Neonatal tetanus in Sagamu, Nigeria during the Expanded Programme on Immunization and the National Programme on Immunization eras: A comparative analysis.

摘要

Background: It is essential to continually study the pattern of occurrence of neonatal tetanus (NNT) for better control measures. Objective: To compare the prevalence rates and outcome of NNT in a Nigerian tertiary hospital over two periods characterized by different national immunization programmes - the Expanded Programme on Immunization (EPI) and the National Programme on Immunization (NPI). Methods: The records of babies hospitalized with NNT between 1991 and 1996 (EPI period) and between 1997 and 2005 (NPI period) were studied. Results: The prevalence rates for the EPI and NPI periods were 6.4 percent and 2.9 percent respectively. Most of the mothers did not receive ante-natal care (81.4 percent for EPI and 75.6 percent for NPI), did not take anti-tetanus vaccines in pregnancy (87.7 percent for EPI and 88.4 percent for NPI) and delivered their babies outside the health facilities (86.6 percent for EPI and 83.3 percent for NPI). The Case Fatality Rate was 49.5 percent and 61.5 percent for the EPI and NPI periods respectively. Conclusion: The prevalence and mortality of NNT remains high in Nigeria despite a change in immunization programme. Introduction Over the years, studies have shown that neonatal tetanus (NNT) is a major cause of neonatal morbidity and mortality in the developing world. 1-3 As at 1999, Nigeria was listed as one of the three major countries in the whole world where NNT still constituted a major public health issue. 4 Several international interventions have been instituted to reduce this global burden but the persistence of NNT cases in clinical practice is evidence that the various interventions might have failed. NNT is said to have been eliminated from a country when the annual incidence is less than 1 per 1000 live births. 4, 5 Although, only 5 percent of NNT cases are actually reported to health services, 6 the incidence of NNT in Nigeria ranges between 14.6 and 20 per thousand live births. 7 Poor anti-tetanus coverage of women in the child-bearing age has been identified as a bane of successful elimination of NNT in the developing world. 6 One major step taken to address the problem of poor vaccine coverage in Nigeria was the replacement of the Expanded Programme on Immunization (EPI) with the National Programme on Immunization (NPI) in 1997. 8 The former which was largely funded by donors like the WHO and the UNICEF presumably failed due to poor implementation arising from lack of governmental commitment. 8 Therefore, the funding of the latter was completely taken over by the Nigerian government to reflect governmental commitment to the immunization scheme and attract better implementation especially in terms of vaccine provision and delivery to the end-users. The targets included improved distribution of vaccines and increased community participation. 8 However, the programme, as far as anti-tetanus vaccination was concerned, remained clinic-based.Therefore, this study aims to compare the prevalence and outcome of NNT in a Nigerian Teaching Hospital over the two periods (spanning over 15 years) characterized by different immunization programmes in Nigeria. Methods A review of all neonates managed for tetanus at the Olabisi Onabanjo University Teaching Hospital (OOUTH) Sagamu, Nigeria between January 1991 and December 2005 was carried out. The hospital provides specialist neonatal services to at least three states of the federation. Cases of NNT were defined according to the WHO criteria.9For the purpose of this study, the EPI period spanned January, 1991 to December 1996 while the NPI period spanned January 1997 to December 2005. The hospital records of the patients were studied and the information retrieved included the personal data, the clinical presentations, place of delivery, details of treatment, duration and outcome of hospitalization. Maternal data such as age, parity, place of antenatal care (ANC) and anti-tetanus immunization history were also recorded. Parental occupation and educati