Why Tetanus Toxoid Vaccination in Pregnancy Matters in Africa

By Chika Jones BNSc, RN, RM, RPHN. Freelance Health Writer. Medically reviewed by: Azuka Ezeike, MBBS, FWACS (Obstetrics and Gynaecology), FMCOG, MSc. (Public Health).

November 17, 2025

An image of a healthcare worker administering tetanus toxoid vaccine to a mother. Image credit: Google Gemini

Highlights

• Tetanus is a severe and life-threatening bacterial infection of the nervous system that causes severe muscle spasm, rigidity, pain and breathing difficulties among many other problems. It is still a common infection in sub-Saharan African countries.

• Research shows that over 110,000 deaths occur every year in Africa due to maternal and neonatal tetanus.

• While treatment of tetanus is extremely challenging, the tetanus toxoid vaccine and the practice of basic wound care are highly effective in saving lives through prevention of infection in mothers and their babies.

• Poor maternal awareness and education, limited access to healthcare facilities, and a shortage of healthcare professionals are some of the factors hindering low tetanus toxoid vaccination uptake among African mothers.

Introduction 

Tetanus is a preventable disease that affects African mothers and their newborn babies. The World Health Organization reports that over 110,000 African mothers and newborn babies die yearly due to tetanus. Neonates (babies aged 0-28 days old) die within seven days if they contract tetanus from their mother [1].

As tetanus infection has no cure, the best way to prevent it is by vaccination and other precautions, like proper hygiene during delivery, etc. Research reveals that compared to developed countries, sub-Saharan Africa's tetanus toxoid (TT) vaccine coverage is less than 50% [2]. 

This report aims to educate Africans on what tetanus is, and to provide clear information on the importance of the tetanus toxoid vaccination for pregnant African mothers and their babies. 

Understanding maternal and neonatal tetanus 

Image of an African baby with tetanus. Note that due to muscle spasm, the baby’s head is thrown back on the neck, the back is arched inwards and the limbs are held straight and in stiff posture. Image credit: Chipo James Mainda. Click on image to enlarge.

Tetanus, also commonly known as “lockjaw”, is caused by a bacterium (germ), called Clostridium tetani, which affects the nervous system. [2] It is a severe, life-threatening illness that has no cure. The first symptom of tetanus is painful muscle spasms. The spasms are uncontrollable muscle contractions that affect muscles of the jaw, neck, back and limbs. The spasms first start around your jaw or mouth region (trismus), and may be so severe that your jaws may not open or are locked (lockjaw).

Tetanus produces resistant spores and are found in the soil or moist environment. The spores can enter the body through puncture or open wounds. 

Info poster: Understanding maternal and neonatal tetanus; causes and prevention. Click on image to enlarge,

The most common cause of maternal and neonatal tetanus (MNT) is poor hygiene during delivery. [3] This poor hygiene can be from the use of unclean instruments to cut the umbilical cord, as well as unclean deliveries in unhygienic conditions, etc.

The nervous system, which consists of the brain and spinal cord, is the main target of tetanus infection. The function of this system is to relay information from the environment to the brain, process it, and produce appropriate responses to the information either through muscle movements or in other ways. 

When the tetanus germ enters into your body, it releases harmful agents called neurotoxins, which especially harms your nervous system’s control of muscle function. It is the neurotoxins that cause muscle spasms, locked jaw and other nervous system dysfunctions. [4] There are additional symptoms of tetanus besides muscle spasm.

Anyone can contract tetanus regardless of age. Pregnant women who haven't received the tetanus toxoid vaccination and newborn babies are at a higher risk of tetanus infection. [5] Unvaccinated individuals in low-income countries face a 50% risk of death, as over 30,000 cases are reported annually. [2]

Related: Tetanus: What Africans need to know

How does the tetanus toxoid vaccine prevent tetanus infection?

Vaccines teach your immune system how to fight diseases and infections. There are different types of vaccines, but we'll focus on toxoid vaccines. 

Tetanus is caused by a bacterium (germ) that produces neurotoxins. Neurotoxins are harmful substances that affect the nervous system and interfere with its functioning.

