likelihood\u0026thinsp;=\u0026thinsp;108.705. (r)\u0026thinsp;=\u0026thinsp;reference group; SSS\u0026thinsp;=\u0026thinsp;Senior Secondary School; JSS\u0026thinsp;=\u0026thinsp;Junior Secondary School; aOR\u0026thinsp;=\u0026thinsp;adjusted odds ratio\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePredictors of willingness to receive or boost Tetanus vaccination among study participants (Model 2)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003e\u003cem\u003eModel 2\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\varvec{\\beta\\:}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eaOR\u003c/b\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e95% CI\u003c/b\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eP-value\u003c/b\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.034\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.966\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(0.721, 1.296)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.820\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTribe\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndigenous\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.0323\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.724\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(0.195, 2.694)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.630\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon-indigenous (ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eClass\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSSS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.378\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.460\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(0.379, 5.620)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.582\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJSS (ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTV possession\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.752\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.764\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(0.892, 37.266)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.066\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes (ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMother's level of education\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.767\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.465\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(0.074, 2.929)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.414\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-1.317\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.268\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(0.046, 1.549)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.141\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTertiary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.173\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.841\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(0.180, 3.937)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.826\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo Formal education (ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDistance to nearest health facility\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;30 minutes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.960\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.612\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(0.905, 7.535)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.076\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;30 minutes (ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eKnowledge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.017\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.983\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(0.957, 1.009)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.202\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDoses received\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.041\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.960\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(0.691, 1.335)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.810\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCost\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.936\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.392\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(0.135, 1.138)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.085\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes (ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eModel characteristics: Overall percentage accuracy\u0026thinsp;=\u0026thinsp;76.0%; Hosmer-Lemeshow\u0026rsquo;s p-value\u0026thinsp;=\u0026thinsp;0.843; Cos \u0026amp; Snell R\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;\u003cem\u003e=\u0026thinsp;0.132; Nagelkerke R\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;\u003cem\u003e=\u0026thinsp;0.194; -2log likelihood\u0026thinsp;=\u0026thinsp;104.375. SSS\u0026thinsp;=\u0026thinsp;Senior Secondary School; JSS\u0026thinsp;=\u0026thinsp;Junior Secondary School; ref\u0026thinsp;=\u0026thinsp;reference group; aOR\u0026thinsp;=\u0026thinsp;adjusted odds ratio\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOnly approximately one-third demonstrated good knowledge of tetanus infection and prevention. Only one-fifth have received adequate doses of TT, with more than three-quarters willing to receive or boost vaccination shortly. Prevention of tetanus is the most common reason for receiving vaccination, whereas cost and ignorance are the most common reasons for not receiving TT vaccination. A significant predictor of good knowledge is being in senior classes. Significant predictors of willingness to receive or boost vaccination include living at least 30 minutes away from the nearest health facility and a maternal secondary level of education.