Tetanus Toxoid Vaccine Research Articles

Spatial distribution and determinants of tetanus toxoid immunization among pregnant women in Ethiopia using data from Ethiopian demographic and health survey 2016

IntroductionTetanus is a major public health problem caused by clostridium tetani. Although it is vaccine-preventable, the case fatality rate among neonates in areas with poor immunization coverage and limited access to clean deliveries reaches 80-100%. Vaccination of pregnant mothers with the tetanus toxoid (TT) vaccine is the most effective way to protect against neonatal tetanus. This study aimed to examine the spatial distribution and determinants of tetanus toxoid immunization among pregnant mothers using the 2016 EDHS data.MethodSecondary analysis of the Ethiopia Demographic and Health Survey 2016 was done to assess the spatial distribution and determinants of tetanus toxoid vaccine among pregnant women in Ethiopia. Spatial autocorrelation analysis and hot spot analysis were used to detect spatial dependency and spatial clustering of the tetanus toxoid vaccine in Ethiopia. Spatial interpolation was used to predict the tetanus toxoid vaccine coverage in unsampled areas. The multilevel binary logistic regression model was fitted to identify factors associated with tetanus toxoid vaccination. An adjusted odds ratio with 95% CI was calculated and used as the measure of association and a p-value less than 0.05 were considered statistically significant.ResultFrom the total of 7043 pregnant women, 42.4% of them have taken at least two doses of tetanus toxoid immunization. Spatial clustering of TT immunization was observed in the Northern, Southwestern and Southwestern parts of Ethiopia. Whereas, low TT coverage was observed in the Eastern and Western parts of the country. Increased ANC visits and the richest economic status favored TT immunization, whereas living in Addis Ababa and Dire Dewa cities decreased the TT immunization coverage.ConclusionThe finding of this study reveals that TT immunization had spatial dependency, with the highest immunization coverage observed in the Northern, Southwestern and Southeastern parts of the Country. Thus, geographically targeted interventions should be implemented particularly in the eastern and western parts of the country.

Pregnant women’s knowledge of Tetanus disease and immunization against Tetanus disease in the City of Baghdad

Objective: To estimate the understanding of tetanus and tetanus toxoid injections among pregnant women.Method: The cross-sectional study was conducted at the Baghdad General Hospital and a primary healthcare centrein Bab-Almuadham, Iraq, from November 15, 2020, to January 15, 2021, and comprised 100 pregnant women aged15-45 years. Data was gathered through face-to-face structured interviews using a complete self-assessmentquestionnaire. Data was analysed using SPSS 27.Results: Of the 100 women with mean age of 28.4±10.6 years (range: 15-44 years), 27(27%) were aged 20-24 years,70(70%) were from the urban areas, 40(40%) had primary education, 69(69%) were housewives, and 85(85%) had hadfull or partial tetanus toxoid vaccine doses. With respect to knowledge about tetanus disease, 60(60%) subjectsanswered correctly that tetanus is a serious disease, 52(52%) knew that tetanus infection could also kill the foetus,and 30(30%) recognised that tetanus produces significant side effects. Besides, 80(80%) women considered the vaccinea necessity, and the most common source of information about tetanus vaccination was the health authorities 76(76%).Conclusion: The pregnant women studied were found to have an acceptable level of knowledge about tetanus andtetanus toxoid immunisation.Keywords: Pregnancy, Tetanus, Clostridium tetani, Asymptomatic infections, Tetanus toxoid, Nervous system,Demography, Uterus, Foetus

Evaluation of the immune response to diphtheria and tetanus toxoids by the serological methods