The toxoid or tetanus toxoid vaccines are created with toxins produced by Clostridium tetani. This vaccine protects you from the harmful neurotoxins that tetanus bacteria produce. It achieves this by mimicking a harmless tetanus infection, which your body notes and produces antibodies against. Antibodies are specialized proteins that fight against infections or diseases. In case you're exposed to the real tetanus infection it would be quickly fought off.

You'll need to take multiple doses to see the desired outcome, which is long-lasting protection against tetanus. [6] Tetanus toxoid vaccine is safe for you and your baby.

What is the tetanus toxoid vaccination schedule for pregnant African women and coverage in Africa?

Table 1: Showing dose, timing and protection information for tetanus toxoid vaccine schedule for pregnant African women. Click on image to enlarge.

Even after recovering from tetanus, you can still be reinfected. [8] Its unlike measles or chicken pox, where getting infected once provides you with long-lasting immunity. This is why completing the doses of the tetanus toxoid vaccine is essential for everyone including pregnant African mothers and babies.

It's recommended that every woman of reproductive age (15-49 years) start and complete the five-dose regimen for tetanus toxoid (TT) vaccine for anyone who hasn't received it. [8] See Table 1.

• The first dose (TT1) is taken at first contact or in early pregnancy. It doesn't offer any protection. 

• The second dose is taken at least a month after the first dose. It offers protection from tetanus for 1-3 years. A pregnant mother should ensure to take the second dose two weeks before giving birth if she forgot to take it one month after the first dose.

• The third dose is received at least 6 months after the second dose. It protects the mother against tetanus for at least 5 years.

• The fourth dose is received one year after the third dose and protects the mother for 10 years.

• The fifth and last dose is received one year after the fourth dose. It provides lifelong immunity to the mother against tetanus.

So what are the benefits of tetanus toxoid vaccines?

Benefits of tetanus toxoid vaccination for pregnant African Mothers and their babies

• It protects the mother and baby from tetanus infections and its complication.

• Highly effective: When the complete dose of tetanus toxoid vaccine is taken, it provides around 99.9% protection to your baby from the disease. [6]

• Provides long immunity: The main function of vaccines is to protect you from infections. Some vaccines protect for a short period of time, like a year, two years or ten years, while others provide long-lasting protection for life. Taking the complete TT vaccine gives mother lifetime protection. It also protects your baby for at least some time before the baby receives their own vaccination.

Pregnant African mothers who are fully immunized prior to pregnancy or start their TT vaccine can pass the antibodies to their babies during pregnancy and in so doing, prevent neonatal tetanus. [7].

Challenges hindering tetanus toxoid vaccination in pregnant African mothers and how to resolve them

• Poor maternal education: If the mother isn't aware of tetanus as a disease, and how to prevent it, then she won't appreciate the importance of receiving the tetanus toxoid vaccine.

Solution: African mothers must be taught about tetanus and when they can start taking the vaccination. Healthcare professionals have a role to play here, but it shouldn't end with them. Public health awareness campaigns through the use of print media, radio stations, TV and social media have a role to play in creating awareness about tetanus.

• Poor access to health: Most pregnant African mothers may not have access to health facilities or hospitals due to long distances, money problems or bad road network. 

Solution:  African governments should ensure that primary healthcare centres are accessible in every community, as they form the backbone of local healthcare. This would enable every pregnant woman to attend antenatal care with qualified professionals, receive proper health education, and be vaccinated with tetanus toxoid.

• Shortage of first line healthcare professionals: First line healthcare professionals like community health workers/nurses are the first to educate, administer and ensure continuous follow-up of pregnant African mothers towards tetanus vaccinations. Most times, there aren't enough of these healthcare professionals to carry on this role.   

Solution: More qualified first line healthcare workers should be employed and trained to curb the shortage. Every pregnant African mother attending antenatal care and those in the communities should be encouraged to start and complete their TT vaccination.

