Prevention Of Neonatal Tetanus Research Articles

Neonatal tetanus in South Sudan: a case series

Introduction: Neonatal tetanus is a life-threatening disease of public health importance; it is yet to be eliminated and is still occurring in South Sudan. It is caused by a neurotoxin from a bacterium Clostridium tetani whose spores exist in the environment. Compared to high-income countries, most low-income countries lack intensive care units, and magnesium sulfate shown to improve neonatal tetanus outcomes. Objectives: We aimed to determine the outcome of neonatal tetanus in Al Sabah Children’s Hospital, Juba, South Sudan. Methods: We conducted a case series study in Al Sabah Children’s Hospital in Juba, South Sudan. It described three neonates who presented within the first seven days of life with a history of excessive crying, inability to breastfeed, and tetanic muscle spasms when stimulated. They had signs of respiratory distress, fever, and labile heart rates. We made a diagnosis of neonatal tetanus with autonomic dysfunction, and started them on phenobarbitone because diazepam was not available, oxygen, and antibiotics. However, tetanus immune globulin and anti-tetanus serum were not available. Results: Unfortunately, all three neonates died within 24 hours of admission. Conclusion: Our primary focus as a nation is to improve access to quality health services and the prevention of neonatal tetanus through encouraging appropriate antenatal care, facility delivery, clean delivery and healthy umblical cord care practices, and tetanus vaccinations in teenage girls and young adults. When prevention fails, there is a need for neonatal intensive care with recommended medicines to significantly decrease mortality in this preventable tragic illness. Keywords: Neonatal tetanus; low-income countries; neonates; Al sabah children hospital; South Sudan.

Neonatal tetanus: An old enemy still lurking around in 2021


 
 
 
 Neonatal tetanus (NT) is a severe but preventable disease for which South Africa achieved elimination status in 2000. It is under-reported, especially in poorly resourced areas where there is minimal surveillance and immunisation coverage is overestimated, and where traditional practices are employed. The case fatality rate is high and surviving infants often have significant morbidity. The aim of our case report is to alert clinicians to the presence of NT and its clinical presentation and to emphasise the value of notification and surveillance. Prevention of NT should be prioritised through: education around hygienic practices at delivery; ensuring adequate immunity against tetanus in all women through routine childhood immunisation; and administration of tetanus toxoid in each pregnancy. NT should be considered in any neonate who could suck and cry in the first 2 days of life and who, between 3 and 28 days of life, cannot suck normally and becomes stiff or has spasms.
 
 
 

HUBUNGAN TINGKAT PENGETAHUAN IBU TENTANG PERAWATAN TALI PUSAT BAYI BARU LAHIR DENGAN LAMANYA PELEPASAN TALIPUSAT PADA BAYI BARU LAHIR DI PRAKTEK BIDAN DELPI SARAGIH TAHUN 2021

Background: the Ministry of Health has implemented various programs related to maternal and child health and one of them is prevention of neonatal tetanus and newborn care including umbilical cord care (WHO). , 2017). about newborn umbilical cord care and the length of umbilical cord detachment in newborns at the Delpi Saragih Midwife Practice. Methods: This study subjects were postpartum mothers who had newborns until the umbilical cord was separated at the Delpi Saragih Midwife Practice. Sampling technique with Total Sampling of 35 respondents with measuring instruments, namely questionnaires and observation sheets, data analysis using Chi-Square The results of the study: the level of knowledge of mothers about newborn umbilical cord care showed that of the 35 respondents, most of the respondents had good knowledge, namely 14 people (40.0%), and a small proportion of respondents had sufficient knowledge, namely 9 people (25.8%). With the length of the release of the umbilical cord in newborns, most respondents were normal 5-7 days in releasing the umbilical cord in newborns, as many as 15 people (42.9%), and a small proportion of respondents were fast < 5 days and long > 7 days in releasing the cord. center for newborns as many as 10 people each (28.6%). The results of the Chi-Square analysis show that the value of p = 0.020 <α = 0.05 Conclusion: There is a relationship between the level of knowledge of the mother about newborn umbilical cord care and the length of time the newborn's umbilical cord is released.

