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Curr Neurol Neurosci Rep (2012) 12:655665
DOI 10.1007/s11910-012-0314-3
INFECTION (B JUBELT, SECTION EDITOR)
Tetanus in Ethiopia: Unveiling the Blight of an Entirely Vaccine-Preventable Disease
Yohannes Woubishet Woldeamanuel
Published online: 21 September 2012# Springer Science+Business Media, LLC 2012
Abstract Today, tetanus exacts its toll only in resource-poor countries like Ethiopia. Agrarian rural life with limited vaccine typifies tetanus risk in Ethiopia where current tetanus control trends on expanding infant immunization and eliminating highly prevalent maternal and neonatal tetanus (MNT). Protection by infant tetanus immunization primers disappears within an average of 3 years, if not followed by boosters. Second-year of life, school-based, and universal 10-yearly tetanus immunizations need to be supplemented. Facility-based reviews in Ethiopia reveal a continued burden of tetanus at tertiary-level hospitals where ICU care is suboptimal. Quality of medical care for tetanus is low -reflected by high case-fatality-rates. Opportunities at primary-health-care-units (antenatal-care, family planning, abortion, wound-care, tetanus-survivors) need to be fully-utilized to expand tetanus immunization. Prompt wound-care with post-exposure prophylaxis and proper footwear must be promoted. Standard ICU care needs to exist. Realization of cold-chain-flexible, needle-less and mono-dose vaccine programs allow avoiding boosters, vaccinerefrigeration, and improve compliance.
Keywords Tetanus . Ethiopia . Tetanus vaccination . Maternal and neonatal tetanus
Introduction
Ethiopia: Basic Indicators, Health Service and Immunization Delivery
Ethiopia, a low income country with a population of 83 million and a fertility rate of 4.8, is the second most populous country in Africa [1, 2]. Around 80 % of its people are rural. In 2010, its PPP GNI per capita (PPP GNI is gross national income converted to international dollars using purchasing power parity rates. An international dollar has the same purchasing power over GNI as a U.S. dollar has in the United States [120]) was $1040 [1]. Health budget as a proportion of total national budget is 10 %. Ethiopia uses a three-tier health service delivery -a primary-health-care-unit at first-tier, a general hospital at second-tier and a specialized hospital at third-tier. Ethiopia started its Expanded Programme of Immunization (EPI) in 1980 with the objective of fully vaccinating 90 % of its infants within 10 years. The country has been adopting WHO (World Health Organization) recommendations for developing countries including routine vaccination of infants for the 6 traditionally known vaccine-preventable diseases (tuberculosis, diphtheria-tetanus-pertussis...