Scientific relevance. Currently, two types of methods are used to evaluate the potency of diphtheria and tetanus toxoids: the gold standard, which involves administering toxins to immunised animals, and serological methods, which involve quantifying protective antibodies in the serum of immunised animals. International validation studies of serological methods for assessing the potency of diphtheria and tetanus toxoids have resulted in revisions to the relevant chapters of the WHO Manual for Quality Control of Diphtheria, Tetanus and Pertussis Vaccines, as well as the European, Japanese, and several other pharmacopoeias. Consequently, some diphtheria and tetanus vaccine manufacturers have substituted the potency evaluation methods that require administering toxins to animals with alternative serological methods.Aim. The study aimed to assess the suitability, reproducibility, and feasibility of an alternative enzyme immunoassay method (ELISA) for assessing the potency of diphtheria and tetanus components of diphtheria, tetanus, and whole-cell pertussis (DTwP) vaccines and to determine the possibility of implementing this method in Russia using standards and reagents manufactured in the country.Materials and methods. The study used combined vaccines for diphtheria prophylaxis, diphtheria toxin, and reference vaccines. The potency of diphtheria and tetanus toxoids was determined in guinea pigs and mice by the pharmacopoeial lethal challenge method and an alternative ELISA method.Results. ELISA and lethal challenge methods demonstrated comparable results of potency determination: 230 IU/mL vs 264 IU/mL (diphtheria toxoid), 188 IU/mL vs 160 IU/mL (tetanus toxoid), respectively. As opposed to the lethal challenge, the serological method allows testing the efficacy of several antigens in the same animals. The study showed the possibility of using purified diphtheria and tetanus toxoids manufactured in Russia as coating antigens. The authors obtained comparable antibody titres for each animal, using plates coated with international standards and Russian-made diphtheria and tetanus toxoids.Conclusions. The authors demonstrated the possibility of using ELISA to determine the potency of diphtheria and tetanus toxoids in DTwP vaccines. Moreover, the study demonstrated the suitability of Russian purified diphtheria and tetanus toxoids as coating antigens. Researchers should continue working on enzyme immunoassay validation with a view to harmonising national and international methods for assessing the potency of diphtheria and tetanus toxoid vaccines, as these efforts will not only facilitate the registration of foreign vaccines in Russia but also accelerate the approval of Russian vaccines in other countries.

Assessing the impact of the 2018 tetanus guidelines on knowledge and practices of emergency physicians in trauma patients: a national survey study.

Tetanus remains a significant public health issue in China, with the approach of anti-tetanus prophylaxis in the emergency department resulting in both overuse, particularly of human tetanus immune globulin (TIG), and underuse with the tetanus vaccine. This is largely due to the absence of updated guidelines on tetanus prophylaxis before 2018. Our study aimed to evaluate the effects of the 2018 Chinese tetanus guidelines on the knowledge and practices of emergency physicians about tetanus prevention in trauma patients. From November 2019 to April 2020, we conducted a web-based survey involving 499 emergency physicians. The survey included a questionnaire covering knowledge, attitudes, and practices related to tetanus. We assessed the influence of the 2018 tetanus guidelines on the knowledge and practices of emergency physicians related to tetanus prevention for patients with trauma using multiple regression analysis. The survey results showed that only 45.3% of the participants had received formal training on tetanus immunization, despite 53.3% reporting the availability of tetanus vaccines at their institutions. Physicians typically prescribed tetanus antitoxin or human TIG instead of tetanus toxoid (TT) to treat injuries, regardless of the patient's TT vaccination history. Among the respondents, those who were aware of the 2018 tetanus guidelines had higher mean scores on the general knowledge, risk knowledge, and treatment knowledge scales, with increases of 6%, 13%, and 9%, respectively, compared to those who were unaware of the guidelines. Awareness of the 2018 tetanus guidelines was associated with a high level of knowledge, as indicated by the general knowledge score, recommendation knowledge score, and total knowledge score, after adjusting for the effects of all variables on the knowledge, attitudes, and practices of the participants. A high level of education was also associated with a high level of knowledge indicated by the recommendation knowledge score and total knowledge score. Our study highlights a substantial gap in the attitudes, knowledge, and practices of emergency physicians in China regarding tetanus immunization. The results suggest an urgent need to promote the Chinese Expert Consensus Guidelines on tetanus to improve emergency physicians' knowledge and competence in tetanus prophylaxis. The findings underscore the importance of enhancing physicians' awareness of the latest guidelines to ensure appropriate and effective treatment for patients with tetanus-prone injuries.

Predictors of Tetanus Vaccine Uptake among Pregnant Women in Khartoum State, Sudan: A Hospital-Based Cross-Sectional Study.

