Introduction:

Background information: Maternal tetanus is defined as tetanus acquired during pregnancy or within 6 weeks after the end of conception (whether the pregnancy ended with live birth, miscarriage or abortion). As tetanus is a vaccine preventable disease, immunization of pregnant women with TT dose is one of the most effective ways to protect against the disease [1]. The mothers who are fully vaccinated with TT doses develop protective antibodies against tetanus for about 3,5,10 and 30 years. Besides, the vaccination provides enormous protection against neonatal tetanus for three months postpartum. Some studies showed that 94% of neonatal mortality reduction could be achieved through immunization of pregnant and childbearing age women [2]. That is why TT vaccines are recommended to eliminate maternal and neonatal tetanus for these parts of the community. Neonatal tetanus shared the highest number of mortality from the 3.3 million new born death which occurred each year globally [3]. WHO 2015 report showed that an estimated 34019 new born deaths occur due to neonatal tetanus. Globally, 22 countries had not eliminated maternal and neonatal tetanus yet, and 40 million pregnant mothers remained in need of immunization against maternal tetanus [4]. The number of mothers living in high risk area and protected at least two doses of TT vaccination during the 1999 – 2006 supplementary immunization activities was only 73 million. Nowadays, TT2+ immunization coverage among pregnant mothers account for 75% worldwide ranging from 95% in South East Asia to 53% in the East Mediterranean and 63% in Africa. Maternal tetanus continues to occur among mothers living in developing countries as labor and deliveries occur at home without trained birth attendants. Thus, the unclean surface with unclean hands and instruments increase the chances of acquiring the disease [5]. The results from different studies revealed the number of factors contributing to TT2+ utilization among mothers. According to the study conducted in India, educated and mothers in the age group of 20-30 had a better uptake. On the contrary the study from two places in Pakistan presents some reasons for not taking the vaccine such as long distance to reach a health facility, the myth that the vaccine is useless, harmful to the fetus, lack of awareness, fear of side effects and sterility were among of mentioned reasons [6]. Ethiopia has the highest maternal and neonatal tetanus morbidity and mortality rates in the world due to low TT immunization coverage. The Ethiopia Demographic health survey report of 2011 showed only 48% mothers were protected tetanus at birth. A very static progress had been shown up to 2016 evidenced by only 49% of mothers who were protected at birth [6]. This low utilization emerges as numerous deliveries occur at home with unsanitary conditions. Despite the country’s efforts of interventional policy to meet WHO goals towards maternal new born tetanus elimination through extended immunizations and campaigning tetanus toxoid vaccinations, Ethiopia continues to have highest neonatal tetanus morbidity and mortality rates. The problem worsens more extensively in pastoralist communities like in Somali region where mothers lead their lives by raising livestock and lack of access to health care services due to distance, myth and lack of awareness towards the vaccine [7]. Thus knowing the reliable estimate of tetanus toxoid vaccination uptake and factors affecting utilization is found to be very crucial to plan and implement a corrective intervention in Errer district of Somali region of Ethiopia. Henceforth, this study aims at determining the awareness of TT vaccine in the study area [8].