\u003c/p\u003e\u003cp\u003eThis study revealed that only a third demonstrated good knowledge of tetanus infection and prevention. This is similar to the similar population in Ibadan and relatively older students of higher education in Ile-Ife (southwest-Nigeria, respectively) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This demonstrates that the educational sector has been neglected in vaccination promotion campaigns over the years. Although adolescent girls have the potential to pass the right information about tetanus infection and prevention to communities and future generations, school children are often neglected in the promotion of vaccination health among many populations.\u003c/p\u003e\u003cp\u003eThis study revealed that one-fifth of the study population received adequate doses of TT, which is higher than those obtained among relatively older students with higher education in Ile-Ife (southwest-Nigeria), Port-Harcourt (southsouth-Nigeria), and women of reproductive age in the Kwarbai ward (northwest-Nigeria) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. This finding shows that despite the higher proportion reported in this study, the use of the TT vaccine is generally low among women of reproductive age, irrespective of their place of residence, as most of the studies cited were conducted in urban centers rather than in rural populations.\u003c/p\u003e\u003cp\u003eMore than three-quarters are willing to receive or boost vaccination in the near future to this study. This figure is higher than those obtained among students of higher education in Ile-Ife (Nigeria) and among basketball players in Italy [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Vaccine hesitancy has become an issue of public health importance\u0026mdash;even before the advent of COVID-19 [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u0026mdash;with high hesitancy among nursing students being accentuated by misinformation about COVID-19 vaccines and uncoordinated government policies, as seen in Texas, USA [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], and greater acceptance when there is a coordinated response, as seen among secondary school students, as seen in rural Bangladesh [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAccording to this study, the most common reason for vaccination is to prevent tetanus infection, which is similar to that reported among Italian amateur basketball players [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. A similar phenomenon has also been reported for COVID-19 among nursing students in Texas, USA [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. This might be due to increased risk perception among young people with infectious diseases, which might make them less likely to access more information about diseases, develop vaccination intentions, and eventually achieve adequate uptake of the vaccine [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. However, according to this study, ignorance was reported as the most common reason for not receiving vaccination, which is similar to that reported among female nursing students at government universities in Khartoum State, Sudan [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Other commonly expressed concerns include no particular reason among undergraduates in Port-Harcourt, Nigeria, and the fear of side effects expressed by basketball players [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. This is, however, different from the reasons for COVID-19 vaccine hesitancy observed among similar populations, which are mainly concerns about development and approval concerns, safety, side effects and injection anxiety [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eBeing in senior classes is a significant predictor of good knowledge of tetanus infection and prevention, according to this study. This finding is similar to that observed among female undergraduates in Port-Harcourt (Nigeria), where increasing years of study are associated with an increasing proportion of students with good knowledge [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Vaccine literacy strongly predicts vaccination intention, whereas vaccination uptake is blunted. Thus, more studies are needed to establish the role of vaccine knowledge in the vaccination decision-making process [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. There is also a need for innovative methods, such as the use of educational videos, which has been shown to significantly improve accuracy/knowledge among similar populations [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAccording to this study, living at least 30 minutes away from the nearest healthcare facility is a significant predictor of willingness to receive or boost vaccination and, by extension, eventual