Tetanus toxoid immunization to reduce mortality from neonatal tetanus

Abstract

Background Neonatal tetanus remains an important and preventable cause of neonatal mortality globally. Large reductions in neonatal tetanus deaths have been reported following major increases in the coverage of tetanus toxoid immunization, yet the level of evidence for the mortality effect of tetanus toxoid immunization is surprisingly weak with only two trials considered in a Cochrane review.Objective To review the evidence for and estimate the effect on neonatal tetanus mortality of immunization with tetanus toxoid of pregnant women, or women of childbearing age.Methods We conducted a systematic review of multiple databases. Standardized abstraction forms were used. Individual study quality and the overall quality of evidence were assessed using an adaptation of the GRADE approach. Meta-analyses were performed.Results Only one randomised controlled trial (RCT) and one well-controlled cohort study were identified, which met inclusion criteria for meta-analysis. Immunization of pregnant women or women of childbearing age with at least two doses of tetanus toxoid is estimated to reduce mortality from neonatal tetanus by 94% [95% confidence interval (CI) 80–98%]. Additionally, another RCT with a case definition based on day of death, 3 case–control studies and 1 before-and-after study gave consistent results. Based on the consistency of the mortality data, the very large effect size and that the data are all from low/middle-income countries, the overall quality of the evidence was judged to be moderate.Conclusion This review uses a standard approach to provide a transparent estimate of the high impact of tetanus toxoid immunization on neonatal tetanus.

STUDY OF INCIDENCE, MORTALITY & CAUSES OF NEONATAL TETANUS AMONG ALL NEONATAL INTENSIVE CARE UNIT [NICU] ADMISSIONS IN TERTIARY HEALTH CARE CENTER OF SBHGMC, DHULE

“…11 Two or more properly timed doses of Tetanus toxoid immunization given to pregnant woman or woman of child bearing age will reduce Neonatal Tetanus mortality by 94%. 12 Tetanus immunoglobulins are actively transported through the placenta from an immunized mother to her foetus, providing passive protection against Tetanus during Neonatal period & following month or two of life. 12 …”

“…12 Tetanus immunoglobulins are actively transported through the placenta from an immunized mother to her foetus, providing passive protection against Tetanus during Neonatal period & following month or two of life. 12 …”

Stillbirths: how can health systems deliver for mothers and babies?

“…Costs of visits were estimated to be 9% higher in regions with 80-95% coverage, and 24% higher in regions with 95-99% coverage, than were visits in regions with less than 80% coverage. Cost assumptions are detailed in webappendix pp [3][4][5][6][7][8][9][10][11][12][13][14][15] Eff ect estimates refer to the reduction in deaths due to a specifi c cause as a result of intervention-eg, 0·41 for stillbirths due to neural tube defects means that 41% of stillbirths due to neural tube defects could be averted with introduction of folic acid supplementation or fortifi cation. Postnatal interventions are not included so the estimates do not represent the full eff ect on neonatal deaths.…”

The interconnections between maternal and newborn health – evidence and implications for policy

“…The review by Lawn et al [275] reported that it can lead to significant reduction in the risk of neonatal mortality 52000 g (RR 0.49; 95% CI: 0.29 to 0.82) and severe neonatal morbidity (RR 0.34; 95% CI: 0.18 to 0.65). Moreover, KMC was also found to increase rates of breastfeeding (RR 1.20; 95% CI: 1.01 to 1.43), and mother-infant attachment (RR 6.24; 95% CI: 5.57 to 6.91) [276].…”