Knowledge, Attitudes, and Self-Reported Tetanus-Toxoid-Containing Vaccine Uptake Among Women Aged 15-44 Years in Ifakara Town, Tanzania: A Community-Based Cross-Sectional Study.

BACKGROUND AND AIMS: Tetanus-toxoid-containing vaccines protect mothers and newborns, but cumulative uptake may decline at higher dose thresholds. We assessed knowledge, attitudes, self-reported tetanus-toxoid-containing vaccine uptake, and factors associated with receipt of at least three doses among women aged 15-44 years in Ifakara Town, Tanzania. METHODS: A community-based analytical cross-sectional study included 383 women aged 15-44 years; electronic records were submitted between September 14, 2025, and January 6, 2026. Participants were selected through multistage sampling and completed an interviewer-administered questionnaire. The primary outcome was self-reported receipt of at least three tetanus-toxoid-containing vaccine doses. Participant-level data were reanalyzed using multivariable logistic regression. The parity-adjusted complete-case model included 382 women; Firth bias-reduced regression assessed sparse-data sensitivity. RESULTS: Almost all participants had heard of tetanus vaccination (97.7%) and reported ever receiving it (97.4%). Self-reported uptake was 80.7% for at least two doses, 66.6% for at least three doses, 38.4% for at least four doses, and 24.5% for five doses. Good knowledge was reported for 66.1%, and 74.4% had a positive attitude score. In the parity-adjusted model, the odds of reporting at least three doses were higher for ages 26-35 years (aOR 2.89, 95% CI 1.34-6.20) and 36-44 years (aOR 5.89, 95% CI 1.66-20.96), healthcare-provider information (aOR 2.06, 95% CI 1.07-3.97), and parous status (aOR 15.94, 95% CI 6.84-37.14). Education, knowledge, and reported access barriers were not independently associated after parity adjustment. CONCLUSION: Initial contact with tetanus vaccination services was high, but self-reported uptake declined at higher dose thresholds. Age and parity probably reflect cumulative opportunities for vaccination, rather than causal effects. Dose-history review, provider-led counseling, and access support may improve cumulative uptake.