Neonatal tetanus in an African newborn

•Tetanus is caused by the toxin of Clostridium tetani.•Neonatal tetanus occurs after the contamination of the umbilical stump with the spores of C. tetani in newborns without protective antibodies.•Inadequate maternal vaccination and poor perinatal hygiene are the main risks factors.•The diagnosis is mainly clinical and the early onset of a specific treatment can improve the prognosis.•Prevention of neonatal tetanus is achieved with improvement in perinatal and ante-natal care, with vaccination of unimmunised pregnant women. A 7-day-old newborn was brought to our hospital with fever. The mother had not followed any ante-natal care. She gave birth at home and the umbilical cord was cut with a non-sterile blade. The newborn had been well up to the day of admission, when fever and some difficulties for breastfeeding appeared. Physical examination was unremarkable, including a preserved suction reflex. A urinary dipstick ruled out a urinary infection. A rapid test for malaria was negative. There was no possibility to perform blood cell count or cultures due to the limited resources. A lumbar puncture showed clear spinal fluid, but biochemical or microbiological tests were unavailable. Regardless of ampicillin and gentamicin administration, the fever increased and the baby developed an impossibility to suck. He had muscular spasms, aggravated by touch. Trismus and rigidity were marked (Figure 1). The evolution and epidemiology posed the suspicion of neonatal tetanus, a disease caused by the toxin of Clostridium tetani, still common in low income countries due to limited access to ante-natal care, inadequate maternal vaccination and home-deliveries with no use of clean delivery kits and poor hygiene of the umbilical stump (WHO, 2017). The early onset of a specific treatment may modify the prognosis, so human tetanus immunoglobulin (500 UI intramuscularly) and metronidazole (15 mg/kg as loading dose, followed by 7.5 mg/kg every 12 h for 10 days) were administered. A nasogastric-tube was placed for feeding, the newborn was located in a quiet, dark place, and diazepam was initiated to control the spasms (Thwaites et al., 2015Thwaites C.L. Beeching N.J. Newton C.R. Maternal and neonatal tetanus.Lancet. 2015; 385: 362-370Abstract Full Text Full Text PDF PubMed Scopus (114) Google Scholar, Gibson et al., 2009Gibson K. Bonaventure Uwineza J. Kiviri W. Parlow J. Tetanus in developing countries: a case series and review.Can J Anaesth. 2009; 56: 307-315Crossref PubMed Scopus (36) Google Scholar). Despite the high mortality of this entity (Mwaniki et al., 2010Mwaniki M.K. Gatakaa H.W. Mturi F.N. Chesaro C.R. Chuma J.M. Peshu N.M. et al.An increase in the burden of neonatal admissions to a rural district hospital in Kenya over 19 years.BMC Public Health. 2010; 10: 591-604Crossref PubMed Scopus (34) Google Scholar), the evolution was good, with spasm disappearance and recovery of suction capacity (Figure 2). The baby was discharged 15 days after arrival. As tetanus infection does not confer immunity, he received the first dose of tetanus toxoid vaccination before discharge and was included in immunization program for the following two doses. The mother was also vaccinated. Prevention of neonatal tetanus is achieved with a combination of improvement in perinatal care and vaccination of women of childbearing age and unimmunised pregnant women, since maternal antibodies are passively transferred to the fetus and protect the newborn (Demicheli et al., 2015Demicheli V. Barale A. Rivetti A. Vaccines for women to prevent neonatal tetanus.Cochrane Database Syst Rev. 2015; 7 (CD002959)Crossref Scopus (39) Google Scholar, WHO, 2000WHO Maternal and neonatal tetanus elimination (MNTE).2000Google Scholar).Figure 2Recovery of the capacity to suck after the treatment.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Author contributions: M.A.P.J.A. and M.L gave medical attention to the newborn. M.A.P.J.A. wrote the paper. Funding sources: No funding sources. Conflict of interest: The authors declare no conflict of interest. Acknowledgement: We acknowledge the mother of the baby for giving her written consent for the publication of her son’s images and signing the informed consent form.