Tetanus toxoid (TT) vaccination during pregnancy has been proven as an effective preventative measure to reduce the incidence of maternal and neonatal morbidity and mortality worldwide. This study aimed to assess the determinants of TT vaccine uptake among pregnant women at two public maternity specialized hospitals in Sudan. A hospital-based cross-sectional study was conducted at two public hospitals, Omdurman Maternity Hospital and Al Saudi Hospital in Omdurman, Khartoum State, in Sudan from February to April 2020. Logistic regression analysis was carried out to identify factors associated with receiving three or more doses of the TT vaccine among pregnant women, presented as odds ratios, with p-values < 0.05 considered significant (at a 95% confidence interval). The study recruited 350 pregnant women, with 313 participants included in the analysis. This study found that only 40% of the pregnant women had received three doses or more of the TT vaccine. Pregnant women who attended Al Saudi Hospital were less likely to be vaccinated with the recommended dose of the TT vaccine in districts at high risk (received ≥3 doses) compared to those who attended Omdurman Hospital [OR = 0.49 (95% C.I. 0.29-0.82), p-value < 0.05]. Furthermore, the number of children at home was a significant predictor of the mothers' immunization status as those with five children or more were ten times more likely to be vaccinated with three doses or more [OR = 10.54 (95% C.I. 4.30-25.86), p-value < 0.05]. We conclude that this low rate of TT vaccine uptake found in this study among pregnant women increases the number of newborn babies susceptible to contracting neonatal tetanus. The findings of this study should be considered in the development of communication strategies targeting and prioritizing at-risk groups to increase TT vaccine uptake among pregnant women in Sudan.

Awareness of Women about Tetanus in Baghdad

Background: Tetanus toxoid (TT) vaccine is still recommended for pregnant women even in countries that declared elimination of neonatal tetanus (NT) and consequently the maternal tetanus (MT). Many factors may affect TT vaccination during pregnancy. Awareness is a key factor that greatly affect the pregnant women to receive tetanus toxoid vaccination during pregnancy. Aims of study: To assess the awareness of women regarding different aspects of tetanus and tetanus toxoid vaccination as well as to identify the factors influencing their awareness. Subjects and Method: A cross sectional study conducted in Baghdad from first of April to the end of September 2021. Convenient sample of women in reproductive age, attended the designated primary health care centers for the study were enrolled. An interview questionnaire was used to collect quantitative data pertaining to awareness of women about tetanus toxoid immunization and tetanus infection. Results: The total number of women enrolled in the study was 400, the study found that that 35.2% and 35% of women had good and fair level of awareness respectively. Good awareness level was significantly higher among older aged women and those with higher level of education as well as working women. Good awareness was more prominent among women’s having1-2 children (39%), as compared to those having five and more children (21.3%). Antenatal care attendance and place of delivery shown statistical significant link with level of awareness. Women identify family members and friends as their primary sources of information about tetanus infection and immunization. Conclusion: Women’s awareness was acceptable regarding Tetanus and TT immunization. Yet still there is a place for proper health education targeting young women to bridge gap in the connection between the tetanus immunization status of women and the occurrence of Maternal neonatal tetanus (MNT), as well as need for the appraisal of the components of health information delivered by health care providers to women attending antenatal care clinics.

Awareness and Uptake of Tetanus Toxoid Vaccination Among Females of Reproductive Age in Rawalpindi

Objectives: To determine awareness and uptake of tetanus toxoid vaccination among females of reproductive age in Rawalpindi, Pakistan.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Fauji Foundation Hospital, Rawalpindi Pakistan, from Feb to Sep 2018.&#x0D; Methodology: A consecutive sample of 400 females completed a structured questionnaire translated into Urdu after giving written informed consent. Females, 15 to 49 years, accompanying patients and seeking healthcare were enrolled, and all those belonging to the category of healthcare providers (doctors, nurses, paramedics, etc.) were excluded.&#x0D; Results: The study showed that 343(85.8%) women were aware of tetanus disease, and 230(57.5%) knew it could be prevented through vaccination. Only 147(36.8%) knew the correct range of reproductive age in females, 178(44.5%) knew the correct schedule, and 46(11.5%) knew the correct number of injections of tetanus vaccination program given by the World Health Organization (WHO) for females of reproductive age group. Around 321(80.3%) were willing to get vaccinated, and 338(84.5%) were willing to recommend it to other females. The number of females who ever received tetanus vaccination for females of reproductive age was 81(20.25%), out of which 7(1.8%) completed uptake of all five doses.&#x0D; Conclusion: Our study population was aware of tetanus disease with a positive attitude towards vaccination. However, awareness and uptake of the tetanus toxoid vaccine according to the tetanus vaccination program for females of reproductive age could have been better.Keywords: Reproductive age, Tetanus, Tetanus toxoid Vaccination.

