Maternal And Neonatal Tetanus Research Articles

Epidemiology of tetanus in Canada, 1995–2019

ObjectivesThis report aims to use tetanus hospitalization data to describe the epidemiology in Canada from 1995 to 2019 and to assess progress on national reduction targets, including validating that Canada has eliminated maternal and neonatal tetanus (MNT).MethodsTetanus hospitalizations and fatalities occurring between 1995 and 2019 were retrieved from the Canadian Institute for Health Information (CIHI) and Statistics Canada. Cases coded with ICD-10 codes A33, A34, or A35 as the primary diagnosis (or ICD-9 equivalents) were included. The Canadian national case definition was used for generic tetanus and definitions from the World Health Organization were referenced for MNT. R version 4.0.2 was used for analyses.ResultsFrom 1995 to 2019, 155 non-MNT, 6 neonatal, and 0 maternal tetanus cases were retrieved from CIHI. However, all 6 neonatal cases were excluded after validating with provincial/territorial public health officials. In the same time period, there were 91 national notifications of tetanus. Cases were distributed relatively equally across the country, with the exception of the territories, where zero cases were reported. Adults 75 and over had significantly higher incidence rates compared to younger age groups (p<0.001). Ten deaths were reported during the timeframe.ConclusionTetanus incidence remains low and hospitalization data reveal that Canada has met its reduction target of maintaining 5 cases or fewer annually in recent years. For MNT, Canada has successfully met the elimination target of zero cases. Continued vaccination efforts must be practiced for all age groups, including those aged 75 years and older, to sustain targets moving forward.

Maternal and Neonatal Tetanus Elimination in Nigeria: A Review of Delivery and Cord Care Practices among Women of Child Bearing Age

Introduction: Maternal and Neonatal Tetanus (MNT) are important causes of maternal and neonatal deaths, and this led the World Health Assembly in 1999 to launch the maternal and neonatal tetanus elimination strategy with a target of 2020 after earlier targets of 2005, 2015 were missed. Tetanus claims tens of thousands of deaths annually with majority of the deaths occurring in Sub-Saharan Africa and Asia. Safe delivery practice is one of the strategies for elimination of MNT and it can be achieved if delivery is handled by a skilled health worker that have adequate knowledge on the care of the umbilical cord. Methods: This study which is a descriptive study that covered 62 high risk Local Government Areas (LGAs) is aimed at determining the delivery practices and cord care practice of Women of Child bearing Age. (WCBA) in sixty–two Local Government Areasin the six States of Ondo, Osun, Ekiti, Imo, Enugu and Ebonyi in Nigeria that were involved in the three rounds of tetanus toxoid vaccination campaign as part of the Nigeria’s Maternal and Neonatal Tetanus Elimination program from 2014 to 2016. Results: A total of 23,860 households were visited by enumerators in all the 1,860 selected clusters surveyed across the 62 high-risk LGAs of the 6 States. Eligible respondents were found in 13,020 of these households (54.6%).Most of the respondents were wives of the household heads, Christians (83.9%), educated with majority attending secondary school (53.8%), employed with majority doing petty trading 30.9% and located in predominantly rural LGAs (74.4%). Across the 62 LGAs, 84.8% of respondents had their delivery handled by doctors, nurses/midwives and CHEW while 76.7% had their delivery handled by doctors and nurses/midwives. On cord care practices the survey results showed that on the average, only 3.1% of women used chlorhexidine with Ebonyi state recording the highest while 79.0% of respondents used methylated spirit for cord care. Conclusion: Sociocultural factors such as maternal education, financial preparedness, marital status, religion has been shown to be strong determinants of Skilled Birth Attendants (SBA) use. SBA usage has a direct effect on maternal and neonatal tetanus elimination as such government is encouraged to support the promotion of formal education for women and women empowerment and autonomy.

Neonatal Tetanus in Northern Region, Ghana – A Case Report

Maternal and Neonatal Tetanus (MNT) has become a rare disease in Ghana following the intensive immunization campaigns over the last few decades. The country was certified as MNT-free by the World Health Organization (WHO) in 2013.We report on 2 cases ofNeonatal Tetanus (NT) seen in the Northern Region of Ghana. Although the mothers of both patients attended antenatal clinics, they were not vaccinated against tetanus. Both patients were successfully managed and discharged from the hospital. These cases call forpractitioners to be mindful of sporadic cases of NT that may present to our facilities.