Long-term outcome in survivors of neonatal tetanus following specialist intensive care in Vietnam

BackgroundNeonatal tetanus continues to occur in many resource-limited settings but there are few data regarding long-term neurological outcome from the disease, especially in settings with critical care facilities.MethodsWe assessed long-term outcome following neonatal tetanus in infants treated in a pediatric intensive care unit in southern Vietnam. Neurological and neurodevelopmental testing was performed in 17 survivors of neonatal tetanus and 18 control children from the same communities using tools previously validated in Vietnamese children.ResultsThe median age of children assessed was 36 months. Eight neonatal tetanus survivors and 9 community control cases aged < 42 months were tested using the Bayley III Scales of Infant and Toddler Development (Bayley III-VN) and 8 neonatal tetanus survivors and 9 community controls aged ≥42 months were tested using the Movement Assessment Battery for Children. No significant reductions in growth indices or neurodevelopmental scores were shown in survivors of neonatal tetanus compared to controls although there was a trend towards lower scores in neonatal tetanus survivors. Neurological examination was normal in all children except for two neonatal tetanus survivors with perceptive deafness and one child with mild gross motor abnormality. Neonatal tetanus survivors who had expienced severe disease (Ablett grade ≥ 3) had lower total Bayley III-VN scores than those with mild disease (15 (IQR 14–18) vs 24 (IQR 19–27), p = 0.05) with a significantly lower cognitive domain score (3 (IQR 2–6) severe disease vs 7 (IQR 7–8) mild disease, p = 0.02).ConclusionsNeonatal tetanus is associated with long-term sequelae in those with severe disease. In view of these findings, prevention of neonatal tetanus should remain a priority.

Do traditional Birth Attendants (TBAs) Have a Role in the Prevention of Neonatal Tetanus

Background: In spite of the significant achievement of the global NNT elimination campaign and with the deadline set at 2015, NNT is still among the leading causes of death in 25 developing countries. Additionally, the sub-Saharan African region still has the lowest coverage of Antenatal care services and hospital deliveries. Study Design: Retrospective study Methods: Quantitative cross-sectional involving mothers of NNT children using secondary data collected between January 2008 and December 2013 from northeastern Nigeria. Results: The result shows that a significant difference existed between mothers that delivered with the help of TBAs and those that did not; z-statistic (N = 171) = 5.278, p < .001; 95% confidence interval (CI) = 0.235 to 0.371. Conclusion: The Nigerian government should prioritize its activities to give quality training to the TBAs to help in the delivery of pregnant women who reside especially in the rural underserved communities.

A Cross-sectional Study on Perception of Medical Students Regarding Tetanus Immunization

Introduction: Tetanus is an acute, often fatal, disease caused by an exotoxin and highly potent neurotoxin, tetanospasmin, which is produced during the growth of the anaerobic bacterium Clostridium tetani. Tetanus can be prevented by vaccination with tetanus toxoid (TT). A thorough knowledge of the tetanus immunisation in wounds is necessary to prevent the occurrence of wound related tetanus. Knowledge regarding TT vaccination as per the NIS among all levels of health care personnel is important not only for the prevention of neonatal tetanus but also tetanus in the children and adults Materials and method: The present cross-sectional study was conducted among final year medical students of Katuri Medical College and Hospital, Guntur, Andhra Pradesh during June -August 2010. A pre-tested, pre-designed questionnaire was adapted. Results: 68.97 % students were not aware of the number of doses of tetanus vaccine recommended for children under the age of 16 years and 62.07% students were not aware of the number of doses of tetanus vaccine recommended for adults over the age of 16 years. More than half of the study population (51.15%) considered every cut injury to be tetanus prone. The majority of the students (79.31% and 77.01%) considered burn injury and animal bite wounds to be tetanus prone. More than 70% of the students were aware that age of the wound, type of wound and previous immunization status of patients as important considerations before immunizing a patient against tetanu. Conclusion: Better awareness and knowledge regarding tetanus vaccine is needed in medical students which are future health care providers.

