G605(P) The missing link in preventing tetanus deaths in nigerian children

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Background Global evidence reports tetanus as one of the highest contributors to preventable child deaths. Despite increasing advances in medicine, Nigeria still contributes a large burden to unnecessary child deaths having failed to eradicate tetanus. Methods A multipronged cross-sectional study aimed at identifying contributors to tetanus deaths in children in Lagos state. A 5-year retrospective hospital survey was carried in a tertiary centre to identify paediatric admissions due to tetanus, outcomes and factors contributing to the deaths. An epidemiological assessment tool was given to paediatricians to identify their practices in care of children with tetanus. A survey among 1000 caregivers in the Idi-Araba community assessed knowledge of- and preventives practices of tetanus in the community. Data was analysed using the SPSS version 22, demographic, clinical and social data were presented using descriptive statistics in the form of frequency tables, continuous data was presented as means ± standard deviation. Associations were determined using independent t-tests. Statistical significance was (p-values) set at ≤0.05. Results There were 102 tetanus admissions between September 2012 and 2017. Mean age at admission was 9.14 ± 3.65 years. Although 63.26% of the children had been previously vaccinated according to the National program of immunization, mortality rates for tetanus was 49.26%. Several (65.26%) health care professionals lacked adequate information about prevention of- or management of a child with tetanus. Among caregivers, 48.21% had never heard of tetanus, 50.21% of those who were aware had never vaccinated their wards and poor preventive practices was seen in 70.46% of caregivers. Only 12% of community children received booster doses after 5 years of age. Conclusion Despite the nationwide policy to immunise all children with 3 doses of tetanus before the age 1, in Idi-Araba community there is a problem of implementation. In children who were vaccinated according to the national schedule, Majority still did not get booster doses at school entry points which leaves them at risk. If we hope to reduce tetanus mortality, there is a need to educate health care professionals and caregivers and ensure proper establishment and implementation of appropriate immunisation practices.

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