Sustaining Maternal and Neonatal Tetanus Elimination (MNTE) in countries that have been validated for elimination \u2013 progress and challenges

BackgroundAs of October 2021, 47 (80%) of the 59 countries, identified at highest risk for Maternal and Neonatal Tetanus (MNT), had been validated for elimination. We assessed sustainability of MNT elimination (MNTE) in 28 countries that were validated during 2011‒2020.MethodsWe assessed the attainment of the following MNTE sustainability indicators: 1) ≥ 90% coverage with three doses of Diphtheria-Tetanus-Pertussis vaccine (DTP3) among infants < 1 year, 2) ≥ 80% coverage with at least two doses of tetanus toxoid-containing vaccine (TTCV2 +) among pregnant women, 3) ≥ 80% protection at birth (PAB), 4) ≥ 70% skilled birth attendance (SBA), and 4) ≥ 80% first (ANC1) and fourth antenatal care (ANC4) visits. We assessed the introduction of TTCV booster doses. Data sources included the 2020 WHO /UNICEF Joint Reporting Forms, and the latest Demographic and Health Survey (DHS) or Multi-Indicator Cluster Surveys (MICS) for each country, if available. We reviewed literature and used DHS/MICS data to identify barriers to sustaining MNTE.ResultsOf 28 assessed countries, 7 (25%) reported ≥ 90% DTP3 coverage, 4 of 26 (16%) reported ≥ 80% TTCV2 + coverage, and 23 of 27 (85%) reported ≥ 80% PAB coverage. Based on DHS/MICS in 15 of the 28 countries, 10 (67%) achieved ≥ 70% SBA delivery, 13 (87%) achieved ≥ 80% ANC1 visit coverage, and 3 (20%) ≥ 80% ANC4 visit coverage. We observed sub-optimal coverage in many countries at the subnational level. The first, second and third booster doses of TTCV respectively have been introduced in 6 (21%), 5 (18%), and 1 (4%) of 28 countries. Only three countries conducted post-MNTE validation assessments. Barriers to MNTE sustainability included: competing program priorities, limited resources to introduce TTCV booster doses and implement corrective immunization in high-risk districts and socio-economic factors.ConclusionsDespite good performance of MNTE indicators in several countries, MNTE sustainability appears threatened in some countries. Integration and coordination of MNTE activities with other immunization activities in the context of the Immunization Agenda 2030 lifecourse vaccination strategy such as providing tetanus booster doses in school-based vaccination platforms, during measles second dose and HPV vaccination, and integrating MNTE post-validation assessments with immunization program reviews will ensure MNTE is sustained.

Maternal and Neonatal Tetanus Elimination: Where are We Now?

The maternal and neonatal tetanus elimination (MNTE) program was envisaged by the World Health Organization to overcome the mortality and morbidity caused by maternal and neonatal tetanus (MNT). Although preventable by simple cost-effective practices like universal immunization, clean delivery practices, and healthy umbilical cord care, as of date MNT is still prevalent in 12 developing countries of Asia and Africa. Definitive approaches need to be microplanned by these countries to successfully accomplish the three stages of MNTE, ie, achieving, validating, and sustaining. Once a country achieves MNTE, this status is required to be validated and sustained according to the high-risk and low-risk categorization of the districts. The three-pronged strategies for achieving and sustaining MNTE include (a) rigorous immunization of women of reproductive age with tetanus toxoid-containing vaccines, (b) strengthening of clean delivery services for pregnant women, and (c) effective surveillance for MNT. Although the deadlines for achieving MNTE globally have been missed many times, yet there has been a significant progress to date as evident by 80% reduction in countries requiring validation for MNTE (59 countries in 1999 to 12 countries in 2020). Huge strides have been made in the overall coverage of two doses of tetanus toxoid (13.79% to 65.27%), neonates being protected at birth (12% to 88%), global coverage of third-dose DPT (more than doubled), and reduction of 88% estimated deaths due to NT in the last four decades. Identification of the most vulnerable populations, systematic planning at all levels of health care, involvement of local community support, tackling the implementation gap, strong political will, good financial support, and continued robust surveillance will go a long way in achieving MNTE.