Health Systems Determinants of Delivery and Uptake of Maternal Vaccines in Low- and Middle-Income Countries: A Qualitative Systematic Review.

Maternal vaccination is considered a key component of the antenatal care package for improving maternal and child health. Low- and middle-income countries (LMICs) fall short of global targets to prevent maternal and neonatal deaths, with a disproportionate burden of vaccine-preventable diseases. Strategies towards ending preventable maternal mortality necessitate a health systems approach to adequately respond to this burden. This review explores the health systems determinants of delivery and uptake of essential maternal vaccines in LMICs. We conducted a qualitative systematic review of articles on maternal vaccination in LMICs, published between 2009 and 2023 in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Thematic analysis was conducted to identify key themes in the literature, interpreted within a conceptual framing that explores the systems determinants influencing maternal vaccines. Our search yielded 1309 records, of which 54 were included, covering 34 LMICs. Most of the included studies were from South America (28/54) and included pregnant women as the primary study population (34/54). The studies explored influenza (25/54) and tetanus toxoid (20/54) vaccines predominantly. The findings suggest that systems hardware (lack of clear policy guidelines, ineffective cold-chain management, limited reporting and monitoring systems) are barriers to vaccine delivery. Systems software (healthcare provider recommendations, increased trust, higher levels of maternal education) are enablers to maternal vaccine uptake. Findings show that formulation, dissemination and communication of context-specific policies and guidelines on maternal vaccines should be a priority for decision-makers in LMICs.

Knowledge and Uptake Of Tetanus Toxoid Vaccine and Associated Factors Among Reproductive Age Group Women in Hayk Town South Wollo, Ethiopia, CrossSectional Study

Background Tetanus is an acute, often fatal, disease caused by an exotoxin and highly potent neurotoxin, tetanospasm, Tetanus is a preventable disease by tetanus toxoid immunization, which is usually given to the reproductive women at the age between (15- 44) years in order to protect both mother and newborn in order to prevent maternal and neonatal tetanus For lifelong protection from tetanus a woman needs a total of five tetanus toxoid doses. Objective: To assess the level of knowledge uptake and associated factors of completing tetanus toxoid vaccine among reproductive age women in Hayk town, SouthWollo, Amhara, Ethiopia in 2020. Methods and materials: A community based cross-sectional study conducted in Hayk town, South Wollo Amhara, Ethiopia, from November to December on 2020. Data collected using structured and pretested questionnaire, entered in to Epi Data version 3.1 and exported to statistical package for social science version 25.0 for analysis. Result: Magnitude of uptake of TT2 immunization at Hayk town was 71.2%, have taken at least two doses of TT. But only 35(8.5%) had completed 5 doses of TT according to EPI schedule. Nearly half of 182(44%) of women in the reproductive age group had knowledge on complete TT5 immunization. Educational status, having sort of info on TT5 and knowledge about TT are significantly associated factors for full dose of TT according to EPI schedule. Conclusion: Fair proportions of women had uptake of TT2, but very low proportion for complete dose of TT5 according to expanded program on Immunization. Most of study participants have inadequate knowledge on TT vaccine. Educational status, having sort of info on TT5 and knowledge about TT are significantly associated factors for completing full dose of TT according to EPI schedule.

