Effectiveness of prenatal tetanus toxoid immunization against neonatal tetanus in a rural area in India

Gupta, Shiv Dutt; Keyl, Penelope M.

doi:10.1097/00006454-199804000-00010

Cited by 32 publications

(29 citation statements)

References 10 publications

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“…[379][380][381][382][383][384][385] Even partial immunization was found to be effective in decreasing mortality and tetanus morbidity. 379,382 Hand-washing and use of clean instruments for cord cutting were Thailand; Provincebased study; RCT An education program for TBAs (n ϭ 214) consisting of general midwifery and cordcare training was carried out in 2 provinces with a total population of 500 000, and mass TT immunization was carried out in just 1 of the provinces. Pre-and post-intervention surveys were carried out with randomly selected groups of 210 respondents; the project also interviewed 112 TBAs.…”

Section: Antibiotics For Preterm Labormentioning

confidence: 99%

Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence

et al. 2005

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ABSTRACT. Background. Infant and under-5 childhood mortality rates in developing countries have declined significantly in the past 2 to 3 decades. However, 2 critical indicators, maternal and newborn mortality, have hardly changed. World leaders at the United Nations Millennium Summit in September 2000 agreed on a critical goal to reduce deaths of children <5 years by two thirds, but this may be unattainable without halving newborn deaths, which now comprise 40% of all under-5 deaths. Greater emphasis on wide-scale implementation of proven, cost-effective measures is required to save women's and newborns' lives. Approximately 99% of neonatal deaths take place in developing countries, mostly in homes and communities. A comprehensive review of the evidence base for impact of interventions on neonatal health and survival in developingcountry communities has not been reported.Objective. This review of community-based antenatal, intrapartum, and postnatal intervention trials in developing countries aimed to identify (1) key behaviors and interventions for which the weight of evidence is sufficient to recommend their inclusion in communitybased neonatal care programs and (2) key gaps in knowledge and priority areas for future research and program learning.Methods. Available published and unpublished data on the impact of community-based strategies and interventions on perinatal and neonatal health status outcomes were reviewed. Evidence was summarized systematically and categorized into 4 levels of evidence based on study size, location, design, and reported impact, particularly on perinatal or neonatal mortality. The evidence was placed in the context of biological plausibility of the intervention; evidence from relevant developed-country studies; health care program experience in implementation; and recommendations from the World Health Organization and other leading agencies.Results. A paucity of community-based data was found from developing-country studies on health status impact for many interventions currently being considered for inclusion in neonatal health programs. However, review of the evidence and consideration of the broader context of knowledge, experience, and recommendations regarding these interventions enabled us to categorize them according to the strength of the evidence base and confidence regarding their inclusion now in programs. This article identifies a package of priority interventions to include in programs and formulates research priorities for advancing the state of the art in neonatal health care.Conclusions. This review emphasizes some new findings while recommending an integrated approach to safe motherhood and newborn health. The results of this study provide a foundation for policies and programs related to maternal and newborn health and emphasizes the importance of health systems research and evaluation of interventions. The review offers compelling support for using research to identify the most effective measures to save newborn lives. It also may facilitate dialogue with policy...

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Section: Antibiotics For Preterm Labormentioning

confidence: 99%

Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence

et al. 2005

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“…Therefore, it is desirable to improve tetanus toxid vaccine coverage particularly in a high-risk population. [19] With the exception of low-birth-weight, young maternal age and early presentation in the hospital, multivariate analysis confi rmed that age of 7 days or less, presentation with spasms, low maternal socioeconomic classifi cation, lack of anti-tetanus vaccination during pregnancy and non-administration of anti-tetanus serum during the treatment were determinants of mortality in NNT. Therefore improved quality and accessibility of ante-natal care will ensure better anti-tetanus vaccination and better protection of infants against fatal tetanus.…”

Section: World Journal Of Pediatricsmentioning

confidence: 92%

Risk factors for mortality in neonatal tetanus: a 15-year experience in Sagamu, Nigeria

2010

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“…1,2,41,113 In industrialised countries, neonatal tetanus ceased to be a substantial problem by theantenatal care attendance, and inadequate vaccination with tetanus toxoid. 1,41,117,123,124,131,137,138 Lack of access to effective contraception and safe abortions are additional risk factors associated with tetanus from abortions. 5,119,127,143 Adolescents face special abortion-related risks because they frequently are not targeted for contraceptive services and tetanus toxoid vaccination, and might have increased difficulty in obtaining safe abortions because of societal prohibitions and cultural taboos.…”