Recommendation of Tetanus Toxoid Vaccination for Pregnant Females in a Country that Achieved Elimination of Maternal and Neonatal Tetanus

Maternal and neonatal tetanus (MNT) is a lifethreatening disease, its case fatality approaches 100% in absence of medical care. It is linked to miscarriages, abortion, unhygienic delivery conditions, and poor cord care practices.

Neonatal Tetanus at Pediatric Teaching Hospital in Bangui

Background: Despite the Maternal and Neonatal Tetanus (MNT) elimination initiative, neonatal tetanus still persists in some parts of the world. Objectives: To determine hospital prevalence and describe epidemiological, clinical, therapeutic and outcome aspects of neonatal tetanus at the Pediatric Teaching Hospital in Bangui. Methodology: It was the review of hospitalized newborns’ files in the neonatal unit at Pediatric Teaching Hospital in Bangui between January 2016 and December 2019. Newborns discharged with tetanus diagnosis, and whose files were usable were included. The variables studied were: for the newborn: age, sex, birth weight, the reason for transfer, diagnosis, cause and time of death, place and method of delivery; for the mother: age, antenatal care, tetanus vaccine status, parity and geographical provenance. Epi Info 7 software, version 7.1.3.3 was used for data analysis. The chi2 test with the significance level set at p Résultats: Forty-eight (48) out of 5796 newborns had neonatal tetanus (0.8%). They were newborns to mothers with an average age of 18.8 years of which 68.8% (n = 33) were primipara and 87.5% (n = 42) not vaccinated against tetanus. Childbirth happened at home in 91.7% (n = 44), and the blade was used for sectioning the umbilical cord in 39.6% (n = 19). Newborns were referred from rural area in 47.9% (n = 23). A single antenatal care contact was done in 68.7% (n = 33). Tetanus was classified as severe according to the Dakar prognosis score between 4 and 6 in 89.6% of cases (n = 43). The death occurred in 58.3% (n = 28). Conclusion: The high frequency of neonatal tetanus as well as its severity requires pregnancy follow-up strengthening and childbirth monitoring in order to its elimination. But primary prevention relies on improving individual and general hygiene conditions.

Impact of Health Care Sector on Indian Economic Growth and Challenges: A Socio-Legal Analysis

A large quantity of India‘s population is reduced to destitution because of high coverage health-care expensesand also suffering from antagonistic consequences of poor health care services. India has accomplishedseveral gains in the field of Health since the new millennium, such as, life expectancy at birth has increased,the infant mortality and maternal mortality ratio has fell down and the spread of contagious diseases such asHIV/AIDS has been controlled etc. Again WHO, recently officially declared India free from maternal andneonatal tetanus and also polio free. But at the same time, among the five BRICS Nations, namely (Russia,Brazil, South Africa, China and India), India is considered as the poorest performer on the health indicators.India has failed to sufficiently protect its citizens against poor quality of health care as well as financial risksassociated with health expenditure.Health Care Industries of a Country can play crucial roles not only in providing quality care and improvingaccess to medicines for the citizens, but also in developing economic growth of the Country. Again, as itis universally accepted that Health is magnificent and efficacious investment for the economic growth of aNation, this paper will analyze several major challenges that India need to be addressed, most notably thepoor and ineffective regulation of the country, the rapid growth of commercialization of health care services,inadequate public expenditure along with very low level of public expenditure. Here the approach ofJudiciary towards the various challenges surrounding the health care services in India will also be discussed.

Knowledge and health beliefs of reproductive-age women in Alexandria about tetanus toxoid immunization

