Gynaecologists have expressed worry over the resurgence of tetanus infections among pregnant women in Nigeria, blaming the alarming rise on hesitancy in receiving the tetanus vaccine by expectant mothers.
The maternal health experts stated that the preference of some pregnant mothers to visit Traditional Birth Attendants and their exclusion from receiving the COVID-19 vaccination made antenatal women see mandatory tetanus immunisation as an option and not a requirement.
The specialists said that the tetanus vaccine, which is part of the antenatal package, was meant to protect the mothers and unborn babies throughout the pregnancy and after, yet some mothers are not ready to get vaccinated.
Recently, the National Primary Health Care Development Agency raised an alarm over the increasing tetanus threat to pregnant women and their babies, recommending urgent immunisation to ensure the safety of pregnant women and their babies.
In 2018, about 25, 000 newborns died from neonatal tetanus, the World Health Organisation, said.
According to the United States Centre for Disease Control and Prevention, tetanus is an infection caused by Clostridium tetani bacterium, which has its spores in the soil, dust, and manure.
The CDC said its spores develop into bacteria when they enter the human body through broken skin or injuries, saying that tetanus is not spread from person to person.
“The time from exposure to illness is usually between three and 21 days and may also range from one day to several months, depending on the kind of wound.
“Most cases occur within 14 days, but in general terms, doctors see shorter incubation periods with more heavily contaminated wounds and more serious disease,” the CDC added.
Physicians, who spoke with PUNCH Healthwise in different interviews, lamented that few women who go for immunisation end up taking only one shot of the vaccine which does not protect them throughout the pregnancy.
A consultant Obstetrician and Gynaecologist, who is also the Chairman of the Nigerian Medical Association, Southwest Zone, Dr Babatunde Rosiji, said tetanus vaccine hesitancy experienced in the country was the reason for the resurgence of tetanus cases in Nigeria.
He said though the immunisation of mothers is important to the protection of their babies yet not all women access antenatal care during pregnancy, saying that many women still visited TBSs for deliveries, especially in Ekiti State.
He said, “These people are not part of the compulsory immunisation exercise that comes with the antenatal package, but what we have done was to sensitise the TBAs to always refer them to the tertiary institutions for immunisation of their babies.”
Rosiji, who noted that tetanus is deadly and fatal, said, “Once a neonate, a newborn within 28 days of birth, contracts tetanus, the mortality rate is as high as approaching 100 per cent. They rarely survive.
“The essence of the vaccination is to protect the neonates from contracting tetanus. But we have observed that some women only take a dose of the vaccine which does not protect them against tetanus throughout the pregnancy.
“At least, two shots will protect the mother and child but we aim to administer five doses to cover the baby for life. Regrettably, COVID-19 experience, where vaccination was made a choice and not compulsory, women now think that tetanus vaccination is also an option.
“We need awareness that people should vaccinate to protect themselves and protect the neonates as well. The anti-tetanus toxin does not only protect the mother alone, it also gives protection to the neonates.”
Also, a Consultant Obstetrician and Gynaecologist at the Epe General Hospital, Epe, Lagos State, Dr Cynthia Okafor, affirmed the resurgence of tetanus cases due to partial compliance to immunisation programmes.
She said, “Some tetanus cases are more with the women who do not go for antenatal and end up having their babies without immunisation.
“We have several cases from these women who feel that the TBAs are the best people to patronise. They make use of herbs but do not immunise the mothers even when the tetanus mortality rate is high.”
On the symptoms, she added, “People often call tetanus ‘lockjaw’ because one of the most common signs of this infection is tightening of the jaw muscles.
“Tetanus infection can lead to serious health problems, including being unable to open the mouth and difficulties breathing. There might be sudden involuntary muscle spasms, painful muscle stiffness, seizures, headache, fever, changes in blood pressure and heart rate.”
In a study published in the National Library of Medicine, by Mustapha Fawale and team, the authors examine the pattern of clinical presentation of tetanus, the immunisation status, case fatality rate and factors influencing mortality.
Themed “Tetanus remains a formidable health challenge in Nigeria: The experience from a single Teaching Hospital in Osun State, Nigeria,’ the study affirms that tetanus, though preventable, is still a cause of death in Nigeria.
According to the study, the reported mortality for severe tetanus varies from 20 to 60 per cent and depends on the availability and quality of intensive care, indicating that farmers and artisans are mostly affected.
It concluded that the mortality of tetanus is still high from this retrospective study, recommending an active immunisation of all Nigerians particularly those in the vulnerable group.
