Maternal and Neonatal Tetanus Elimination (MNTE) in The WHO African Region

Abstract

Tetanus is a vaccine-preventable disease of significant public health importance especially in developing countries. The WHO strategy for the elimination of maternal and neonatal tetanus recommends the promotion of clean delivery practices, systematic immunization of pregnant women and those in the reproductive age (15-49 years) and surveillance for neonatal tetanus. Implementation of the recommended strategy with the support of WHO, UNICEF and other partners has led to significant decline in number of cases and deaths due to NT over the last decades. The coverage with the second or more dose of tetanus toxoid-containing vaccines (TT2+) a proxy for Protection at Birth (PAB) for the WHO African region has risen from 62% in 2000 to 77% by 2015 Reported cases of NT declined from 5175 in 2000 to 1289 in 2015.The goal of eliminating maternal and neonatal tetanus by 2015 was missed, but some progress has been made. By the end of 2016, 37 out of 47 (79%) of the WHO AFR member states achieved elimination. The 10 member states remaining need additional support by all partners to achieve and maintain the goal of MNTE. Innovative ways of implementing the recommendations need to be urgently considered.

Prevalence and predictors of taking tetanus toxoid vaccine in pregnancy: a cross-sectional study of 8,722 women in Sierra Leone

“…For instance, women with primary and higher educational level had lower odds of receiving TT immunization when compared to those with no formal education. This finding is in contrast with previous studies that reported TT immunization was positively associated with women's level of education [14,19,29,[45][46][47]. Additionally, significantly lower TT immunization was found among women from the Temme ethnicity compared to those from another ethnicity.…”

“…Findings reveal that the proportion of pregnant women who received TT immunization was 97.8% and that of adequate doses was 82%. These findings concur with results from previous studies that reported higher prevalence of receiving TT immunization [30] but are inconsistent with studies that reported lower rates of receiving adequate doses of TT immunization [14,19,28,29]. This difference may be due to cultural practices, and financial capabilities of women needed to seek immunization services.…”

“…The guidelines require that a pregnant woman receives three doses of tetanus vaccine to protect her and her newborn(s) from tetanus, compared to those whose woman do not receive the vaccine [13]. Two or more doses of tetanus toxoid vaccine in pregnancy affords the fetus passive immunity and have been shown to reduce NT mortality by 96% [14,15].…”

Use of Social Mobilization and Community Mobilizers by Non-governmental Health Organizations in Malawi to Support the Eradication of Polio, Improve Routine Immunization Coverage, and Control Measles and Neonatal Tetanus

“…Although there has been significant improvement in vaccination coverage in Africa, challenges remain. For example, the goal of eliminating maternal and neonatal tetanus by 2015 was missed, 2 and neonatal tetanus had only been eliminated in 34 of 47 (72%) of the WHO African Region Member States by 2015. 3 The remaining 13 countries need additional support, and those that have achieved control need to sustain this achievement through the implementation of context-specific immunization and surveillance strategies.…”

The Survivor: A Clinical Case of Tetanus in a Non-Immunized, Parenteral Drug User, Former Female Convict with HIV and HCV

“…Despite the existence of the vaccine with the tetanus toxoid, tetanus is still an endemic disease in under-developed countries, and its incidence tends to increase after natural disasters. In these countries, it is a problem for public health due to the mortality associated with neonatal tetanus [ 8 , 9 ].…”