vaccination. This finding is similar to that of a study in Northwest Ethiopia, where those who lived within 30 minutes' distance were less likely to be fully immunized than those who lived more than 30 minutes away from the nearest vaccination site [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This is contrary to most studies measuring distance and vaccination, where every increase in distance leads to a decrease in vaccination demand [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. This might be due to proximity to functional proximity rather than home proximity to health facilities, which has been shown to improve the probability of vaccination among populations [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Additionally, the sociodemographic characteristics, access to information, and geographical proximity to the city center of those farther from the study site might have also been responsible for these unexpected results [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis study also revealed that students whose mothers have a secondary level of education are 80.7% less likely to be willing to receive or boost TT vaccination than those whose mothers have no formal education. This is contrary to reports in low- and middle-income countries (LMICs), where increasing maternal education increases the probability of vaccination of children [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Evidence has shown that if all women (after controlling for household wealth and average community education) in LMICs are to attain at least basic education, the probability of a child receiving diphtheria, pertussis, and tetanus vaccines will increase by 43% [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. This deviation might be due to the inability of those attaining secondary school education to differentiate between vaccine-related myths and facts despite better access to health information. Additionally, access to vaccine-related disabilities among children reported in a northern Nigerian state might have heightened vaccine hesitancy among those with basic education who might have had access to the news [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. However, less educated women with positive cultural attitudes toward child health, with access to health information from government-subsidized health facilities, are more likely to be willing to vaccinate their wards [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis study is, however, limited because generalizability to the whole local government might be difficult. This study might also be affected by recall bias. However, this study revealed the state of willingness and uptake of the TT vaccine among rural women of reproductive age who were educated in a suburban secondary school.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study revealed that the level of knowledge and completion of TT vaccination remain low compared with those reported in previous studies. However, there is a great level of enthusiasm to receive or boost TT vaccination among the study population, with the leading motivation being prevention of disease and the leading barrier being ignorance. This study also deviates from most previous studies by showing that home proximity to health facilities and attainment of secondary education are not positive predictors of willingness to vaccinate.\u003c/p\u003e\u003cp\u003eDespite the increased number of vaccination campaigns, the young people in this study had a low level of knowledge about tetanus infection and prevention. Therefore, there is a need for health authorities to increase the dissemination of vaccination information via media (such as social media, the internet, and peer-to-peer mentoring), with strong youth appeal to improve vaccination knowledge. There should be more school-based outreach campaigns instituted by ministries of health and education, local government health authorities, and health facilities to increase the demand for health activities such as vaccination among adolescents. The prevention of disease should be incorporated into early childhood curricula by the Ministry of Education to aid in the improvement of healthful and healthy behavioral practices as children grow into adulthood.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to acknowledge the school principal and parents who permitted us and gave consent, respectively, for us to be able to conduct the study and administer the TT vaccine during the school vaccine campaign. We would also like to thank the staff of the Family Health Clinic of the Department of Community Medicine, Jos University Teaching Hospital, for participating in the vaccination campaign.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: PAA, SL,FTD, MB, HAA; Data curation: PAA, SL,FTD, MB, HAA; Formal analysis: PAA; Methodology: PAA, SL,FTD, MB, HAA; Resources: PAA, SL,FTD, MB, HAA; Visualization: PAA; Writing-original draft: PAA; Review and Editing: PAA, SL,FTD, MB, HAA\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNil\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDhir SK, Dewan P, Gupta P. Maternal and Neonatal Tetanus Elimination: Where are We Now? Res Rep Trop Med [Internet] 2021;12:247\u0026ndash;61. https://doi.org/10.2147/RRTM.S201989\u003c/li\u003e\n\u003cli\u003eKanu FA, Yusuf N, Kassogue M, Ahmed B, Tohme RA. Progress Toward Achieving and Sustaining Maternal and Neonatal Tetanus Elimination - Worldwide, 2000-2020. MMWR Morb Mortal Wkly Rep [Internet] 2022;71(11):406\u0026ndash;11. https://doi.org/10.15585/mmwr.mm7111a2\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Protecting all against tetanus: guide to sustaining maternal and neonatal tetanus elimination (MNTE) and broadening tetanus protection for all populations [Internet]. 