• Poor infrastructure: Structural challenges hinder pregnant African women from receiving tetanus vaccines. One major issue is vaccine transportation. Vaccines must be stored between 2°C and 8°C [9], requiring cold carriers for transport and refrigerators with reliable power at healthcare facilities. 

However, some facilities lack this equipment, and inconsistent power supply in certain African countries compromises vaccine efficacy. Studies have revealed that vaccines lose their effectiveness if the right temperature isn't maintained [9]. Even when mothers are willing and are available to take the vaccines, unavailable or spoiled vaccines due to temperature fluctuations render them ineffective. This leads to shortages, causing African mothers to miss crucial doses.

Solution: The government and health managers have important roles to play in ensuring that vaccines are available in the country and efficiently distributed to healthcare facilities. Proper cold chain management and transportation are essential, along with a reliable power supply or solar generators to keep vaccine refrigerators running. 

Conclusion

Tetanus is a preventable disease that disproportionately affects pregnant African mothers and their newborn babies. The disease has no known cure, but it can be prevented by taking the tetanus toxoid vaccine. It's essential for pregnant African mothers to understand the importance of tetanus toxoid vaccination and to start and complete the recommended dosage schedules. 

Public health managers, healthcare professionals, governments, and individuals need to work together to address the challenges hindering low vaccination uptake, including poor maternal education, limited access to healthcare facilities, shortage of first line healthcare professionals and vaccine storage management. By prioritising tetanus toxoid vaccination, countries in sub-Saharan Africa can reduce the occurrence of maternal and neonatal tetanus and save countless lives. Every pregnant African mother and their babies deserve protection from this preventable disease. 

References: 

1. Maternal and Neonatal Tetanus [Internet. n.d.]. WHO | Regional Office for Africa. Available from here. 

2. Taye BA, Weldearegay BY, Yirsaw BG et al. Tetanus toxoid vaccination coverage and associated factors among pregnant women in East Africa: systematic review and meta-analysis. BMC Public Health 25, 3319 (2025). /doi: 10.1186/s12889-025-24687-9. Available from here.

3. Shey C. Progress, challenges and priorities in eliminating maternal and neonatal tetanus in the African region from 2016 to 2024: cross-sectional retrospective analysis. The Pan African Medical Journal. 2020;51(17). Available from here. ‌

4. Tamir TT, Kassie AT, Zegeye AF. Prevalence and determinants of two or more doses of tetanus toxoid-containing vaccine immunization among pregnant women in sub-Saharan Africa: Evidence from recent demographic and health survey data. Vaccine. 2023 Nov;41(49):7428–34. Available from here. 

5. Liyew AM, Ayalew HG. Individual and community-level determinants of poor tetanus toxoid immunization among pregnant women in Ethiopia using data from 2016 Ethiopian demographic and health survey; multilevel analysis. Archives of Public Health. 2021 Jun 4;79(1).Available from here.‌‌

‌6. Rabadi T, Brady MF. Tetanus Toxoid. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan- Available from here.

7. Abubakar MS. Uptake and Determinants of Tetanus Vaccination among Female Clinical Medical Students in North-Western Nigeria. Archives of Medicine and Health Sciences. 2024 May 1;12(2):152–9. Available from here. ‌

8. Tamiru YD, Sendo EG, Deressa JT. Factors associated with tetanus toxoid vaccine utilization among reproductive-age women in Debre Markos town, Ethiopia, 2021: a cross-sectional study. Therapeutic Advances in Vaccines and Immunotherapy. 2024;12. doi: 10.1177/25151355241305855. Available from here. 

9. Laizer SN, Hemed A, Cyril PM, Lintu Z, Biswaro SM, Mmbaga BT, et al. Challenges Experienced by Healthcare Workers on Maternal Tetanus Toxoid Vaccination in Kilimanjaro Region Tanzania. Clinical Immunology & Research. 2021 Dec 30;5(2). Available from here. 

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Related:  

What Africans Need to Know About Antenatal Care

Men’s Participation in Maternal Healthcare in Africa is a Win-Win for All

How to Boost Positive Childbirth Experience in African Women

Published: November 17, 2025

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