NAN-H-36
Tetanus
By Vivian Ihechu
Lagos, Sept. 30, 2016 (NAN) Dr Lucy Yaguo Ide, a Community/Social Paediatrician, on Friday said there was need for improved awareness and strategies to eliminate Maternal Neonatal Tetanus (MNT) infections in Nigeria.
Yaguo Ide, told the News Agency of Nigeria (NAN) in Lagos that MNT contributed a high proportion to neonatal deaths in the country.
According to her, a major way to achieve this elimination is to sensitise and urge pregnant women to take the Tetanus Toxoid (TT) vaccine, as well as expand immunisation coverage.
The UNICEF website, www.unicef.org says: “Neonatal tetanus strikes rapidly, killing newborns soon after birth; tetanus occurs when a bacterium, Clostridium tetani, enters the body through an open wound or puncture.
“In the new born, through the umbilical cord, ear piercing and circumcision wounds, especially if these procedures are carried out with unsterile materials; the bacteria produce a toxin, poison that attacks the central nervous system.
“MNT elimination in a country is defined as neonatal tetanus rate of less than one case of neonatal tetanus per 1000 live births in every district of the country’’.
Yaguo Ide of the Department of Paediatrics and Child Health, University of Port Harcourt Teaching Hospital, Port-Harcourt, said that Nigeria was one of the 19 countries in the world that still recorded MNT.
“A 2015 World Health Organisation’s report says that Nigeria is still one of the high risk countries that have yet to achieve the maternal and neonatal tetanus elimination goal.
“ It is one of the 13 in Africa.
“In Nigeria, it is estimated that the mortality rate of MNT infection is as high as 50 per cent and ranges from two per cent to 50 per cent or more, depending on the locality.
“The NDHS 2013 reports that the percentage of women who received two or more tetanus toxoid (TT) injection during their last pregnancy is 48 per cent.
“The report also said that only 53 per cent of women had their last birth protected against neonatal tetanus.
“The proportion of these women who received two or more TT injections during the pregnancy for their last live birth, however, varied considerably across zones,’’ she quoted the report as saying.
According to her, many women are ignorant about the devastating effects of not being immnusied and the gravity of MNT.
“ Maternal immunisation protects both the mother and fetus from the morbidity of some infections; women of child bearing age are expected to have five potent doses of the tetanus toxoid.
“A pregnant woman is to take at least two doses of tetanus toxoid vaccine before delivery; the second dose is to be taken within a month of the first dose.
“ As the organism that causes tetanus attacks fast, it is very important to take these doses before the child is born, because, the newborn does not yet have immunity.
“So, if the mother was vaccinated during that pregnancy, she develops antibodies which are transferred to her baby and the baby gets protected at birth.
“The antibodies are able to cross over from the mother to protect the baby from the tetanus organism, if the child gets infected,’’ she said.
She added: “The first dose (TT-1), is taken at first contact sometime within a pregnancy, the second dose (TT-2) is taken a month later and the third dose (TT-3) is taken six months later.
“The fourth dose is taken one year later and the last dose another year later.
“However, TT-1 does not offer protection rather it is TT-2 that gives that tangible immunity against the disease for both the baby and mother.
“Adherence to this is estimated to contribute to the reduction of mortality from neonatal tetanus by 94 per cent’’.
On the contributing factors to the high prevalence of neonatal deaths as a result of tetanus, Yaguo Ide said that “our preventive and control interventions for tetanus are still very poor.
“Interventions such as immunisation, essential obstetric care and good cord care as well as education are still very poor and they are major contributing factors to the continued existence of tetanus.
“ The prevalence of neonatal tetanus has also remained high in Nigeria because a high proportion of deliveries still take place at home or in unhygienic environments.’’
Yaguo Ide called for certain measures to be put in place to address these challenges.
“Every case of tetanus in Nigeria indicates a major failure of public health practice; something needs to be done urgently.
“ Neonatal tetanus can be completely prevented by ensuring the full immunisation of females before or during pregnancy, ensuring clean delivery, and clean severance of the umbilical cord and proper care of the cord after delivery.
“Post neonatal tetanus can be prevented by ensuring complete tetanus toxoid doses in infancy and giving booster doses at primary and secondary school entry and then every 10 years thereafter.
“ There is need to promote and strengthen female education as well as increase the level of public awareness on tetanus and the associated risk factors.
“ The health facilities should be made more accessible and affordable to pregnant mothers and children by offering them free or subsidised healthcare services,’’ she said. (NAN)
VIV/PDE
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(Edited and Controlled by Peter Ejiofor)