Section: Distribution a N D Riskmentioning

confidence: 99%

“…In the first trial, three doses of fluid tetanus toxoid (without adjuvant; equivalent to about two doses of aluminium-adsorbed tetanus toxoid) had an efficacy of 94% for the prevention of deaths from neonatal tetanus; 114 in the second trial, no deaths from neonatal tetanus were seen in neonates born to mothers who had received two or three doses of aluminium-adsorbed tetanus toxoid within the previous 5 years. 92 Subsequent observational and case-control studies assessing the effect of tetanus toxoid on neonatal tetanus incidence or mortality have consistently noted vaccine effectiveness to be 80% or better, 74,115,131,153,154 except when subpotent tetanus toxoid vaccine was inadvertently used. 128 Although no studies designed to measure the effect of tetanus toxoid on maternal tetanus are available, a hospital-based study in Vietnam, where the vaccination of women has been vigorously promoted, showed a 90% reduction in tetanus in women aged 20-40 years.…”

Section: Distribution a N D Riskmentioning

confidence: 99%

“…1,41,117,[120][121][122][123]126 Postnatal cord treatment with contaminated traditional substances in the first few days of life has been identified with multivariate analysis as a particular hazard in casecontrol studies; 121,125,126,130,132 the use of such materials has been noted to negate the benefits of hospital deliveries. [140][141][142] Poverty, lack of maternal and paternal education, rural residence, young maternal age, and cultural restrictions on women's access to health services are all associated with unhygienic practices, low antenatal care attendance, and inadequate vaccination with tetanus toxoid.1, 41,117,123,124,131,137,138 Lack of access to effective contraception and safe abortions are additional risk factors associated with tetanus from abortions. 5,119,127,143 Adolescents face special abortion-related risks because they frequently are not targeted for contraceptive services and tetanus toxoid vaccination, and might have increased difficulty in obtaining safe abortions because of societal prohibitions and cultural taboos.…”

mentioning

confidence: 99%

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Maternal and Neonatal Tetanus

Roper

Vandelaer

Gasse

2008

Obstetric Anesthesia Digest

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Maternal and neonatal tetanus are important causes of maternal and neonatal mortality, claiming about 180 000 lives worldwide every year, almost exclusively in developing countries. Although easily prevented by maternal immunisation with tetanus toxoid vaccine, and aseptic obstetric and postnatal umbilical-cord care practices, maternal and neonatal tetanus persist as public-health problems in 48 countries, mainly in Asia and Africa. Survival of tetanus patients has improved substantially for those treated in hospitals with modern intensive-care facilities; however, such facilities are often unavailable where the tetanus burden is highest. The Maternal and Neonatal Tetanus Elimination Initiative assists countries in which maternal and neonatal tetanus has not been eliminated to provide immunisation with tetanus toxoid to women of childbearing age. The ultimate goal of this initiative is the worldwide elimination of maternal and neonatal tetanus. Since tetanus spores cannot be removed from the environment, sustaining elimination will require improvements to presently inadequate immunisation and health-service infrastructures, and universal access to those services. The renewed worldwide commitment to the reduction of maternal and child mortality, if translated into effective action, could help to provide the systemic changes needed for long-term elimination of maternal and neonatal tetanus.Tetanus in the first 28 days of life (neonatal tetanus) was long recognised by clinicians in resource-poor settings as an important cause of neonatal death. However, since babies affected by this disease usually are born at home and die there without registration of either event, the true burden was unknown. In the 1970s and 1980s, community-based surveys about neonatal tetanus from more than 40 countries showed that fewer than 10% of tetanus-related cases and deaths were routinely reported in most countries: in some regions, the reporting fraction was as low as 2-5%. 1,2 Estimates based on the results of these surveys, and tetanus data routinely reported to WHO suggested that, in the 1980s, more than 1 million deaths every year were attributable to tetanus, with an estimated 787 000 deaths in 1988 from neonatal tetanus alone. 1,3 In 1989, the worldwide public-health community made a commitment to the elimination of neonatal tetanus (defined as fewer than one case of neonatal tetanus per 1000 livebirths in all districts) by 1995. 3,4 Maternal tetanus is defined as tetanus during pregnancy, or within 6 weeks of the end of pregnancy (whether pregnancy ended with birth, miscarriage, or abortion), and has the same risk factors and means of prevention as neonatal tetanus. In the early 1990s it was estimated to account for about 5% of maternal mortality, or 15 000-30 000 deaths every year. 5,6 In 1999, the elimination of maternal tetanus was added to the goals of the elimination programme for neonatal tetanus, and the initiative was renamed the Maternal and Neonatal Tetanus Elimination Program. 6 Good progress has been made in the 15 ...

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Effectiveness of prenatal tetanus toxoid immunization against neonatal tetanus in a rural area in India

Abstract: Immunization of pregnant women with tetanus toxoid was the single most effective intervention against neonatal tetanus independent of other interventions.

Cited by 32 publications

References 10 publications

Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence

Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence

Risk factors for mortality in neonatal tetanus: a 15-year experience in Sagamu, Nigeria

Maternal and Neonatal Tetanus

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