A Retrospective Assessment Of Tetanus Toxoid Vaccination Coverage In Nigeria: 2014 – 2016

Authors: testAdamu D. Dawud

E-mail:adam.dwd@outlook.com

Citation: Adamu D. Dawud, Muhammad N. Lawal, Hussaina Abdullahi, Nneka Onwu, Murtala Bagana, Hadiza Iyal, Anthony Onimisi, Ali Daniel, Adeboye Simeon. Peter Nsubuga and Faisal Shuaib. A Retrospective Assessment Of Tetanus Toxoid Vaccination Coverage In Nigeria: 2014 – 2016.

Copyright: This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Abstract

Background: Infection with tetanus toxoid (TT) is fatal. Immunization with tetanus toxoid vaccine is recommended for all women of child-bearing age (WCBA) and a ­ve dose vaccination schedule for every woman is o‑ered at all health facilities in Nigeria.

Methods: The TT antigen vaccine coverage in every health facility was captured monthly through the district vaccine database monitoring tool (DVD-MT). Thirty months TT vaccination coverage across Nigeria was reviewed.

Result: We found that there was high compliance to tetanus toxoid one (TT 1) and tetanus toxoid two (TT 2) uptake compared to tetanus toxoid three (TT 3), tetanus toxoid four (TT 4) and tetanus toxoid ­ve (TT 5) regimens. The poor performing local government areas (LGA) for TT2+ (<50%) are in all the states across the country. However, it was worst in the Southern Zones, North Central Zone & North East Zone. Conclusion :This study revealed that TT vaccination coverage in Nigeria was low (74.5%) and there is a need for active sensitization to WCBA for completion of their ve doses regimen. Keywords:Tetanus toxoid vaccination coverage, Fatality, Clostridium tetani bacterium, Compliance of Women in reproductive age group.><50%) are in all the states across the country. However, it was worst in the Southern Zones, North Central Zone & North East Zone.

Conclusion: This study revealed that TT vaccination coverage in Nigeria was low (74.5%) and there is a need for active sensitization to WCBA for completion of their ­ve doses regimen.

Keywords: Tetanus toxoid vaccination coverage, Fatality, Clostridium tetani bacterium, Compliance of Women in reproductive age group.


Description

Background

Vaccination against tetanus infection became important because the tetanus spores are ubiquitous. Hence, their eradication is not biologically possible leading to high morbidity and mortality. Tetanus manifests systemic toxicity primarily by neuromuscular dysfunction caused by a potent exotoxin elaborated by Clostridium tetani. The case fatality rate in the unvaccinated varies from 10% to over 80% and is highest in infants and elderly.

Tetanus remains one of the ten principal causes of death in the developing countries including Nigeria [1]. The incidence ranges between 30% - 50% in developing countries [2] and in Nigeria it is a major cause of high mortality in both neonates and older adults [3].

The source of this infection has been attributed to unhygienic birth attendants’ practices. The majority of childbirth is assisted at homes by traditional birth attendants and they use razor blades or scissors to cut the umbilical cord. The majority of rural women are farmers, and their farming utensils can be infected with Clostridium tetani and unexpected injury from infected utensils or prick injuries when walking barefooted can occur. When a woman is infected with tetanus and become pregnant, she might predispose her baby to neonatal tetanus during delivery. However, it is imperative for clinicians to consider unusual and uncommon portals of entry especially in the light of the changes in the socio-cultural arena. The post-abortion TT doses should be encouraged and captured on monthly summary reports. 

The commonest source of infection in tetanus is the wound sustained by stepping on dirty nails, wood, or thorns[2]. The infected site needs initial care referred to as wound treatment and post-wound tetanus prophylaxis injection is very important.

The instruments used for delivering babies have been attributed to contamination with tetanus bacteria and mere contact with fetal and maternal blood can transmit the tetanus infection[3], leading to neonatal and maternal morbidity as well as, mortality.

The tetanus toxoid (TT) vaccination gives a protection against tetanus infection and women of child bearing age (WCBA) i.e. 15 – 45 years old are advised to receive five doses of TT vaccine[4] for complete life protection against tetanus infection. The TT antigens were maintained in a cold chain of temperature between plus II to plus VIII degrees Celsius and efforts are intensied to achieve this temperature range across all health centers, clinics and hospitals by ensuring temperature chatting of the refrigerators’ function, mornings and evenings. The refrigerator temperature chatting provides assurance that the vaccines are potent for human administration and the vaccine vial monitor (VVM) is also conducted on each vial before use.

