Upsurge in neonatal tetanus in Benin City, Nigeria

Neonatal tetanus was on the decline from mid 1970's to mid 1990's due to the various efforts by many governments of the developing countries and such agencies as World Health Organisation (WHO) and United Nation's Children's Fund (UNICEF). However recently there appear to be an increase in neonatal tetanus despite these interventions leading to increasing neonatal morbidity and mortality.

To study the upsurge in neonatal tetanus despite the various interventions, examine possible causes responsible for it and proffer suggestions for eliminating neonatal tetanus by new target date of 2005 set by World Health Organisation.

A prospective study.

The study was done at the University of Benin Teaching Hospital, Benin city and Modic Medical Centre, a private paediatric hospital in Benin City, Nigeria between January 1997 to December 2001.

In 1996, it was noticed that cases of neonatal tetanus had increased suddenly among the total admissions. Morbidity and mortality among the under six months children had also increased and about ten percent of it was due to neonatal tetanus. It became imperative therefore to determine the magnitude of this problem. Consequently, cases of neonatal tetanus admitted to Special Care Baby Unit (SCBU) of the University of Benin Teaching Hospital and the Intensive Care Unit (ICU) of the Modic Medical Centre, a private paediatric hospital in Benin over a five year period January 1997 to December 2001 were examined. One hundred and fifty three tetanus cases were recorded during the period comprising 87 (56.9%) males and 66 (43.1%) females.

The annual incidence in UBTH was 6.9% (99/1425) and 5.3% (54/1021) in Modic Centre. Forty three point eight percent (67/153) survived while 56.2% (86/153) died. There was a yearly increase in incidence of neonatal tetanus of total neonatal admissions. Average age on admission was 8.8 days and incubation period was 5-22 days. Only 40 (26.1%) did not have any antenatal care. Eighteen of the 40 (45%) mothers who had antenatal care had two doses of tetanus toxoid only. Many of the mothers were ignorant about immunisation, feared about the consequences of immunisation, some got disenchanted with it because of the out of stock syndromes associated with the vaccines whenever they visited the health centres. Some of them did not even know about antenatal care.

Problem identified included lack of awareness of antenatal services among the target population, under utilisation of antenatal service, non immunisation with tetanus toxoid vaccines, negative cultural beliefs, primordial cord care, lack of economic and decision making empowerment of the target population and lack of government commitment towards elimination of neonatal tetanus. The following recommendations which may lead to elimination of Neonatal Tetanus were made: Strengthening school health programmes, intensive mobilisation and advocacy, regular availability of tetanus toxoid vaccines, empowerment of the target population, training and retraining personnel including Traditional Birth Attendants and increasing commitment by various tiers of government.