Tetanus Vaccination Knowledge, Uptake, and Willingness Among Adolescent Girls in a Suburban Secondary School in North-Central Nigeria: Levels and Predictors of Knowledge and Willingness

<title>Abstract</title> <p> <bold>Background:</bold> Tetanus remains an important vaccine-preventable disease, particularly among women of reproductive age. However, limited evidence exists regarding knowledge of tetanus vaccination, uptake, willingness, and their associated factors among adolescent girls in North-Central Nigeria. <bold>Objective:</bold> to evaluate knowledge levels, tetanus vaccination uptake, and willingness to receive or boost tetanus vaccination, as well as to determine predictors of knowledge and willingness among adolescent girls in a suburban secondary school in North-Central Nigeria. <bold>Methods:</bold> A cross-sectional study was conducted among 183 female secondary school students using a semi-structured, self-administered questionnaire. Knowledge and willingness were assessed using predefined criteria. Factors associated with good knowledge and willingness were examined using bivariate analysis, while multivariable logistic regression was used to identify independent predictors. A sensitivity model examined the effect of perceived cost on predictors of willingness. <bold>Results:</bold> Only 56/183 (30.6%) participants demonstrated good knowledge of tetanus infection and prevention, while 24/114 (21.1%) had received adequate doses of tetanus toxoid vaccine. However, 144/183 (79.6%) were willing to receive or boost vaccination. Prevention of tetanus was the commonest reason for vaccination, while cost and ignorance were commonly reported barriers. Senior class was independently associated with good knowledge (aOR 4.68, 95% CI 1.88–11.60; p&lt;0.001). Living ≥30 minutes from the nearest health facility (aOR 2.98, 95% CI 1.06–8.40; p=0.038) and maternal secondary education (aOR 0.19, 95% CI 0.04–0.97; p=0.046) predicted willingness. In sensitivity analysis, perceived cost was not independently associated with willingness, and the associations with maternal education and distance were attenuated and became non-significant. <bold>Conclusion:</bold> Knowledge and vaccination uptake were low despite high willingness. School-based vaccination and targeted education addressing knowledge gaps and perceived barriers may help translate willingness into uptake. </p>