title: [Missed opportunities for tetanus immunization of pregnant women in Juiz de Fora, Minas Gerais, Brazil].
abstract: OBJECTIVE
  To estimate the missed opportunities for tetanus vaccination and to determine the immunization coverage at the end of pregnancy in women living in the city of Juiz de Fora, which is in the state of Minas Gerais, Brazil.
  
  
  METHODS
  A cross-sectional study was carried out of 430 women who were randomly selected from all the maternity hospitals in the city, from February through August 1996. The women were interviewed regarding prenatal care, their knowledge of tetanus, and tetanus immunization before or during the latest pregnancy.
  
  
  RESULTS
  The age of the participants ranged from 14 to 45 years (mean = 26.4 +/- 6.9 years); 420 women lived in urban areas and 10 in rural areas. Prenatal care was from the Brazilian public Unified Health System in 69.5% of the women (299 of 430); 27.6% (119) received prenatal care through other types of providers; and 2.8% (12) did not receive prenatal care. Of the 430 participants, 352 of them (81.8%) had their prenatal care card with them during the interview; 85.6% (368) had four or more prenatal care visits. Regarding their knowledge of tetanus, 92.1% (396) knew about the disease and its severity. Out of the 430 women, 359 of them (83.5%) started the latest pregnancy without having had a tetanus vaccination; 104 were vaccinated during the latest pregnancy, so 255 had not been vaccinated by the time of delivery. This was in spite of the significant increase in the opportunities for being vaccinated with an increase in the number of prenatal visits. The odds ratio for pregnant women with four or more prenatal visits being vaccinated by the end of the pregnancy was 2.7 times that of the women with zero to three visits. Seventy percent of the opportunities for tetanus immunization were missed in the study population. The overall tetanus immunization coverage was 40.6% by the end of pregnancy.
  
  
  CONCLUSIONS
  The low immunization coverage was below the level recommended by the World Health Organization. In combination with the high rate of missed opportunities for vaccination, this points to the need to implement a tetanus vaccination promotion strategy directed at health professionals in general but especially at those who provide care for pregnant women, in both public and private health clinics. In addition, the vaccination practices in Juiz de Fora should be strengthened.
authors.affiliation: Universidade Federal de Juiz de Fora, Faculdade de Medicina, Departamento Materno-Infantil, Juiz de Fora (MG), Brasil.
authors.forename: Laura Maria Braga
authors.initials: LM
authors.lastname: Borges de Mattos
authors.forename: Waleska Teixeira
authors.initials: WT
authors.lastname: Caiaffa
authors.forename: Ronaldo Rocha
authors.initials: RR
authors.lastname: Bastos
authors.forename: Edward
authors.initials: E
authors.lastname: Tonelli
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D008875:Middle Aged; D011247:Pregnancy; D011295:Prenatal Care; D013745:Tetanus Toxoid
chemical_list: D013745:Tetanus Toxoid