2019;152. Available from: https://iris.who.int/bitstream/handle/10665/329882/9789241515610-eng.pdf?ua=1\u003c/li\u003e\n\u003cli\u003eNjuguna HN, Yusuf N, Raza AA, Ahmed B, Tohme RA. Progress Toward Maternal and Neonatal Tetanus Elimination - Worldwide, 2000-2018. MMWR Morb Mortal Wkly Rep [Internet] 2020;69(17):515\u0026ndash;20. https://doi.org/10.15585/mmwr.mm6917a2\u003c/li\u003e\n\u003cli\u003eJos Business School. Plateau State is open for business - investors\u0026rsquo; guide [Internet]. 2019;62. Available from: https://www.plateaustate.gov.ng/uploads/Investing-in-Plateau-State-OSS-booklet.pdf\u003c/li\u003e\n\u003cli\u003eShaba HA, Omomoh E, Nannim S, Danlami GRR, Omitunde M, Omirinde GYD, et al. Cluster and Buffer Analysis of the Distribution of Healthcare Facilities in Plateau State. Int J Med Sci Clin Res Stud [Internet] 2023;3(10):2420\u0026ndash;31. https://doi.org/10.47191/ijmscrs/v3-i10-58\u003c/li\u003e\n\u003cli\u003eBolarinwa OA. Sample size estimation for health and social science researchers: The principles and considerations for different study designs. Niger Postgrad Med J [Internet] 2020;27(2):67\u0026ndash;75. https://doi.org/10.4103/npmj.npmj_19_20\u003c/li\u003e\n\u003cli\u003eAdegbenro CA, Olowookere SA, Fehintola FO, Adegbenro PA, Orioke OT. Knowledge about and preventive practices against neonatal tetanus among young Nigerian women. Tzu-chi Med J [Internet] 2019;31(3):154\u0026ndash;7. https://doi.org/10.4103/tcmj.tcmj_55_18\u003c/li\u003e\n\u003cli\u003eOrimadegun AE, Adepoju AA, Akinyinka OO. Adolescent girls\u0026rsquo; understanding of tetanus infection and prevention: implications for the disease control in Western Nigeria. Front public Heal [Internet] 2014;2:24. https://doi.org/10.3389/fpubh.2014.00024\u003c/li\u003e\n\u003cli\u003eAlex-Hart BA, Okoh BAN. Awareness and status of tetanus toxoid vaccination among female undergraduate students in a Nigerian University. Int J Trop Dis Heal [Internet] 2015;7(1):6\u0026ndash;15. https://doi.org/10.9734/IJTDH/2015/15468\u003c/li\u003e\n\u003cli\u003eMuhammad-Idris ZK, Shehu AU, Isa FM. Assessment of tetanus toxoid coverage among women of reproductive age in Kwarbai, Zaria. Arch Med Surg [Internet] 2017;2(2):48. https://doi.org/10.4103/archms.archms_43_17\u003c/li\u003e\n\u003cli\u003eRicc\u0026ograve; M, Peruzzi S. Tetanus Vaccination Status and Vaccine Hesitancy in Amateur Basketball Players (Italy, 2020). Vaccines [Internet] 2022;10(1):131. https://doi.org/10.3390/vaccines10010131\u003c/li\u003e\n\u003cli\u003eWorld Health Organizaton. Ten threats to global health in 2019 [Internet]. Spotlight2019 [cited 2019 Aug 6];14. Available from: https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019\u003c/li\u003e\n\u003cli\u003eBerry DM, Adams LM, Vytla SP. Vaccine hesitancy and hesitant adoption among nursing students in Texas. Prev Med reports [Internet] 2024;38:102612. https://doi.org/10.1016/j.pmedr.2024.102612\u003c/li\u003e\n\u003cli\u003eRoy DN, Islam E, Hossen MM, Ferdiousi N, Azam MS. Sociopsychological determinants of COVID‐19 vaccine acceptance and hesitancy among the students\u0026rsquo; of higher secondary schools in rural Bangladesh: A cross‐sectional study. Psychol Sch [Internet] 2024;61(2):568\u0026ndash;81. https://doi.org/10.1002/pits.23069\u003c/li\u003e\n\u003cli\u003eIsonne C, Iera J, Sciurti A, Renzi E, De Blasiis MR, Marzuillo C, et al. How well does vaccine literacy predict intention to vaccinate and vaccination status? A systematic review and meta-analysis. Hum Vaccin Immunother [Internet] 2024;20(1):2300848. https://doi.org/10.1080/21645515.2023.2300848\u003c/li\u003e\n\u003cli\u003eMohamed AA, Nasor FA. Effect of tetanus toxoid immunization training program on knowledge and attitude on female nursing students in Government Universities in Khartoum State. Int J Nurs Midwifery [Internet] 2020;12(2):51\u0026ndash;63. https://doi.org/10.5897/IJNM2020.0415\u003c/li\u003e\n\u003cli\u003eAkmal M, Lateef RS, Wolyniak MJ, Orenstein W. Evaluating the impact of educational videos on vaccine science knowledge among Virginia high school students. Am J Heal Educ [Internet] 2024;55(3):220\u0026ndash;8. https://doi.org/10.1080/19325037.2023.2295553\u003c/li\u003e\n\u003cli\u003eTesfaye TD, Temesgen WA, Kasa AS. Vaccination coverage and associated factors among children aged 12 - 23 months in Northwest Ethiopia. Hum Vaccin Immunother [Internet] 2018;14(10):2348\u0026ndash;54. https://doi.org/10.1080/21645515.2018.1502528\u003c/li\u003e\n\u003cli\u003eKim D, Lauria DT, Poulos C, Dong B, Whittington D. Effect of travel distance on household demand for typhoid vaccines: implications for planning. Int J Health Plann Manage [Internet] 2014;29(3):e261-76. https://doi.org/10.1002/hpm.2172\u003c/li\u003e\n\u003cli\u003eBeshears J, Choi JJ, Laibson DI, Madrian BC, Reynolds GI. Vaccination Rates are Associated With Functional Proximity But Not Base Proximity of Vaccination Clinics. Med Care [Internet] 