Elimination of Neonatal Tetanus in Rural Central African Republic: Issues and Challenges

Like other countries in the world, the Central African Republic is committed to the fight against the elimination of neonatal tetanus (NNT). Despite the efforts made, the number of NNT cases continues to grow. The objective of this work was to describe the epidemiological profile and identify the risk factors for the occurrence of NNT in rural Central African areas in order to improve control strategies in this context. This was a case-control study of newborns with tetanus (case) or not (controls), conducted between 2014 and 2019 at the Gazi Secondary Health Center. A questionnaire collected socio-demographic and clinical data that were entered and analyzed using the Epi info 7 software. Multiple logistic regression used to establish the relationship between the occurrence of tetanus and the characteristics of the mother and the newborn, through the ORs and their 95% CI. A total of 332 newborns were included, including 166 cases of NNT and 166 controls. The average age was 7.8 ±3.6 days. The incidence of NNT was 2.7 and 5.2 cases per 1000 live births in 2014 and 2019 respectively. The main risk factors for NNT were new males (p=0.04), low maternal education (p=0.001), separation from health care (p=0.006), primiparity (p<0.001), low number of antenatal visits (p<0.003) and low tetanus vaccine coverage (p<0.001). According to newborn care practices: home birth (p=0.002), delivery by unskilled personnel (p<0.001), umbilical cord septic section (p<0.001), no cord dressing (p<0.001) and septic dressing (p=0.012) were statistically associated with the occurrence of NNT in our context. In rural Central African Africa, the incidence of neonatal tetanus remains high and the risk factors are multiple. Effective health promotion measures can contribute to the elimination of this disease.