Strategies to increase immunization coverage of tetanus vaccine among women in Sub Saharan Africa: a systematic review

Abstract

World Health Organization (WHO) estimated in 2013 that 49,000 deaths all over the world were caused by neonatal tetanus. Only as recently as the year 2000, neonatal tetanus was a public health problem in 59 countries, but since then it has been eliminated in 36 of the countries concerned. The objective of this piece of work, therefore, was to investigate which strategies intended to increase demand for vaccination are effective in increasing anti-tetanus vaccination coverage of women in Sub Saharan Africa. We searched the following electronic databases from January 1989 to July 2016: Medline, EMBASE (Excerpta Medica Database), The Cochrane Library, Google Scholar, CINAHL (Cumulative Index to Nursing and Allied Health Literature), WHOLIS (World Health Organization Library Database), LILACS (Latin American and Caribbean Literature on Health Sciences) and contacted experts in the field. There were no restrictions to language or publication status. All study designs that could provide the information we sought were eligible, provided the studies were conducted in sub-Saharan Africa. Critical appraisal of all identified citations was done independently by two authors to establish the possible relevance of the articles for inclusion in the review. Our search strategy yielded 191 records and after assessment for eligibility, 6 papers met the criteria for inclusion. In Ivory Coast, after reorganization, health workers said they were satisfied with the work environment and the care provided in 91% and 96% of cases, respectively. In Kenya, the main factors contributing to having sufficiently immunized part of the population against tetanus are lower birth order, higher household wealth index, women's employment, making joint health-related decisions with a partner, and higher number of antenatal care visits. Particularly in Ethiopia, compared with other member countries, the size of the unimmunized population, reporting quality, fragileness of the health system, resource limitation, and others deserve further concerted attention. In Nigeria, the prevalence of missed opportunities was 66%. The factors responsible for missed opportunities were; poor history taking, lack of knowledge of the current immunization schedule, dependence on physician referral for immunization and inefficient immunization records keeping system. In Nigeria, socio-logistic variables found to be important in Expanded Programme on Immunization implementations included scheduling, health staff attitude, intersectoral collaboration, and health education. Lack of community participation was also found to be a crucial constraining factor. There are many challenges to increase immunization coverage of tetanus vaccine for women. So far very few interventions addressing these challenges have been evaluated scientifically. Community mobilization interventions to change or impact beliefs and attitudes of women are absolutely needed. Additionally, improving accessibility, affordability, availability and accommodation of vaccination service venues will make them ...

Individual and community-level determinants of poor tetanus toxoid immunization among pregnant women in Ethiopia using data from 2016 Ethiopian demographic and health survey; multilevel analysis

“…Interventions to improve vaccination outcomes are commonly grouped into those targeting health services delivery such as improving human resources training, logistics, cold chain maintenance, and vaccine storage, effective financing, monitoring and evaluation, and supportive supervision. The most recent review considered shows that much remains to be done to improve immunization coverage among women in Subsaharan Africa [38]. Besides, identifying potential hindering factors of TT uptake is vital for policymakers.…”

The role of the single interchains disulfide bond in tetanus and botulinum neurotoxins and the development of antitetanus and antibotulism drugs

“…Yet, in those areas of the world where vaccination programs are inadequate, it is still a major killer. In this respect, a horrible though frequent form of tetanus, usually fatal, is tetanus neonatorum , which is acquired by newborns, whose umbilical cord was cut using nonsterile tools and whose mothers were not immunised against TeNT (Galazka & Gasse, ; Vouking, Tadenfok, & Ekani, ).…”

Drivers and barriers of vaccine acceptance among pregnant women in Kenya

“…13 Lower levels of education, lack of knowledge on vaccination during pregnancy and other socioeconomic factors like high parity and low income have been identified as barriers to maternal vaccination in low-and middle-income countries (LMICs); however data on maternal vaccine acceptance from African settings are very limited. 4,[14][15][16] TT is the most widely implemented vaccine among pregnant women in LMIC. 14 In 2012, however, the WHO recommended that countries considering initiation or expansion of seasonal influenza vaccination give the highest priority to pregnant women, 17 and in 2015 noted that maternal vaccination against pertussis is likely to be the most costeffective way to prevent the disease in infants too young for vaccination.…”