Disposable clean delivery kits and prevention of neonatal tetanus in the presence of skilled birth attendants

ObjectiveTo determine whether the use of disposable clean delivery kits (CDKs) is effective in reducing neonatal tetanus (NNT) infection, regardless of the skills of birth attendants in resource-poor settings. MethodsA secondary analysis was conducted on data from a matched case–control study in Karachi, Pakistan, involving 140 NNT cases and 280 controls between 1998 and 2001. Conditional logistic regression was performed to assess the independent effect on NNT of CDKs and skilled birth attendants (SBAs). ResultsAfter adjustment for socioeconomic factors, both CDKs (adjusted matched odds ratio [mOR] 2.0; 95% confidence interval [CI], 1.3–3.1) and SBAs (adjusted mOR 1.7; 95% CI, 1.1–2.7) were independently associated with NNT. The association with CDKs remained significant when additionally adjusted for SBAs (mOR 2.0; 95% CI, 1.0–3.9; P=0.05). The population attributable risk for lack of CDK use was 24% in the study setting. ConclusionIn the context of resource-poor settings in low-income countries with poor coverage of tetanus toxoid immunization, the use of CDKs seems to be an effective strategy for reducing NNT infection, irrespective of the skill levels of birth attendants. Approximately one-quarter of NNT cases could be prevented in low-income populations with the use of CDKs.

Prevention of neonatal tetanus: Much preached, less practiced!

Nigerian family with two consecutive perinatal deaths from neonatal tetanus is reported. The important role of missed opportunities in the failure of immunization programmes and the persistence of neonatal tetanus in the developing world is highlighted. Other important factors are also emphasised in order to reawaken a need for concerted effort towards the elimination of the disease. Keywords : immunization; missed opportunities; neonatal tetanus Nigerian Medical Practitioner Vol. 50 (2) 2006: pp 39-41

Duration of protective immunity conferred by maternal tetanus toxoid immunization: further evidence from Matlab, Bangladesh.

Although maternal tetanus immunization has been shown to be highly effective in the prevention of neonatal tetanus, unresolved questions remain concerning the required minimum number of doses and the resulting duration of effective immunity. This study examined the duration of effective immunity against neonatal tetanus provided by maternal tetanus immunization. A randomized, double-blind cholera vaccine trial of 41,571 children and nonpregnant adult women carried out in 1974 in the Matlab comparison area of rural Bangladesh provided a unique opportunity to address dose and immunity issues. Children of women who received either 1 or 2 injections of tetanus toxoid experienced 4- to 14-day mortality levels consistently lower than those of children of unimmunized mothers. Analysis of neonatal-tetanus-related mortality showed that 2 injections of tetanus toxoid provided significant protection for subsequent durations of up to 12 or 13 years. The data demonstrate that a limited-dose regimen of maternal tetanus toxoid provides significant and extended protection against the risk of neonatal tetanus death.

Long-term prognosis after neonatal tetanus.

Twenty-four Turkish children who had had neonatal tetanus were evaluated by means of physical and neurological examinations and psychometric tests at four to 15 years of age. Enuresis, mental retardation and growth retardation were frequent findings. The prevention of neonatal tetanus is important not only because of the high mortality rate but also because of its sequelae.

Prevention of neonatal tetanus in India: a prospective cost-effectiveness analysis.

Although the vaccine which effectively prevents tetanus has been available for some time tetanus remains a significant cause of mortality throughout the world with neonatal tetanus accounting for 1/4 to 1/2 of all tetanus deaths. Tetanus is associated with poor environmental sanitation and non-antiseptic birth practices. The incidence of tetanus tends to vary inversely iwith socioeconomic status. This paper investigates the feasibility in cost effectiveness terms of programs to intervene in neonatal tetanus. The geographical focus of the study in north India where in some rueal areas neonatal tetanus mortality rates are estimated to be 5300/100000 live births. Alternative intervention strategies are discussed 2 possible delivery models are developed and the cost per death is estimated. The information collected can assist decision-makers in choosing a program appropriate to their needs. Prevention of neonatal tetanus can be made by vaccinating the child in the 1st 3 days of life training indigenous midwives in aseptic birth practices or immunizing pregant women or women of childbearing age. Other than economic criteria the rapidity with which immunizations are delivered and the ease with which the proposed program may be integrated into existing health services are factors to be considered in determining cost-effectiveness. Immunization is found to be relatively inexpensive and therefore an economically feasible intervention in neonatal tetanus. The addition of a midwife training program and/or multi-valent vaccine would increase cost-effectiveness. It is important to consider alternative interventions in infant and child mortality given the other major causes of infant death e.g. pneumonia and diarrhea.

Birth care practice and neonatal tetanus in a rural area of Bangladesh.

