Tetanus: a terrible neurological disorder in rural Africa

Tetanus is a critical disease contracted through exposure to the spores of Clostridium tetani bacterium, which live in soil, saliva, dust, and manure. The routes of administration comprise transmission through deep open cuts, wounds, or burns affecting the nervous system. This condition is rare in developed countries. However, it remains a crucial public health issue, especially in many developing countries leading to 25,000 newborn deaths in 2018. Although, the reduction in this public health situation reached 88% compared with its situation in 20001. In Africa, tetanus is associated with increased rates of intensive care unit and hospital admissions resulting from many associated risk factors. Most importantly, the agricultural lifestyle alongside soil nature is rich in organic matter. Other factors associated with the condition were posttropical monsoon seasons, insufficiencies concerning effective wound care, and inadequate pursuit of public health awareness by governing health care authorities2,3. The best defense against tetanus is having current vaccinations. Pertussis and diphtheria are used in combination with tetanus vaccines, referred to as tetanus-toxoid-containing vaccines (TTCVs). Tetanus is a very preventable disease, with the administration of successful TTCVs used in preventing tetanus through routine immunization programes globally and provided during antenatal care4. There are currently 5 TTCVs authorized (DTaP, DTP, Tdap, Td, and DT). Diphtheria, tetanus, pertussis, and acellular are represented by the letters D, T, and P, respectively; the lowercase p and d simply indicate reduced vaccine toxoid5. DPT (diphtheria, tetanus, and pertussis) doses for children should be administered at ages 2, 4, and 6 months, with additional doses administered between ages 15 and 18 months and 4 and 6 years, according to the current Advisory Committee on Immunization Practices5. This is followed by 1 Tdap booster at 11 or 12 years, followed by a booster every decade after. Adults should receive the Td or Tdap vaccine every 10 years if all other vaccinations have been administered. One said the dose must be Tdap for individuals over the age of 19. A sequence of 3 vaccines will be administered to those who have never been immunized. The dose is administered 4 weeks after the first, and the last dose is administered 6–12 months later6. A prior illness and a vaccine’s protection do not provide lifetime protection. As a result, even if you have had tetanus or had the vaccine in the past, you still need to receive the vaccination regularly to maintain a high level of protection against this dangerous illness. However, tetanus infection can lead to serious health problems, including laryngospasm, fractures, hospital-acquired infections, pulmonary embolism, and aspiration pneumonia. Difficulties in breathing are a major cause of tetanus-associated mortality, with 1–2 in 10 cases being fatal (10%–20% of cases are fatal). Tetanus may manifest with unusual symptoms, masquerading as the underlying diagnosis. One such unusual sequelae include a case of a 20-year-old female patient who developed a series of complications post-tetanus diagnosis. These comprised locked temporomandibular joints (trismus) and fused hips bilaterally, as well as kyphoscoliosis and sustaining a right subtrochanteric fracture7. Maternal and neonatal tetanus (MNT), a neurological condition that annually threatens thousands of lives, is brought on by toxins secreted by the Clostridium tetani bacteria. WHO estimates that MNT kills 110,000 people annually in the African Region, mostly during this time of pandemic6, which accounts for 90% of all cases of neonatal tetanus worldwide. Unfortunately, the eradication of this disease is almost impossible because of the ubiquitous nature of the bacterium in the environment. Therefore, constant efforts are required to manage and maintain MNT. The level of knowledge and skills of medical practitioners correlate with the medical services provided. In this regard, little information is available concerning medical practitioners in rural Africa. But, it depends on the practitioners’ working conditions, education, training, and level of experience. A study has revealed inadequate competencies in enhancing primary health care, hospital management, and public health issues due to personnel insufficiencies, ill-developed health bodies, and lack of training8. Immunization acts as a preventative measure against pathogens9. Immunization in children is the best health care intervention and strategy to combat infectious diseases and high mortality rates among children10. In conclusion, early diagnosis and intervention are lifesaving for tetanus. Therefore, the importance of childhood immunization and boosters must be stressed. Midwives and birth attendants in African countries should receive professional training in aseptic birthing procedures. Securing appropriate routine tetanus vaccination, prophylaxis, and treatment, as well as universal coverage for developing countries, is paramount, intending to limit tetanus development and complications. Ethical approval Not Applicable. Sources of funding Not Available. Author contributions O.U., C.B., S.C.E., A.N., J.W., and M.K.S.: conceptualization of ideas, critical reviews with comments, and approved the final draft. Conflict of interest disclosures The authors declare that they have no financial conflict of interest with regards to the content of this report. Research registration unique identifying number (UIN) Not Applicable. Guarantor Abubakar Nazir.