Coverage-level and predictors of maternity continuum of care in Nigeria: implications for maternal, newborn and child health programming

BackgroundCompleting maternity continuum of care from pregnancy to postpartum is a core strategy to reduce the burden of maternal and neonatal mortality dominant in sub-Saharan Africa, particularly Nigeria. Thus, we evaluated the level of completion, dropout and predictors of women uptake of optimal antenatal care (ANC) in pregnancy, continuation to use of skilled birth attendants (SBA) at childbirth and postnatal care (PNC) utilization at postpartum in Nigeria.MethodsA cross-sectional analysis of nationally representative 21,447 pregnancies that resulted to births within five years preceding the 2018 Nigerian Demographic Health Survey. Maternity continuum of care model pathway based on WHO recommendation was the outcome measure while explanatory variables were classified as; socio-demographic, maternal and birth characteristics, pregnancy care quality, economic and autonomous factors. Descriptive statistics describes the factors, backward stepwise regression initially assessed association (p < 0.10), multivariable binary logistic regression and complementary-log–log model quantifies association at a 95% confidence interval (α = 0.05).ResultsCoverage decrease from 75.1% (turn-up at ANC) to 56.7% (optimal ANC) and to 37.4% (optimal ANC and SBA) while only 6.5% completed the essential continuum of care. Dropout in the model pathway however increase from 17.5% at ANC to 20.2% at SBA and 30.9% at PNC. Continuation and completion of maternity care are positively drive by women; with at least primary education (AOR = 1.27, 95%CI = 1.01–1.62), average wealth index (AOR = 1.83, 95%CI = 1.48 –2.25), southern geopolitical zone (AOR = 1.61, 95%CI = 1.29–2.01), making health decision alone (AOR = 1.39, 95%CI = 1.16–1.66), having nurse as ANC provider (AOR = 3.53, 95%CI = 2.01–6.17) and taking at least two dose of tetanus toxoid vaccine (AOR = 1.25, 95%CI = 1.06–1.62) while women in rural residence (AOR = 0.78, 95%CI = 0.68–0.90) and initiation of ANC as late as third trimester (AOR = 0.44, 95%CI = 0.34–0.58) negatively influenced continuation and completion.Conclusions6.5% coverage in maternity continuum of care completion is very low and far below the WHO recommended level in Nigeria. Women dropout more at postnatal care than at skilled delivery and antenatal. Education, wealth, women health decision power and tetanus toxoid vaccination drives continuation and completion of maternity care. Strategies optimizing these factors in maternity packages will be supreme to strengthen maternal, newborn and child health.

Awareness of Women about Tetanus in Baghdad

Background: Tetanus toxoid (TT) vaccine is still recommended for pregnant women even in countries that declared elimination of neonatal tetanus (NT) and consequently the maternal tetanus (MT). Many factors may affect TT vaccination during pregnancy. Awareness is a key factor that greatly affect the pregnant women to receive tetanus toxoid vaccination during pregnancy. Aims of study: To assess the awareness of women regarding different aspects of tetanus and tetanus toxoid vaccination as well as to identify the factors influencing their awareness. Subjects and Method: A cross sectional study conducted in Baghdad from first of April to the end of September 2021. Convenient sample of women in reproductive age, attended the designated primary health care centers for the study were enrolled. An interview questionnaire was used to collect quantitative data pertaining to awareness of women about tetanus toxoid immunization and tetanus infection. The total number of women enrolled in the study was 400, the study found that that 35.2% and 35% of women had good and fair level of awareness respectively. Good awareness level was significantly higher among older aged women and those with higher level of education as well as working women. Good awareness was more prominent among women’s having1-2 children (39%), as compared to those having five and more children (21.3%). Antenatal care attendance and place of delivery shown statistical significant link with level of awareness. Women identify family members and friends as their primary sources of information about tetanus infection and immunization. Conclusion: Women’s awareness was acceptable regarding Tetanus and TT immunization. Yet still there is a place for proper health education targeting young women to bridge gap in the connection between the etanus immunization status of women and the occurrence of Maternal neonatal tetanus (MNT), as well as need for the appraisal of the components of health information delivered by health care providers to women attending antenatal care clinics.

Annual two-dose tetanus toxoid vaccination induces protective humoral immunity to all age groups of rhesus macaques.

