Interventions to Eliminate Tetanus in Nigeria: A Systematic Review

Tetanus, though vaccine preventable, is a commonly occurring life-threatening affliction of new-borns and pregnant women in low- and middle-income countries, including Nigeria. This is mostly due to the infection of wounds with Clostridium tetani from unhygienic delivery and cord care practices. While tetanus cannot be eradicated, elimination is possible through a combination of strategies. A literature review from 2015 to 2024 was conducted in PubMed/MEDLINE, African Journals Online, Google Scholar, and the Grey literature, following PRISMA guidelines to identify relevant publications. Eight studies met the inclusion criteria and were assessed for evidence quality using an expanded PRISMA checklist. The studies identified the several interventions operationalized for the elimination of tetanus in Nigeria and the outcomes of these interventions, inclusive of: conditional cash transfer (single conditionality – N5 vs N300 vs N800) for maternal vaccination with tetanus toxoid vaccine, single dose (versus none) maternal tetanus toxoid vaccination during pregnancy (AOR=3.2; 95% CI =1.1, 10; p=0.04), improved maternal antenatal care follow-up (AOR=3.3; 95% CI= 1.2, 8.3; p=0.03), and improved access to tetanus toxoid immunization information in pregnancy (last 12 months: AOR = 2.5; 95% CI = 1.1, 2.5; p=0.02). The key demand-side and supply-side factors influencing these outcomes include: lack of knowledge of the current immunization schedule, dependence on physician referral for immunization, inefficient immunization records keeping systems, poor health staff attitude as well as lack of community participation. Targeted health education and promotion, maximisation of opportunities for vaccination of high-risk groups, adequate financing of immunization and improved disease surveillance at all levels are essential for achieving elimination targets.

Public Health

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