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Table of Contents
ORIGINAL ARTICLE
Year : 2019  |  Volume : 10  |  Issue : 3  |  Page : 155-158

Knowledge and practices regarding the prevention of tetanus among adults of resettlement colony of Delhi, India


1 Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Community Medicine, Maulana Azad Medical College and Associated Hospitals, New Delhi, India

Date of Submission10-Apr-2019
Date of Decision02-Jun-2019
Date of Acceptance06-Jun-2019
Date of Web Publication19-Aug-2019

Correspondence Address:
Dr. Palak Goel
Department of Community Medicine, Maulana Azad Medical College and Associated Hospitals, New Delhi - 110 002
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INJMS.INJMS_36_19

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  Abstract 

Background: Community awareness about tetanus immunization schedules and its importance in preventing tetanus is very low. Aim: This community-based, cross-sectional study was conducted to assess the knowledge, attitude, and practices about tetanus toxoid (TT) immunization among the general population in a resettlement colony of East Delhi. Materials and Methods: Stratified random sampling was done. There were five blocks and 50 participants were taken from each block randomly. The study was explained to the prospective participants during routine home visits. The study was conducted over a 3-month period from November 2017 to January 2018. Adult residents of the urban resettlement colony, of either sex, who gave written informed consent to participate in the study, were interviewed at their homes, at a time convenient to them, using a semi-structured proforma, and their responses were recorded and analyzed using the SPSS version 20. Results: Of the 250 participants enrolled, 230 persons who were willing to respond were included. The mean age was 35.9 years. 68.3% of the participants were female and 31.7% were male. Awareness of tetanus immunization regarding injury shows that only 52.1% of the respondents knew about the need of tetanus injection after injury beside other measures such as medicine and bandage. This knowledge was significantly associated with education. Majority (85.6%) of the respondents did not know the correct schedule of tetanus prevention immunization schedule in children. Only 30.8% of the participants knew that diphtheria and tetanus toxoid prevents tetanus. Conclusions: Sustained and focused health education efforts are necessary to combat misconceptions regarding TT immunization.

Keywords: Knowledge attitude and practices, tetanus immunization, tetanus toxoid


How to cite this article:
Dahiya N, Kumar R, Meena GS, Goel P. Knowledge and practices regarding the prevention of tetanus among adults of resettlement colony of Delhi, India. Indian J Med Spec 2019;10:155-8

How to cite this URL:
Dahiya N, Kumar R, Meena GS, Goel P. Knowledge and practices regarding the prevention of tetanus among adults of resettlement colony of Delhi, India. Indian J Med Spec [serial online] 2019 [cited 2019 Nov 12];10:155-8. Available from: http://www.ijms.in/text.asp?2019/10/3/155/264524


  Introduction Top


Tetanus is also known as lockjaw caused by tetanospasmin, a neurotoxin caused by obligate anaerobic bacterium Clostridium tetani, commonly found in contaminated soil. This neurotoxin blocks the nerve signals sent from brain to spinal cord and then to muscle. This causes muscle spasm associated with tetanus.[1],[2] Tetanus is classified as generalized tetanus which is the most common form and neonatal tetanus, and the most common cause of neonatal tetanus is contamination of the cord during cutting and dressing. It has a case fatality rate of 70%–100%.[3] Immunization of pregnant women with tetanus toxoid (TT) during pregnancy induces the formation of immunoglobulin IgG which passes on to the fetus and prevents them from neonatal tetanus. Hence, the most crucial preventive measures are institutional deliveries and immunization. In spite of proper guidelines and national immunization scheduled running in the country for >30 years, 3781 cases of tetanus occurred in 2016 which has increased from 2015 in which 2268 cases were reported.[4] Globally, 10,337 cases were reported in 2015. Almost 22 % of global cases were reported from India in 2015. Although India had successfully eliminated maternal and neonatal tetanus on 15th may 2015[5] still the awareness about the causes, symptoms and immunization is very low. Nonconformity to a pre- or post-exposure immunization schedule and administration of TT after every injury may lead to adverse hypersensitivity reactions.[6] Trends of immunization status are increasing compared to the last few years, but it is very important to know the previous immunization status so as to decide whether booster is required or primary immunization schedule. Several studies have also emphasized that dissemination of accurate information is crucial for the success of the immunization program.[7] The present study was conducted to assess the knowledge, attitude, and practices about TT immunization among the general population in a resettlement colony of East Delhi.