A tetanus outbreak occurred during 2014-2015 in the rhesus macaques reared in an open enclosure in our facility. As the soil of the facility was suspected to be contaminated with Clostridium tetani spores, there was a risk of further tetanus occurring among the macaques. To protect them from tetanus, a tetanus toxoid vaccination was recommended; however, the vaccinated elderly animals might not be effectively protected due to insufficient humoral immune responses. Hence, we evaluated the dynamics of antibody responses among rhesus macaques of all age groups vaccinated with two-dose tetanus toxoid at a 1-year interval during a 3-year follow-up study. The vaccination developed anti-tetanus toxin-specific antibodies in animals of all age groups, the antibody levels peaked 1 year after the second vaccination, and the peak levels decreased with age. However, the levels among elderly individuals (aged ≥13 years) were still higher than the threshold level, which was supposed to protect them from tetanus development. Although the rhesus macaques in our facility had a risk of occasional exposure to the spores due to the outbreak, no incidence of tetanus has ever occurred to date. These results indicate that the vaccination protocol is effective in protecting not only younger but also older animals from tetanus.

Maternal Tetanus Toxoid Vaccination in Benin: Evidence from the Demographic and Health Survey.

Tetanus toxoid vaccination is critical for improving maternal and child health. Yet, the prevalence and correlates of maternal tetanus toxoid vaccination coverage remain largely underexplored in Benin where infant and child mortality rates are high. Using the 2017-18 Benin Demographic and Health Survey, we apply logistic regression analysis to address this void in the literature. We find that overall maternal vaccination coverage is 69%. A range of demographic, health care, and socioeconomic factors are associated with maternal tetanus toxoid vaccination coverage. Women aged 20-34 (OR = 0.84, p &lt; 0.05) and 35-49 (OR = 0.63, p &lt; 0.01) are less likely to receive tetanus toxoid vaccination in comparison to those aged 15-19. Health care factors are also significantly associated with maternal tetanus toxoid vaccination, indicating that women who deliver at home (OR = 0.20, p &lt; 0.001) and visit antenatal care fewer than eight times (OR = 0.62, p &lt; 0.001) are less likely to receive tetanus toxoid vaccination than their counterparts who deliver in a health facility and visit antenatal care eight times or more. We also find that women with secondary (OR = 0.54, p &lt; 0.05), primary (OR = 0.47, p &lt; 0.01), and no education (OR = 0.47, p &lt; 0.01) are less likely to receive tetanus toxoid vaccination compared to their counterparts with higher education. Based on these findings, we discuss several implications for policymakers.

Trends and determinants of taking tetanus toxoid vaccine among women during last pregnancy in Bangladesh: Country representative survey from 2006 to 2019.

BackgroundTetanus occurring during pregnancy is still an important cause of maternal and neonatal mortality in developing countries. This study estimated the trend of tetanus toxoid (TT) immunization coverage from 2006 to 2019 in Bangladesh, considering socio-demographic, socio-economic, and geospatial characteristics.MethodsThe dataset used in this study was extracted from Multiple Indicator Cluster Surveys (2006, 2012–13, and 2019) including 28,734 women aged between 15–49 years. Data analysis was performed using cross-tabulation and logistic regression methods. Further, the spatial distribution of TT immunization coverage was also depicted.ResultsThe trend of TT immunization (81.8% in 2006 to 49.3% in 2019) and that of taking adequate doses of TT (67.1% in 2006 to 49.9% in 2019) has gradually decreased throughout the study period. Among the administrative districts, North and South-West regions had lower coverage, and South and West regions had relatively higher coverage of both TT immunization and that of adequate doses. Antenatal TT immunization (any dosage, inadequate or adequate) was significantly associated with lower age (AOR = 3.13, 1.55–6.34), higher education (AOR = 1.20, 1.03–1.40), living in urban areas (AOR = 1.17, 1.03–1.34), having immunization card (AOR = 5.19, 4.50–5.98), using government facilities for birth (AOR = 1.41, 1.06–1.88), and receiving antenatal care (ANC) (AOR = 1.51, 1.35–1.69). In addition, living in urban areas (AOR = 1.31, 1.10–1.55), having immunization cards (AOR = 1.62, 1.36–1.92), and choosing others’ homes for birth (AOR = 1.37, 1.07–1.74) were significantly associated with adequate TT immunization. However, higher education (AOR = 0.57, 0.44–0.74), having poor wealth index (AOR = 0.65, 0.50–0.83), and receiving ANC (AOR = 0.76, 0.63–0.92) had lower likelihood of taking adequate TT immunization.ConclusionsThe gradual decline in the TT immunization rate in the present study suggests the presence of variable rates and unequal access to TT immunization, demanding more effective public health programs focusing on high-risk groups to ensure adequate TT immunization.

