­­By Offiong Esop Akpabio

I had never seen such stiffness of the neck as I did holding this three-week old baby in my arms during one of my house rounds in a rural community in Nigeria monitoring polio immunisation. Taking a course on perinatal health three years previously should have prepared me for this sight. The neonate was as tiny as a day-old, premature baby and was irritable and cried continuously, his face grimaced and he was restless. Gathering from the inquisitive look on my face, the eighteen year-old adolescent mother couldn’t help but break down in tears.    When she eventually mustered up courage to speak, she said that the baby who was born with the normal ability to suck, suddenly could not suck after three days. It was at this point that it dawned on me that this was a classic case of neonatal tetanus.


Neonatal tetanus, popularly misconstrued in Ibibio as Aron, is an acute disease in newborns (a baby that is less than 28 days old) where the nervous system is attacked by an infection from a bacterium known as Clostridium tetani. It is a consequence of umbilical cord contamination and unclean delivery practices as well as an indicator of a lack of or inadequate maternal immunisations causing rigidity with spasms in the jaw muscles and this accounted for the poor feeding practice of the baby as a result of the difficulty in swallowing.


A child’s exposure to neonatal tetanus is a consequence of an action (cord care) or inaction (lack of vaccinations) of the mother. Risk factors include unvaccinated pregnant mothers (non-utilisation of the Tetanus Toxoid injection to confer immunity), unclean hands and unsterilised instruments during delivery, traditional practices like female genital cutting, harmful birth practices (conducting home delivery with the assistance of untrained midwives, cutting of the cord with an old razor blade and tying with unsterilised thread) and treatment of the umbilical cord with potential infections.


A few months ago, I was part of a routine immunisation campaign and had the opportunity to interact with several settlements to understand communities from their social background and currencies. Suffice to say that the effect of the poor literacy rate in Nigeria is strongly highlighted in the poor outcome of maternal and child health. In Nigeria, the guideline for the treatment of umbilical cords is the use of chlorhexidine gel or methylated spirits, however, mothers in rural settlements stated that they used concoctions such as rat faeces, herbs and ashes, cattle dung, soil, crystalised salt, toothpaste and saliva to care for the cord of their neonate.


Socio-culturally, it is widely believed that a woman who has lost a child within the first month of its life is a bad omen and should not be allowed to set her eyes on or carry another mother’s child within the first one month of life because she carried death and may likely strike the child with “aron”. To avoid this, mothers hide their babies from guests as they can’t tell which guest has the spirit of aron. This is a myth strongly upheld by a fraction of the people in Nigeria. To break this myth, the most effective public health tool - education (communication for behavioural change) - must be employed to change attitudes, knowledge and the practices of mothers in Nigeria and Africa.


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