Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada.
Int J Infect Dis. 2012 Dec;16(12):e833-42. doi: 10.1016/j.ijid.2012.07.015. Epub 2012 Aug 30.
Pakistan is one of the 34 countries that have not achieved the neonatal tetanus (NT) global elimination target set by the World Health Organization (WHO). NT, caused by Clostridium tetani, is a highly fatal infection of the neonatal period. It is one of the most underreported diseases and remains a major but preventable cause of neonatal and infant mortality in many developing countries. In 1989, the World Health Assembly called for the elimination of NT by 1995, and since then considerable progress has been made using the following strategies: clean delivery practices, routine tetanus toxoid (TT) immunization of pregnant women, and immunization of all women of childbearing age with three doses of TT vaccine in high-risk areas during supplementary immunization campaigns. This review presents the activities, progress, and challenges in achieving NT elimination in Pakistan. A review of the literature found TT vaccination coverage in Pakistan ranged from 60% to 74% over the last decade. Low vaccination coverage, the main driver for NT in Pakistan, is due to many factors, including demand failure for TT vaccine resulting from inadequate knowledge of TT vaccine among reproductive age females and inadequate information about the benefits of TT provided by health care workers and the media. Other factors linked to low vaccination coverage include residing in rural areas, lack of formal education, poor knowledge about place and time to get vaccinated, and lack of awareness about the importance of vaccination. A disparity exists in TT vaccination coverage and antenatal care between urban and rural areas due to access and utilization of health care services. NT reporting is incomplete, as cases from the private sector and rural areas are underreported. To successfully eliminate NT, women of reproductive age must be made aware of the benefits of TT vaccine, not only to themselves, but also to their families. Effective communication strategies for TT vaccine delivery and health education focusing on increasing awareness of NT are strongly suggested. It is imperative that the private and government sectors work cooperatively to report NT cases and improve routine TT vaccination coverage.
巴基斯坦是世界卫生组织（WHO）设定的全球消除新生儿破伤风（NT）目标尚未实现的 34 个国家之一。NT 是由破伤风梭菌引起的新生儿期高致命性感染。它是最被低估的疾病之一，在许多发展中国家仍然是新生儿和婴儿死亡的主要但可预防原因。1989 年，世界卫生大会呼吁到 1995 年消除 NT，此后，通过以下策略取得了相当大的进展：清洁分娩实践、孕妇常规破伤风类毒素（TT）免疫接种，以及在补充免疫活动期间在高危地区为所有育龄妇女接种三剂 TT 疫苗。本综述介绍了巴基斯坦实现 NT 消除的活动、进展和挑战。对文献的回顾发现，过去十年中，巴基斯坦 TT 疫苗接种覆盖率在 60%至 74%之间。NT 是巴基斯坦的主要驱动因素，其疫苗接种覆盖率低，原因有很多，包括生殖年龄女性对 TT 疫苗的认识不足导致 TT 疫苗需求不足，以及医疗保健工作者和媒体对 TT 益处的信息不足。与低疫苗接种率相关的其他因素包括居住在农村地区、缺乏正规教育、对接种地点和时间的知识不足，以及对疫苗接种重要性的认识不足。由于获得和利用医疗保健服务的机会有限，城市和农村地区 TT 疫苗接种覆盖率和产前保健存在差异。由于私营部门和农村地区的病例报告不完整，NT 报告不完整。要成功消除 NT，必须让育龄妇女认识到 TT 疫苗的益处，不仅对她们自己，而且对她们的家人。强烈建议采取有效的 TT 疫苗接种和健康教育沟通策略，重点提高对 NT 的认识。私营部门和政府部门必须合作报告 NT 病例并提高常规 TT 疫苗接种覆盖率。