Maternal Risk Factors Associated with Preterm Births among Pregnant Women in Mogadishu, Somalia.

Background: Premature birth impacts millions of newborns annually. Sixty percent of the world’s preterm births occur in Sub-Saharan Africa and South Asia. Somalia’s premature birth rates and maternal risk factors are poorly studied; hence, this study aims to identify maternal risk factors related to premature births in Mogadishu, Somalia. Methods: This unmatched case-control study was conducted at four maternity hospitals in Mogadishu, Somalia. The cases were newborns with gestational ages of less than 37 weeks; controls were newborns with gestational ages of 37 to 42 weeks. All were live singletons. Cross-tabulation and binary logistic regression were used to analyze the data; a p-value of 0.05 was deemed statistically significant. Result: Of the total of 499 newborns, 70 were cases, and 429 were controls. Adequate prenatal care, maternal urine analysis, tetanus toxoid (TT) vaccination, hemoglobin (Hb) measurement, ultrasound monitoring, intake of iron + folic acid (IFA) supplement, blood pressure (BP) measurement during the current pregnancy, as well as partograph usage during labor all significantly decreased risk of having premature births. A prior history of preterm delivery and preeclampsia, obstetric complications, and female genital mutilation (FGM) significantly increased the risk of preterm births. Conclusion: The utilization of antenatal care services, use of a partograph, obstetric complications, and prior history of premature birth and preeclampsia had a substantial effect on preterm birth rates. This study identifies female genital mutilation (FGM) as a previously unidentified risk factor for preterm birth that needs additional investigation.

Neonatal Tetanus: case series from Dilla univeristy referal hospital, Ethiopia

Background: Neonatal tetanus is a deadly infection leading to 7-8% of neonatal mortality in de-veloping countries. WHO defines Neonatal tetanus as an illness in a child who has the normal ability to suck in the first 2 days of life, presented with failure to suck between 3rd and 28th days of life and has rigidity and spasms? Though Ethiopia declared maternal and neonatal tetanus elimination in 2017, there has been significant number of neonates presenting with this problem in Neonatal ICU’sMethods: This review characterized clinical profile, demography and outcome of seven neona-tal tetanus cases admitted at Dilla University hospital, neonatal ICU from September 11, 2018 to September11, 2020.Results: All mothers gave birth at home with unskilled birth attendant, local blade or knife was used to cut the cord. Median age for mothers was 26 years and two out of seven had antenatal care (ANC) follow up and took Two doses of tetanus toxoid (TT) vaccine. Fever, failure to suck, spasm and convulsions were the common presenting symptoms. The overall mortality was 70%.Conclusion: Continuous emphasis on antenatal tetanus immunization and safe delivery practic-es should be maintained. Clinicians caring for neonates should be aware of the presentations of neonatal tetanus to allow them to diagnose these patients early and initiate appropriate lifesaving management.

Determinants of basic childhood vaccination coverage in European and OECD countries

ABSTRACT Vaccination coverage varies between countries and over time. Using official databases, we extracted data on 50 national-level immunization, socio-economic, demographic, healthcare, and cultural factors, and the uptake of the third dose of diphtheria toxoid, tetanus toxoid, and pertussis vaccines (DTP3) and the first dose of measles-containing vaccines (MCV1) for 61 countries between 1990 and 2019. The main branch of the analysis included all covariates, while a secondary branch excluded life-expectancy and child mortality. The statistical analysis was completed in three stages: a variable-selection stage via random forests; multilevel multiple imputation for missing data in the reduced dataset; and generalized estimating equations (GEE) over all imputed datasets with pooled results. Less than 20 covariates were retained after variable-selection. Among a relatively small number of statistically significant (p-value <.05) effects in the pooled GEE results of our main branch, under-5 mortality and long-term orientation culture showed negative associations with both uptake outcomes and GDP per capita a positive association. For MCV1, whether a second dose was integrated into routine immunization appeared as the overall strongest negative correlate. In the secondary analytical branch, results were largely consistent, with a few additional statistically significant effects emerging, mainly related to immunization and healthcare system characteristics. These insights improve our understanding of the main factors influencing vaccine uptake, some of which are broadly contextual (e.g., GDP, socio-cultural factors), requiring bespoke vaccine program approaches, in order to maximize childhood vaccine uptake over time.

