Neonatal tetanus: prevalence before and subsequent to implementation of the Expanded Programme on Immunization

Cases of neonatal tetanus (NNT) admitted into the University of Calabar Teaching Hospital, Calabar, Nigeria during an 8-year period (January 1983-December 1990) were studied in order to evaluate the impact of the Expanded Programme on Immunization (EPI) on this condition. The prevalence rates of NNT were found to be 16% and 24% in the pre-EPI and EPI periods, respectively. In addition, in spite of a high level of awareness among mothers about immunization against NNT in the EPI era, its acceptance was very poor. These disturbing observations indicate the ineffectiveness of strategies employed in the implementation of this immunization programme. It is suggested that intensive health education directed at mothers and traditional birth attendants would eradicate ignorance, superstition and misconceptions which militate against acceptance of tetanus toxoid by mothers. Furthermore, a study of the culture of the Nigerian people may lead to the evolution of acceptable and effective channels of communication which would lead to better understanding of NNT and greater immunization coverage.