BackgroundMaternal neonatal tetanus is a substantial public health problem in many developing countries. In 2017, nearly, 30,848 newborns died of neonatal tetanus; thus, high immunization coverage remains a necessity. This study aims to assess knowledge and health beliefs of reproductive-age women in Alexandria about tetanus toxoid immunization.MethodsA cross-section survey of 700 females attending health offices in Alexandria was done using an interview questionnaire to collect data regarding women’s knowledge and beliefs about tetanus toxoid vaccine (TTV) and maternal and neonatal tetanus (MNT). Nine health offices were selected using multi-stage random sampling.ResultsMost of studied women (83.6%) had poor knowledge of MNT and TTV. The highest percentage of women had low perception of susceptibility to MNT (48.0%), moderate perception of severity of MNT (57.4%) and barriers to TTV (58.9%), high perception of benefits of TTV (86.6%), and high self-efficacy in taking the vaccine (76.2%). Less than one-third of the sampled women (27.7%) were immune by (TT2+). Logistic regression models showed that the place of antenatal care, level of knowledge, perceived barriers, and socio-economic level were significant predictors of immunity status (p = 0.008, p = 0.032, p = 0.011, and p = 0.001, respectively).ConclusionWomen lacked information about MNT/TTV and may even have been discouraged by their private obstetricians from taking the vaccine. Perceived barriers to receiving tetanus toxoid vaccination were shown to be an important predictor of immunization behavior

Increasing Frequency of Antenatal Care Visits May Improve Tetanus Toxoid Vaccination Coverage in Pregnant Women in Pakistan

ABSTRACT Objective Maternal and neonatal tetanus (MNT) elimination in low-income countries is a major aim of public health endeavors, due to poor vaccination status, lack of antenatal care, and unhygienic birth practices. The objective of this study, thus, was to assess the present state and factors associated with maternal tetanus toxoid (TT) vaccination in Pakistan. Methods Overall, 80 pregnant women (26 ± 4 y) during their last trimester were recruited from the district hospital Khanewal, Pakistan. The prevalence of vaccination was ascertained through clinical interviews and examination of health records from each participant. A questionnaire-based interview was conducted to assess the education level, antenatal visits, and sociodemographic variables related to vaccination coverage. A generalized linear model was used for statistical analyses. Results Seventy-nine percent of pregnant women were vaccinated with two doses of TT vaccine, while 16% of women were unvaccinated. Overall, 66% of pregnant women received two or more antenatal visits. Two and more than two antenatal visits during pregnancy were associated with significantly increased odds ratios for sufficient TT vaccination (OR = 1.60, CI [95%] 1.34–1.92 and OR = 1.61, CI [95%] 1.32–1.97, respectively) as compared to no or only one antenatal visit. Conclusion Regular antenatal care can improve vaccination coverage during pregnancy. Hence, reducing barriers for visiting antenatal care facilities could be key to reach the goal for MNT elimination.

Neonatal tetanus surveillance in Bayelsa state of Nigeria: a five-year review

ObjectiveTo assess the performance of neonatal tetanus surveillance in Bayelsa state of Nigeria.IntroductionNeonatal tetanus (NT) though a preventable disease, remains a disturbing cause of neonatal morbidity and mortality particularly in low income countries where maternal and child care are substandard and antitetanus immunization coverage is still poor. The disease, which is mostly fatal, is particularly common in hard to reach and rural areas where deliveries take place at home or with untrained attendants without adequate sterile procedures and in unclean environment. Since eliminating NT became a global target, significant reductions in NT deaths have been reported. The most recent estimates by WHO (2015) put death of newborns due to NT at 34,019, a 96% reduction from the situation in the late 1980s.All countries are committed to “elimination” of maternal and neonatal tetanus (MNT), i.e., a reduction of NT incidence to below one case per 1000 live births per year in every district. A strong neonatal tetanus surveillance (NTS) is however required to achieve this. As of March 2018, only 14 countries were yet to eliminate MNT and this includes Nigeria.The different types of NTS recommended are conducted to varying degrees of efficiency and effectiveness in Nigeria under the major surveillance strategy – the Integrated Disease Surveillance and Response (IDSR). These include routine monthly surveillance, zero reporting, active surveillance and retrospective record review.Nigeria comprises six geopolitical zones, 36 states and a Federal Capital territory (FCT), and is made up of 774 Local Government areas (LGA) (districts) – an LGA being the lowest administrative level. This study was conducted in Bayelsa state – one of the six states in the south zone. It is made up of eight LGAs, more than half of which are riverine and consists of many hard-to-reach communities, where formal functional health facilities are few and far between. Health workers are in short supply and funding of health care delivery is poor in the state.MethodsThis was a retrospective review of all confirmed cases of neonatal tetanus that were managed at the two tertiary hospitals in the state - Niger Delta University Teaching Hospital Okolobiri (NDUTH), and Federal Medical Centre Yenagoa (FMC) - between January 2009 and December 2013. These were the only two public facilities that had the capacity to manage NT cases in the state. Relevant data including sociodemographics, pregnancy and birth history of patients, cord care and tetanus toxoid immunization of mothers were abstracted from the case files. The cases were traced to the office of the State Epidemiologist, where all cases were expected to be documented and investigated in line with the existing neonatal tetanus surveillance. Ethical approval was obtained from the Research and Ethics Committee of NDUTH for the research and permission was given to access case files.ResultsA total of 48 cases were managed in both facilities (36/75.0% in NDUTH and 12/25.0% in FMC) in the period under review but only 13 cases (27.1%) were reported to the office of the State Epidemiologist. Figure 1 shows the number of cases per year of review. The cases were resident in seven out of the eight LGAs. The mean age of cases was 8.98 (SD = 5.14) days and 29 (60.4%) were male while 19 (39.6%) were female. Available evidence showed that only 2.1% of the cases were protected at birth (mothers had TT2+); 91.7% of mothers did not have antenatal care and all the mothers were delivered by traditional birth attendants; 70.8% had their umbilical cord cut with new (?sterile) blade; and 43.8% had their cord treated with methylated spirit, others were treated with just water or some herbal preparation. Educational attainment of mothers of cases was primary (54.2%) and secondary (45.8%).ConclusionsThere were gaps in Neonatal Tetanus Surveillance in Bayelsa State as only 27.1% of cases were captured at the state level. Many mothers and their newborns were still not protected against tetanus, and delivery and cord care were done in unhygienic conditions. There is an urgent need to strengthen NT surveillance, improve vaccination against tetanus, and encourage skilled birth attendance in the state.