Untrained personnel attend 2/3 of all births in the world. In many villages and urban areas of Asia; Africa and Latin America TBAs (traditional birth attendants) deliver majority of births. This paper reports the type of birth attendants; methods of cutting and dressing the umbilical cords and their relationship with the incidence of neonatal tetanus for a cohort of 1351 infants born between 7/76 to 6/77 in Teknaf area of rural Bangladesh. Most of the deliveries were conducted by untrained birth attendants and only <1% were delivered by trained midwives or physicians. 32% of the births were delivered by dais or TBAs; 35% by neighboring women; 30% by relations of the women and 3% were unattended. Razor blades were used to cut the umbilical cords in 22% and bamboo splits in 78%. Overall neonatal mortality rate due to tetanus was 27/100 live births. Among neonates whose umbilical cords were cut by razor blades mortality rate was 21/1000 live births compared to 29/1000 live births for those cut by bamboo splits. These rates were not considered statistically signficant. Mortality rate due to tetanus was significantly higher among the neonates whose umbilical cords were not tied with a thread than those tied with a thread. Incidence of neonatal tetanus can be lo considerably through improvement of rural sanitation and delivery techniques in home. Tetanus toxoid immunization of mothers was suggested as an effective remedy for the prevention of neonatal tetanus.

SINGLE-DOSE ANTENATAL TETANUS IMMUNISATION

A series of two-dose and one-dose antenatal tetanus immunisation schedules using various toxoids and adjuvants have been examined for their efficacy in producing levels of antitoxin protective against neonatal tetanus at the time of delivery. If a maternal antitoxin titre of 0·01 unit per ml. or more at delivery is accepted as protective, then complete protection was afforded by two doses of a 50 limit-flocculation units (Lf) adsorbed toxoid. Standard doses of commercially available tetanus vaccines do not give complete protection unless three doses are given. The best single-dose schedule tested was 100 Lf of an adsorbed toxoid containing the quaternary ammonium adjuvant 'Arquad 2HT' (the principal component of which is dioctadecyl dimethyl ammonium chloride), which achieved 83% protection. There were no adverse reactions of significance reported in any of the schedules. Transfer of antitoxin to the infant is more effective and rapid after a two-dose schedule than after a single dose. Further investigations into immunisation early in pregnancy with adsorbed toxoids in higher doses than used in this investigation (i.e., greater than 100 Lf) are required. From these promising results it is probable that an acceptable one-dose schedule in the prevention of neonatal tetanus will be achieved. Antenatal immunisation effective in protecting against neonatal tetanus does not seem to interfere with subsequent active immunisation in infancy.

The prevention of neonatal tetanus by maternal immunization.

Although the incidence of neonatal tetanus worldwide is not known certain telling statistics on mortality from neonatal tetanus are cited for a number of countries. It is generally agreed that contamination of the umbilical stump or wound is responsible for most of the cases of neonatal tetanus. This condition usually occurs in connection with home deliveries by relatively untrained personnel and in unsanitary surroundings; occasionally however neonatal tetanus will result from a hospital delivery involving a very short postnatal hospital stay. In addition to improved sanitation of delivery and new born care it is suggested that routine maternal immunization with tetanus toxoid as a regular part of prenatal care will reduce the incidence of the disease. Passive immunization using homologous serum is felt to be more effective than immunization using heterologous horse serum. Results from several such programs are cited. Duration of the resultant immunity must be determined. In areas of high incidence of the disease all women of reproductive age should be immunized through mass campaigns.

Tetanus of the Newborn

To the Editor.— Prevention of Neonatal Tetanus Through Immunization of Mother ( 217 :1558, 1971) prompts the following comment. Tetanus neonatorum had been a problem in Alabama for many years. In 1969, we inaugurated an immunization program for the mother during her prenatal course in an effort to offer a temporary passive immunity to her infant to be born. Since the directive was sent to all county health departments and practicing physicians, the incidence of tetanus neonatorum has declined to zero. We feel that this program has saved the lives of several babies each year. The directive, distributed statewide, reads as follows: In view of the fact that the State of Alabama, Bureau of Vital Statistics, records an average of about 10 cases of tetanus neonatorum each year and since this is a preventable disease and it is felt there are few complications involved in an immunization program against tetanus, it