  Materials and Methods Top


This community-based, cross-sectional study was conducted in a resettlement colony which is located in Northeast Delhi served by the urban health training center of Maulana Azad Medical College. Stratified random sampling was done.

Sample size calculation

At 95% confidence level and taking the prevalence of knowledge regarding tetanus vaccination as 28%[8] with a relative error of 20%, the sample size came out to be 246 using the formula,

n = Zα2 p q/l2

where n = sample size.

Zα = 1.96 value of the standard normal variate corresponding to the level of significance alpha 5%.

p is the prevalence of knowledge regarding tetanus vaccination = 28%.[8]

q is (1 − p) =72%.

l is the relative error = 20%.

The minimum sample size required is 246. Therefore, a total of 250 participants were included in the study.

There are five blocks and 50 participants were taken from each block randomly. The study was explained to prospective participants during routine home visits. The study was conducted 3 months from November 2017 to January 2018. Adult residents of the urban resettlement colony, of either sex, who gave written informed consent to participate in the study, were interviewed at their homes, at a time convenient to them, using a semi-structured proforma, and their responses were recorded. All those who were nonresidents who were staying as visitors/guests of the residents in the study area during the study period and those persons who did not give written informed consent to participate in the study were excluded. Ethical permission was taken from the Departmental Ethical Committee.

The results obtained were tabulated and statistically analyzed using the SPSS statistics version 20 (IBM Inc., Chicago, Illinois, USA). Categorical data were presented as percentages and continuous data as mean and standard deviation. Significance of difference in parameters was calculated using the Chi-square test at 95% confidence interval (P < 0.05).


  Results Top


Demographic profile

Of the 250 participants enrolled, 230 persons who were willing to respond were included. The mean age was 35.9 years (18–80). 68.3% of the participants were female and 31.7% were male. 42.6% of the participants were graduate and above, 25.7% studied up to higher secondary, 20.9% were below primary, and 10.9% studied up to the middle. By occupation, majority (50%) were homemakers followed by 8.3% being students, 5.7% office goers, 3.9% shopkeepers, 3.9% business people, 9.5% paramedics, and 17.6% involved in other occupations.

Knowledge about immunization

Awareness of tetanus immunization regarding injury [Table 1] shows that only 52.1% of the respondents knew about the need of tetanus injection after injury beside other measures such as medicine and bandage. This knowledge was significantly associated with education. When asked specifically about the name of injection given after injury, 75.2% knew the name of injection, and it was significantly higher in participants having education level higher than higher secondary (P = 0.016). 22% did not know about the name of injection, and around 3% responded as “septic ka tika.”
Table 1: Knowledge regarding tetanus immunization in relation to injury by education (n=230)

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When asked about the name of disease it prevents, 18.3% responded infection, 17.8% exacerbation, 28.3% tetanus, 28.3% did not know, 5.7% all three, and 1.7% other.

When asked about timing of injection, 22% replied that it should be given after every injury irrespective of the previous immunization status of the individual, and 26% did not know about it. This knowledge varies significantly with the education level (P ≤ 0.05). Only 40.4% of the individual knew that it should be given after burns also. Almost 39% of people believed that TT should not be given after burns, injury with iron metal requires tetanus injection, and 29% did not know about it. Awareness in this regard was significantly associated with the level of education. 64% of respondents knew that tetanus should be given after animal bite, 13.9% answered no, and 1% did not know. There was a statistically significant difference (P = 0.003) between people who were more educated.

Practice about immunization

When asked about the last tetanus injection taken, 35% did not remember and 4% never took tetanus. 39.1% remembered taking tetanus injection and the most common reason was injury 42.5%, during pregnancy 18.4%, and some other reasons were like dog bite.

Awareness regarding tetanus immunization schedule

Majority (85.6%) of the respondents did not know the correct schedule of tetanus prevention immunization schedule in children. Only 14.4% knew it correctly. Although more number of females gave correct answers, the difference with males was not statistically significant [Table 2].
Table 2: Knowledge of tetanus immunization schedule by gender (n=231)

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Only 30.8% of the participants knew that diphtheria and tetanus toxoid (DPT) prevents tetanus, 62.1% did not know, and 7.1% believed that it did not prevent from tetanus. This knowledge was significantly higher in females than that of males (P < 0.005) [Table 2]. Only 41% of the respondents could name tetanus as the injection given during pregnancy, 57.5% did not know, and 4% named some other injections. This was also significantly higher in females as compared to males, but the correct schedule was known to only 13.5%. Only 8.3% of the individual knew about the adult primary vaccination schedule.