Theory of Planned Behavior on Factors Affecting Tetanus Toksoid Immunization Uptake Among Pregnant Women in Boyolali, Central Java

Background : Tetanus is an infectious disease caused by Clostridium tetani bacteria. TT immunization in pregnant women can prevent neonatal deaths. Maternal and Neonatal Tetanus (MNT) has been among the most common life-threatening consequences of unclean deliveries and umbilical cord care practices, and are indicators of inequity in access to immunization and other maternal, newborn, and child health services. The neonatal mortality rate was still high in Boyolali Regency, Central Java. The purpose of this study was to determine the factors of TT immunization uptake among pregnant women in Boyolali, Central Java, using Theory of Planned Behavior. Subjects And Method : This was a cross-sectional study conducted in Boyolali, Central Java, from November to December 2018. A sample of 200 pregnant women from 25 community health centers was selected by simple random sampling and positioned at level 2 in a multilevel model analysis. Eight pregnant women were selected at random from each community health center. The dependent variable was TT immunization uptake. The independent variables were knowledge, education, the influence of midwife private practice, parity, income, intention, attitude, perceived behavior control, and social norm. The data on immunization uptake was obtained from the medical record. The other data were collected by questionnaire. The data were analyzed by multilevel multiple logistic regression analysis. Result s : The use of TT immunization increased with better maternal knowledge (b= 1.47; 95% CI= 0.02 to 2.92; p= 0.047), high maternal education (b = 2.19; 95% CI = 0.64 to 3.75; p= 0.006), influence of midwife private practice (b= 2.07; 95% CI= 0.41 to 3.72; p= 0.014), parity ≥2 (b= 1.81; 95% CI = 0.13 to 3.5; p= 0.034), income ≥minimum regional wage (b= 1.95; 95% CI= 0.39 to 3.50; p= 0.014), strong intention (b = 1.73; 95% CI = 0.11 to 3.34; p= 0.035), positive attitude (b= 2.11; 95% CI = 0.17 to 4.05; p= 0.033), strong perceived behavior control (b= 3.84; 95% CI = 1.47 to 6.20; p <0.001), supportive social norm (b= 2.26; 95% CI= 0.29 to 4.23; p= 0.024). Community health center had a contextual effect on TT immunization uptake with ICC= 35.86%. Conclusion : The use of TT immunization increased with better maternal knowledge, high maternal education, the influence of midwife private practice, parity ≥2, income ≥minimum regional wage, strong intention, positive attitude, strong perceived behavior control, supportive social norm. The community health center has a contextual effect on TT immunization uptake. Keywords: TT immunization, knowledge, education, midwife private practice, parity, income, intention, attitude, perceived behavior control, social norm, pregnant women Correspondence: Tiara Yumafita, Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami 362A, Surakarta 57126, Central Java, Indonesia. Email: Tiarayumafita8@gmail.com. Mobile: +6281230492658. Journal of Maternal and Child Health (2019), 4(3): 190-200 https://doi.org/10.26911/thejmch.2019.04.03.06

A Pilot Study: Factors Influencing Compliance With Tetanus-Diphtheria Vaccine in Katsina State, Northwestern Nigeria.