2016;54(6):578\u0026ndash;83. https://doi.org/10.1097/MLR.0000000000000523\u003c/li\u003e\n\u003cli\u003eYusuf N, Raza AA, Chang-Blanc D, Ahmed B, Hailegebriel T, Luce RR, et al. Progress and barriers toward maternal and neonatal tetanus elimination in the remaining 12 countries: a systematic review. Lancet Glob Heal [Internet] 2021;9(11):e1610\u0026ndash;7. https://doi.org/10.1016/S2214-109X(21)00338-7\u003c/li\u003e\n\u003cli\u003eForshaw J, Gerver SM, Gill M, Cooper E, Manikam L, Ward H. The global effect of maternal education on complete childhood vaccination: a systematic review and meta-analysis. BMC Infect Dis [Internet] 2017;17(1):801. https://doi.org/10.1186/s12879-017-2890-y\u003c/li\u003e\n\u003cli\u003eUnited Nations Educational Scientific and Cultural Organization, Education for All Global Monitoring Report, Global Education First Initiative. Sustainable Development Begins with Education: How Education can contribuate to the proposed post-2015 goals [Internet]. 2014;24. Available from: https://unesdoc.unesco.org/ark:/48223/pf0000230508/PDF/230508eng.pdf.multi\u003c/li\u003e\n\u003cli\u003eBritish Broadcasting Corporation. 100 Women: Is child vaccination boosted by educating mothers? [Internet]. News. 2017 [cited 2019 Aug 6];3. Available from: https://www.bbc.com/news/health-41280113\u003c/li\u003e\n\u003cli\u003eArchibong B, Annan F. What do Pfizers 1996 drug trials in Nigeria teach us about vaccine hesitancy? [Internet]. Brookings. 2021 [cited 2023 Sep 10];4. Available from: https://www.brookings.edu/articles/what-do-pfizers-1996-drug-trials-in-nigeria-teach-us-about-vaccine-hesitancy/\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Jos University Teaching Hospital","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"knowledge, willingness to vaccinate or boost, female students, tetanus infection, rural Nigeria","lastPublishedDoi":"10.21203/rs.3.rs-7373382/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7373382/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eThis study assessed the level and predictors of knowledge of and willingness to receive tetanus vaccination among rural female secondary school students in suburban North Central Nigeria.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis study employed a cross-sectional design, and data were collected through a semistructured, self-administered questionnaire. Factors associated with knowledge and willingness to receive or boost vaccination were determined by chi-square and binary logistic regression, respectively. Predictors of knowledge and willingness to receive or boost vaccination were determined via multivariable logistic regression.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eOnly 30.6% demonstrated good knowledge of tetanus infection and prevention. Only 21.1% have received adequate doses of tetanus toxoid, with 79.6% willing to receive or boost vaccination soon. Prevention of tetanus is the most common reason for receiving vaccination, whereas cost and ignorance are the most common reasons for not receiving tetanus toxoid vaccination. A significant predictor of good knowledge was being in senior classes (OR: 4.68 [95% CI: 1.88, 11.60]; p\u0026thinsp;=\u0026thinsp;0.000). A significant predictor of willingness to receive or boost vaccination \u003cem\u003e(Model I)\u003c/em\u003e includes living at least 30 minutes away from the nearest health facility (OR: 2.98 [95% CI: 1.06, 8.40]; p\u0026thinsp;=\u0026thinsp;0.038) and the maternal secondary level of education (OR: 0.19 [95% CI: 0.04, 0.97]; p\u0026thinsp;=\u0026thinsp;0.046). Cost is not a predictor of willingness to receive or boost vaccination \u003cem\u003e(Model II).\u003c/em\u003e\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eAlthough the majority of respondents reside close to health facilities, a majority still have poor knowledge and uptake but are willing to vaccinate against tetanus infection. More school-based outreach campaigns should be implemented by health facilities and local government health authorities to increase the demand for health activities, such as vaccination, among adolescents. The prevention of disease should be incorporated into early childhood curricula to aid in the promotion of healthful and healthy behavioral practices as children grow into adulthood.\u003c/p\u003e","manuscriptTitle":"Level and Predictors of Knowledge and Willingness to Receive Tetanus Vaccination among Rural Female Secondary School Students in a Suburban North-Central Nigeria","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-18 09:11:33","doi":"10.21203/rs.3.rs-7373382/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fc35e0d0-4a6e-4c57-9f39-e0028270cf24","owner":[],"postedDate":"August 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":53169985,"name":"Epidemiology"},{"id":53169986,"name":"Obstetrics \u0026 Gynecology"},{"id":53169987,"name":"Infectious Diseases"},{"id":53169988,"name":"Sexual \u0026 Reproductive Medicine"},{"id":53169989,"name":"Preventive Medicine"},{"id":53169990,"name":"Statistical Epidemiology"}],"tags":[],"updatedAt":"2025-08-18T09:11:33+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-18 09:11:33","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7373382","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7373382","identity":"rs-7373382","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}