The incidence and mortality rates of neonatal tetanus (NNT) remain underreported in Nigeria. This cross-sectional study was guided by the Mosley and Chen's model for the elements of child survival in developing countries. The goals of the study were twofold: (a) to compare the NNT prevalence and the mortality rates from the existing surveillance system and active surveillance of health facility records in 7 selected health facilities from 2010 to 2014 in Katsina state, Nigeria and (b) to assess the associations between selected NNT risk factors, number of maternal tetanus toxoid injections, frequency of antenatal visits, place of delivery, and cord care, and neonatal mortality as the outcome variable. Data from 332 NNT records were extracted through retrospective records review and analyzed using a logistic regression model. The prevalence of NNT and mortality rate were 336 cases and 3.4 deaths per 100,000 population, respectively, while the prevalence of NNT and mortality rate reported through the IDSR system were 111 cases and 1.0 death per 100,000 population, respectively. Only neonates whose mothers had 1 dose of tetanus toxoid vaccine were significantly associated with NNT mortality, (p < 0.05), OR = 4.12, 95% CI [1.04, 16.29]. Frequency of antenatal visits, place of delivery, and cord care were all not significant predictors of NNT mortality. Implications for positive social change include gaining knowledge on associations between NNT risk factors and neonatal mortality, and strengthening the NNT surveillance system with the capacity for early detection of potential risk factors to develop specific public health interventions aimed at improving the outcome of neonatal tetanus.

Since 2006, Uganda has experienced a nonchanging neonatal mortality rate of 27 out of 1,000 live births, which is higher than the global average of 19 deaths for every 1,000 live births. The purpose of this retrospective cross-sectional study was to determine factors affecting access to health services and their impact on newborn deaths in Uganda. Mosley and Chen's model for child survival in developing nations provided the framework for the study. Secondary data from the 2016 demographic and health survey (UDHS) collected by the Uganda Bureau of Statistics (UBOs) was used. A total of 7,538 cases were used and analyzed using binary logistic regression and one-way analysis of covariance (ANCOVA). The results showed attending less than 4 antenatal care (ANC) visits during pregnancy increased the odds of neonatal deaths 1.57 times, while not taking antimalarial drugs during pregnancy increased the odds of neonatal deaths 1.67 times. However, receiving 4 or more tetanus toxoid (TT) vaccine doses before pregnancy was not statistically associated with an increased risk of neonatal death (p = .597). Also, there was no significant relationship between neonatal mortality and whether distance to health facilities was a challenge (p = .276) or receiving medical assistance during childbirth (p = .420). While there were significant differences in deaths of newborns in geographic regions while controlling for the number of ANC visits (p = .023), there were no differences while controlling for all three covariates, F(4, 117) = 2.00, p = .098. Findings may be used to inform government policies on ANC and malaria prevention during pregnancy, which may reduce neonatal mortality rates in Uganda.

Le médicament prophylactique qui a drastiquement réduit l’impact et la sévérité du tétanos sur les populations humaines est le vaccin antitétanique. Son principe actif appelé anatoxine tétanique résulte de l’inactivation au formaldéhyde de la toxine tétanique. Cette détoxification chimique est une étape critique qui détermine la sécurité, l’antigénicité et l’immunogénicité du vaccin. Pour une meilleure compréhension de ce processus chimique, à l’échelle moléculaire, nous avons dans un premier temps caractérisé l’anatoxine tétanique par chromatographie liquide couplée à la spectrométrie de masse en tandem haute résolution (LC-MS/MS) afin d’identifier et de localiser exhaustivement l’ensemble des modifications induites par le formaldéhyde sur la structure tridimensionnelle de la protéine vaccinale. Dans un second lieu, pour un meilleur suivi qualité du procédé industriel de fabrication de l’anatoxine tétanique, nous avons développé des méthodes uniques d’expertise in vitro par LC-MS/MS pour réaliser la quantification relative et/ou absolue de la toxine tétanique, de l’anatoxine tétanique, ainsi que pour effectuer la quantification relative des fragments de toxine chimiquement modifiés par le formaldéhyde. Ces outils de caractérisation sont complémentaires aux méthodes de contrôles qualités existantes et contribuent actuellement à un meilleur suivi de la reproductibilité des lots de vaccins antitétaniques / The prophylactic drug, which has drastically reduced the impact and severity of tetanus on human populations, is the tetanus vaccine. Its active ingredient called tetanus toxoid results from the inactivation of tetanus toxin with formaldehyde. This chemical detoxification is a critical step, which determines the safety, antigenicity and immunogenicity of the vaccine. For a better understanding of this chemical process, at the molecular level, we first characterized tetanus toxoid by liquid chromatography coupled with high-resolution tandem mass spectrometry (LC-MS/MS) in order to fully identify and map all the modifications induced by formaldehyde on the three-dimensional structure of the vaccine protein. In a second step, for a better quality control of the industrial process of manufacturing tetanus toxoid, we developed in vitro expertise methods by LC-MS/MS to perform the relative and/or absolute quantification of tetanus toxin, tetanus toxoid, and to carry out the relative quantification of the toxin fragments chemically modified with formaldehyde. These characterization tools are complementary to existing quality control methods and currently contribute to better monitoring the reproducibility of tetanus vaccine batches