Background:Tetanus–diphtheria vaccine (Td+) coverage has been steadily declining in Katsina State, Nigeria. The pilot study was guided by The Andersen and Newman Framework of Health Services Utilization. The goal of the pilot study was to identify the Td+ vaccination coverage and identify any association between maternal residence, educational status, occupational status, access to routine immunization services, availability of routine immunization services, perceived need for Td+, perceived severity of maternal and neonatal tetanus (MNT), and compliance with Td+ in Katsina State.Methods:A cross-sectional survey of 309 randomly selected women in Charanchi district of Katsina State, Nigeria, was conducted. Data were collected using structured questionnaire and analyzed using logistic regression model.Findings:The Td+ coverage was low at 23%. Bivariate analysis showed that age, maternal residence, educational status, availability of Td+, perception of Td+, and perception of MNT significantly affected compliance with Td+ (P < .05, P < .05, P < .05, P < .001, P < .001, P < .001, respectively). Multiple logistic regression findings were inconclusive.Conclusion:Effective strategies to improve compliance were awareness creation on Td+ immunization schedule, risk factors associated with MNT, vaccine availability, and safety. Additionally, improving access to routine immunization services, especially in underserved communities, and effective use of Td+ coverage data were used as strategies.Implications:The pilot study suggests that the design can be used to realize more conclusive and generalizable multivariate findings in future studies.

Tetanus in Southern Vietnam: Current Situation.

In Vietnam, there are no accurate data on tetanus incidence to allow assessment of disease burden or vaccination program efficacy. We analyzed age structure of 786 tetanus cases admitted to a tertiary referral center in Vietnam for three separate years during an 18-year period to examine the impact of tetanus prevention programs, namely the Expanded Program on Immunization (EPI) and the Maternal and Neonatal Tetanus (MNT) initiative. Most cases were born before the initiation of EPI. Median age increased from 33 (interquartile range: 20–52) in 1994, to 46 (32–63) in 2012 (P < 0.001). Birth-year distribution was unchanged, indicating the same birth cohorts presented with tetanus in 1994, 2003, and 2012. Enzyme-linked immunosorbent assay measurements in 90 men and 90 women covered by MNT but not EPI showed 73.3% (95% confidence interval [CI]: 62.9–82.1%) of women had anti-tetanus antibody compared with 24.4% (95% CI: 15.9–34.7%) of men, indicating continued tetanus vulnerability in older men in Vietnam.

Maternal and neonatal tetanus elimination: from protecting women and newborns to protecting all.

A total of 35 of the 59 countries that had not eliminated maternal and neonatal tetanus (MNT) as a public health problem in 1999 have since achieved the MNT-elimination goal. Neonatal tetanus deaths have decreased globally from 200,000 in 2000 to 49,000 in 2013. This is the result of increased immunization coverage with tetanus toxoid-containing vaccines among pregnant women, improved access to skilled birth attendance during delivery, and targeted campaigns with these vaccines for women of reproductive age in high-risk areas. In the process, inequities have been reduced, private–public partnerships fostered, and innovations triggered. However, lack of funding, poor accessibility to some areas, suboptimal surveillance, and a perceived low priority for the disease are among the main obstacles. To ensure MNT elimination is sustained, countries must build and maintain strong routine programs that reach people with vaccination and with clean deliveries. This should also be an opportunity to shift programs into preventing tetanus among all people. Regular assessments, and where needed appropriate action, are key to prevent increases in MNT incidence over time, especially in areas that are at higher risk. The main objective of the paper is to provide a detailed update on the progress toward MNT elimination between 1999 and 2014. It elaborates on the challenges and opportunities, and discusses how MNT elimination can be sustained and to shift the program to protect wider populations against tetanus.