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.

A comparative study of adjuvants effects on neonatal plasma cell survival niche in bone marrow and persistence of humoral immune responses.

The neonatal immune system is distinct from the immune system of older individuals rendering neonates vulnerable to infections and poor responders to vaccination. Adjuvants can be used as tools to enhance immune responses to co-administered antigens. Antibody (Ab) persistence is mediated by long-lived plasma cells that reside in specialized survival niches in the bone marrow, and transient Ab responses in early life have been associated with decreased survival of plasma cells, possibly due to lack of survival factors. Various cells can secrete these factors and which cells are the main producers is still up for debate, especially in early life where this has not been fully addressed. The receptor BCMA and its ligand APRIL have been shown to be important in the maintenance of plasma cells and Abs. Herein, we assessed age-dependent maturation of a broad range of bone marrow accessory cells and their expression of the survival factors APRIL and IL-6. Furthermore, we performed a comparative analysis of the potential of 5 different adjuvants; LT-K63, mmCT, MF59, IC31 and alum, to enhance expression of survival factors and BCMA following immunization of neonatal mice with tetanus toxoid (TT) vaccine. We found that APRIL expression was reduced in the bone marrow of young mice whereas IL-6 expression was higher. Eosinophils, macrophages, megakaryocytes, monocytes and lymphocytes were important secretors of survival factors in early life but undefined cells also constituted a large fraction of secretors. Immunization and adjuvants enhanced APRIL expression but decreased IL-6 expression in bone marrow cells early after immunization. Furthermore, neonatal immunization with adjuvants enhanced the proportion of plasmablasts and plasma cells that expressed BCMA both in spleen and bone marrow. Enhanced BCMA expression correlated with enhanced vaccine-specific humoral responses, even though the effect of alum on BCMA was less pronounced than those of the other adjuvants at later time points. We propose that low APRIL expression in bone marrow as well as low BCMA expression of plasmablasts/plasma cells in early life together cause transient Ab responses and could represent targets to be triggered by vaccine adjuvants to induce persistent humoral immune responses in this age group.

Conduct of Integrated Health Services in Real Hard-to-Reach/Under-Served Communities to Address Maternal/Child Health Problems, 2016–2018 in Borno State Nigeria

The study focused on the conduct of integrated health services in real hard-to-reach/under-served communities to address maternal and child health problems from 2016–2018, riding on the Global Vaccine Action Plan that was conducted in Seventeen (17) Local Government Areas at risk of sustaining polio transmission in Borno State from July 2014 to December 2015, it was further expanded to 1712 for both real Hard-to-reach and Under-served communities in 25 accessible Local Government areas for integrated Health services using two strategies, Real Hard-to-reach areas and under-served communities which targeted newly liberated communities including internally displaced persons between 2016 to 2018. The findings from the study show treatment of minor ailment, 628731 clients were seen, and 9482 were referred to next health facilities for proper diagnosis and management, 88421 pregnant mothers received intermittent preventive therapy, sensitization on exclusive breast feeding, complementary feeding, focused antenatal care, Water sanitation, and hygiene. Furthermore, the findings show that oral polio, measles, hepatitis, yellow fever, tetanus toxoid, and pneumococcal conjugate vaccination was carried out for children from 0-11 months, while tetanus vaccination was carried out for pregnant women. Based on the findings of the study, it was concluded that the mobile health teams had improved the health status of Children, women of childbearing age, pregnant mothers, and other age groups in Real Hard-to-reach and under-served communities like Antenatal/post-natal, treatment of minor ailments, vaccination, nutritional screening, HIV testing counselling and referrals, Gender-based violence identification counselling and referrals and de-worming.