More unvaccinated women means more infants with tetanus

While female Sana’ani students are well aware of the dangers of contracting tetanus, the majority of them still do not receive vaccinations for the disease, says a new study by researchers at Sana’a University. When women are not vaccinated, they endanger not only themselves, but their future children. Only 41 percent of the female students in Sana’a schools have received tetanus vaccines, though all of the students are aware of this dangerous disease and its important vaccine, said the study. 

“We found these frightening statistics in Sana’a, the capital of Yemen. Such bad statistics make me ask myself if we make such study in other governorates, what the other bad statistics we may find are. I think that we will find no women, especially those living in the far areas, who receive the tetanus vaccine,” said Mohammed Alalie, one of the researchers.     Tetanus is a condition that affects the nervous system and causes painful, uncontrolled muscle spasms. Because of widespread immunization in developed countries, tetanus is now rare. Tetanus is a major problem in developing countries, where immunization of children is not required by legislation.

Another name for tetanus is “lockjaw.” The new study titled, Knowledge, Attitudes, and Practice of Secondary School Female Students to Tetanus Immunization in Sana’a, was conducted by researchers at the Faculty of Medicine and Health Sciences in Sana’a University to assess the knowledge and use among female students at secondary schools in Sana’a of tetanus immunizations.  About 1,309 students between the ages of 15 and 30, from 13 Sana’a schools, participated in this study.

Some 97 percent of them are single, and 3 percent are married. The study found that the students’ knowledge about tetanus was very high, about 100 percent, and their knowledge about tetanus vaccine was also very high, 98 percent. It noticed a significant increase in knowledge about tetanus from previous studies, which might be due to a difference in the study population and to the role of media, which has increased the awareness of tetanus.  It also found that there are no differences in the level of knowledge among students at different educational levels. The study, supervised by Dr. Mohammed Alnaib, who is an assistant professor in the Community Medicine in the Faculty of Medicine in Sana’a University, found that 90 percent of students know that tetanus is serious disease. 

About 74 percent of the students know that tetanus can cause death, whereas about 20 percent of them don’t know the severity of the disease. The percentage of the students who know that newborns are particularly susceptible to the disease is about 65 percent. Almost all the students, 91 percent, consider vaccination to be important, and most of the students, 85 percent, know that vaccination can prevent the disease. Also, most of the students support vaccination campaigns. However, only 52 percent of the students knew that women of childbearing age should be vaccinated only 37 percent mentioned an effect on newborns.

Two-thirds of the students know that tetanus vaccination must be administered more than once, and two-thirds of them knew that the shots must be administered in a series of injections given to children at ages 2 months, 4 months, 6 months, and 15 to 18 months. A booster is given before starting school (age 4 to 6). After the initial series of immunizations, a booster of Td vaccine should be given at age 11 to 12 and every 10 years thereafter. The study also found that 86 percent of the students want to be vaccinated.  Despite this, only 41 percent of the students take the vaccine. This is due to many reasons, said researchers, the most important being the fear of injection and the delaying of vaccination to after marriage. Only 22 percent of those who take the vaccine complete the doses, usually as a result of the discontinuation of a vaccination campaign. 

The study found that the married students were vaccinated more than the single students, and that most of the students who get vaccinated do it at school.  Some 58 percent of the married students received the vaccine, whereas 39 percent of the single students received the vaccine. Some of the students who did not take the vaccine erroneously believed that the vaccine might prevent subsequent pregnancies. Most of the students do not receive any brochures from the ministries of health and education with information on the topic.

The study also aimed to assess knowledge about the immunization schedule and the degree of adherence; to assess the role of media in increasing the awareness about importance of the tetanus vaccine; and to assess the role of the Ministry of Education in raising the awareness of tetanus. When women are not vaccinated, their infants can contract the disease. The World Health Organization definition of neonatal tetanus as an illness occurring in a child who has the normal ability to suck and cry in the fist two days of life but who loses this ability between day 3 and 28 of life and becomes rigid and has spasms.

Neonatal tetanus is a highly deadly disease, mostly affecting population with little or no access to basic health care services and education.  The disease, which was eliminated in the industrialized world as far back as 1950s, is still a major killer of infants in the developing world, responsible for up to 1 million cases annually, and no less than 500,000 infant death each year because the mothers was not immunized. This accounts for 14 percent of all neonatal deaths.  Up to 90 percent of all cases of neonatal tetanus in the world come from only 27 countries, 18 of which are in Africa. The others are in south East Asia and the Middle East. Up to 70 percent of all babies that develop the disease die in their first month of life.

It occurs as a result of unhygienic birth practices, leading to contamination of the umbilical cord with tetanus spores when it is being cut or dressed after delivery.  The disease usually presents itself on the third day after birth, causing the baby to stop feeding due to stiffness of the jaw muscles. The baby then goes into painful convulsions, coma and eventually dies. Unlike smallpox and polio, complete eradication of tetanus is not possible because tetanus spores can survive for a long time outside the human body in dirt and in the stool of infected people and animals so the disease can be transmitted without any human contact.

The vaccine is nearly 100 percent effective and only through effective vaccination of infants, school-aged children and women at risk, and the promotion of safe and clean delivery practices, deaths from tetanus can become a public health problem of the  past. The study was conducted by Arwa Almurisi, Faisal Alodini, Maha Karesh, Mohammed Alalie, Mohammed Aljarbani, Nabiha Altahiri, Noura Alarosi, Rami Dahrouj, Salah Ahmed and Tahani Alshami.  The study recommended making periodic regular immunization campaigns for schools in all of the various governorates; establishing a health unit in every school, where there is at least one nurse working to distribute leaflets for the various diseases and give lectures talking about the different diseases, including the tetanus.

It also suggested paying attention to the media coverage on various vaccines, including tetanus, especially through television and radio because they are more often accessed by students and housewives. Among other recommendations were: adding health topics related to this disease to the curriculum; paying attention to informing women or girls who are vaccinated of the exact time of the second dose and writing it on the immunization card; providing the health workers with the sufficient time to vaccinate all students; educating people on the correct way to take the booster doses in the event of infection from injuries; and urging the Ministry of Public Health and Population and the World Health Organization to set up training courses for health workers and midwives.

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