Towards Elimination of Maternal and Neonatal Tetanus in the Developing Countries: A Look at the Theory of Planned Behavior

To achieve the global maternal and neonatal tetanus (MNT) elimination, it is vital to develop an ideal theoretical framework that can be used for the disease elimination. The theoretical framework for this review is the Theory of Planned Behaviour (TPB), a modified model of the Theory of Reasoned Action (TRA). The TPB was meant to be applied to the prediction of purely volitional behaviors, and to help understand the psychological determinants of individuals. The TPB shows that the intention of human beings to perform a particular behavior and the conduct of that behavior are based on belief structures and determined by three independent constructs: attitude toward the behavior, perceived behavioral control, and subjective norms to perform the behavior. In relating TPB to the predictive model of NNT, there are various determinants of preventive behavioral intention among the women towards NNT. The beliefs of pregnant women on the outcomes of their pregnancies after they attend antenatal care, receiving tetanus toxoid (TT) vaccination and delivering in a hospital setting are all dependent on how the women value these which likewise determine their attitudes toward receiving a TT to prevent their unborn child from NNT.

Seroprevalence of Anti-tetanus Antibodies in Women attending Omdurman Maternity Antenatal Clinic in Sudan

Seroprevalence of Anti-tetanus Antibodies in Women attending Omdurman Maternity Antenatal Clinic in Sudan

Tetanus in Ethiopia: Unveiling the Blight of an Entirely Vaccine-Preventable Disease

Today, tetanus exacts its toll only in resource-poor countries like Ethiopia. Agrarian rural life with limited vaccine typifies tetanus risk in Ethiopia where current tetanus control trends on expanding infant immunization and eliminating highly prevalent maternal and neonatal tetanus (MNT). Protection by infant tetanus immunization primers disappears within an average of 3years, if not followed by boosters. Second-year of life, school-based, and universal 10-yearly tetanus immunizations need to be supplemented. Facility-based reviews in Ethiopia reveal a continued burden of tetanus at tertiary-level hospitals where ICU care is suboptimal. Quality of medical care for tetanus is low - reflected by high case-fatality-rates. Opportunities at primary-health-care-units (antenatal-care, family planning, abortion, wound-care, tetanus-survivors) need to be fully-utilized to expand tetanus immunization. Prompt wound-care with post-exposure prophylaxis and proper footwear must be promoted. Standard ICU care needs to exist. Realization of cold-chain-flexible, needle-less and mono-dose vaccine programs allow avoiding boosters, vaccine-refrigeration, and improve compliance.

WHO's Initiatives to Control Vaccine Preventable Diseases (VPD) and Labnet for Targeted VPDs in the Western Pacific Region

WHO's Initiatives to Control Vaccine Preventable Diseases (VPD) and Labnet for Targeted VPDs in the Western Pacific Region

Coverage and factors associated with tetanus toxoid vaccination status among females of reproductive age in Peshawar.

To estimate the coverage and determine the factors associated with tetanus toxoid vaccination status among females of reproductive age. Cross-sectional study. District Peshawar, NWFP, from July to September 2002. A total of 646 females of reproductive age (15-49) years were selected from both urban and rural areas of Peshawar through stratified cluster sampling. A pre-tested structured questionnaire was administered to females. Two logistic regression models were built, one for all females and one for married females only. Overall 65.0% females were vaccinated (95% confidence interval (CI) (61.3%, 68.6%). For all females, the variables that were significantly associated with vaccination status were marital status (OR= 8.5, 95% CI (4.7, 15.6)), source of information regarding tetanus toxoid (TT) vaccination, knowledge regarding TT vaccination, visits of lady health worker (LHW) to a household (OR = 2.3, 95% CI (1.4, 3.9) and restriction on TT vaccination (OR = 28.7, 95% CI (3.5, 237.9)). For the married females, the variables that were significantly associated with vaccination status were source of information; visits of LHW to a household (OR = 2.8, 95% CI (1.5 to 5.2)) and an interaction between knowledge regarding TT vaccination and antenatal care visits. These findings are of public health concern as a majority of females is not vaccinated according to WHO recommendations. It is recommended that maternal and neonatal tetanus (MNT) vaccination campaigns should include lady health workers at implementation stage.