The members of staff that offer the vaccination services are either; community health extension workers (CHEW), midwife service scheme (MSS) workers, nurses trained in community health services and nurses or midwives trained in family planning services.

These cadres of staff spans across Nigeria in either public or private centers and hospitals that provide TT vaccination services. Private providers have been encouraged to sign a memorandum of understanding (MoU) to allow for training of their staff on data management to ensure data harmonization. All registered facilities are given routine immunization antigens free. They are also expected to provide their immunization services free, without any cost for the vaccines.

The WCBA are advised to ensure they are immunized with TT vaccine during their visits to family planning clinic and during antenatal care visits. The women that benefited from TT services also encourage their peers for it and campaigns on radio and televisions during neonatal and maternal tetanus vaccination week also helped towards the compliance to TT vaccination completion

Very rarely do adverse events occur with TT vaccination and the few that occur out weights the bene­t of being immunized.

Management of waste generated from TT vaccination throughout Nigeria was done via incinerators. The centers that do not have incinerators are advised to keep the waste generated in a safety box and are collected for safe transportation to the incinerator site for proper incineration.

Infection with tetanus was rated 62% and as one of the top 50 causes of death in Nigeria[5]. We embarked on this study to ­nd out the exact TT vaccination coverage in WCBA in Nigeria.

Methods

The immunization coverage performance in Nigeria is recorded monthly and captured in the district vaccine data monitoring tool (DVD-MT). The DVD-MT is the tool that captured the entire performance of all antigens used in routine immunization (RI) in Nigeria and coverage for the period of 30 months of TT vaccination was analyzed.

The TT antigen vaccine available in each health facility, LGA, state, zonal and national cold store were also analyzed to determine the antigen availability from the same DVD-MT database.

The antenatal and postnatal care services in all health facilities, clinics and hospitals were focal points for TT antigen vaccination of all WCBA. The data generated would be captured and sent to the LGA as a monthly summary report.

The maternal, neonatal and child health (MNCH) as well as maternal, neonatal tetanus elimination (MNTE) weeks were observed across the country annually in all states and WCBA were sensitized to come and be vaccinated with TT antigen. The data generated from the MNCH and MNTE campaigns were harmonized and captured in the DVD-MT database across each state.

The routine immunization services that gives vaccination to children 0 – 12 months of age was a means of ensuring WCBA are e‑ectively vaccinated with TT antigen, too.

Study design

A retrospective, quantitative cohort analysis of TT vaccination coverage in Nigeria.

Data collection instrument

The district vaccine data monitoring tool (DVD-MT) database was used for this study. The Nigeria population censors projection 2006 – 2020 templates were used to extrapolate number of WCBA.

Data variables

TT vaccination of WCBA (15 – 45) years recorded in DVD-MT database for 30 months was studied.

Data analysis

We preformed data aggregation, cleaning, formulation of charts and tabulations with Microsoft excel 2010 and the stock level trend of TT antigen across Nigeria was also analyzed to ensure availability of the antigen within the period of study.

Results

The analysis of tetanus toxoid vaccine coverage within the 30 months of our studies in Nigeria was 74.5%.

The table of TT antigen coverage was shown as Table 1. 

 It shows the schedule of TT vaccinations and the expected type of protection. The coverage of 74.5% from this study was signicantly higher than 62% estimation done by the World Health Ranking in 2015 as shown in Figure1.

In November, 2014 only 173 out of the 774 LGAs in Nigeria achieved 80% of TT vaccinations i.e. 22% coverage. There was a slight improvement of 24%coverage by December, 2015 of TT coverage. Jigawa, Kaduna, Nasarawa and Zamfara were the states that had 80% coverage's as shown in figure 1

Table 2 shows stock availability record of TT vaccines across the country. It was > 80% saturation in all states as at May, 2016. This ascertains the availability of the vaccine as out of stock syndrome can aect the TT immunization coverage.


Table 3 showed a cumulative coverage of TT 1- TT 5 during the 30 months period of study while, Figure 2 showed a cumulative coverage of TT1 - TT 5 trend as a bar chat for the period of study