  Discussion Top


The present study revealed that only 52.1% of the people knew about the importance and need of tetanus injection after injury which is similar to the results of the study done by Taneja et al.[9] The mean age of participants in the present study was 35.9 years, of which 68.3% were female and 31.7% were male which was slightly different from another community-based study done by Patel et al.,[8] in which 55.9% were male and 44.1% were female.

In this study, majority of the candidates were graduate and above, and the results were in contrast to the results of another study, in which majority were illiterate. Knowledge about the name of injection “tetanus” was known to 75% of the people, and this knowledge was higher with higher level of education, and these results are similar to the results of the study done by Taneja et al.[9] Regarding knowledge about TT being given after every injury, 22% replied in affirmative and knowledge varies significantly with level of education. Some of the reasons for not giving tetanus injection after every injury were that it should be given only after iron injury. In this study, only 40.4% of the individuals knew that it should be given after burns, and 64% of the individuals answered that it should be given after animal bite also. In this study, 85.6% of the respondents did not know the correct schedule which was similar to the results of Taneja et al.[9] but in contrast with the results of the study done by Patel et al.,[8] in which 96.27% knew the correct schedule. Only 30.8% knew that DPT prevents tetanus also and this knowledge was significantly higher in females than males, but these results were different from the study done by Taneja et al.[9] In this study, only 8.3% knew about the primary immunization schedule which was almost similar to the results of the study done by Taneja et al.,[9] in which only 3% knew about it. The WHO Tetanus Policies and Recommendation aim to achieve and sustain a high coverage of three doses of tetanus-containing vaccine DPT in infancy and of appropriate booster doses to prevent tetanus in all age groups. The primary series of DPT coverage in infancy only gives the protection for approximately 5 years and reinforcing doses of TT in children of school age and adolescents is important in maintaining antibody levels which can endure for decades.[10]


  Conclusions Top


Although India has successfully eliminated neonatal and maternal tetanus in 2016, there is need to improve the knowledge regarding tetanus in general public specially related to injury, schedule, and need of booster dose.

Financial support and sponsorship

None.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Jogd KS, Yerpude PN. A cross-sectional study on perception of medical students regarding tetanus immunization. Int J Contemp Med 2013;1:27-31.  Back to cited text no. 1
    
2.
Rupani S, Kazmi U, Ahmed U, Ali A, Hafeez-ur-Rehman. Knowledge of tetanus vaccination among undergraduate medical students in Karachi, Pakistan. Int J Res. 2015;2:154-9.  Back to cited text no. 2
    
3.
Park K. Park's Textbook of Preventive and Social Medicine. 23rd ed. Jabalpur: Bhanot Publishers; 2011. p. 358.  Back to cited text no. 3
    
4.
Immunization, Vaccines and Biologicals. Available from: http:// who.int/immunization_monitoring/globalsummary/timeseries/ tsincidencentetanus.html. [Last accessed on 2019 May 15].  Back to cited text no. 4
    
5.
Ministry of Health and Family Welfare. Annual Report (2015-16). Nirman Bhawan, New Delhi: Ministry of Health and Family Welfare. Govt of India; 2016.  Back to cited text no. 5
    
6.
Centers for Disease Control. Diphtheria, tetanus, and pertussis: Recommendations for vaccine use and other preventive measures: Recommendations of the immunization practices advisory committee (ACIP). MMWR 1991:40:1-28. Available from: https://www.cdc.gov/mmwr/preview/mmwrhtml/00041645.htm. [Last accessed on 2017 Mar 08].  Back to cited text no. 6
    
7.
Nath B, Singh JV, Awasthi S, Bhushan V, Kumar V, Singh SK. KAP Study on immunization of children in a city of North India – A 30 cluster survey. Online J Health Allied Sci 2008;7:2.  Back to cited text no. 7
    
8.
Patel PH, Malgaonkar AA, Kartikeyan S. Knowledge, attitude and practices about tetanus toxoid immunisation amongst general population of an urban semi-slum area: A cross-sectional interview-based study from Western India. Int J Community Med Public Health 2017;4:1684-8.  Back to cited text no. 8
    
9.
Taneja DK, Kumar R, Dabas P, Ingle GK. Knowledge regarding tetanus toxoid immunization among persons attending health Mela in Delhi. J Commun Dis 2003;35:256-62.  Back to cited text no. 9
    
10.
Borrow R, Balmer P, Roper HM. Tetanus Update. The Immunological Basis for Immunisation Series Module 3: Tetanus Update 2006. World Health Organization; 2006.  Back to cited text no. 10
    



 
 
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