SynthesisThe Lancet. Global health2021
Progress and barriers towards maternal and neonatal tetanus elimination in the remaining 12 countries: a systematic review.
Synthesis in The Lancet. Global health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to trial NCT06833957 (PReparing for OptimalPhase III/IV maTErnal Group B StreptococCal Vaccine Trials in Africa), which is not on this map. Cited by 25 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
PReparing for OptimalPhase III/IV maTErnal Group B StreptococCal Vaccine Trials in Africa (PROTECT)
Who cites it
25 citing papers in PubMed, 1 synthesis or guideline pooled it, 34 citations in OpenAlex.
- Two decades of global research on tetanus vaccines and tetanus immunoglobulins: a comprehensive bibliometric analysis and integrative review (2000-2025).Frontiers in cellular and infection microbiology · 2026Pooled it
- Global, regional, and national burden of tetanus in 204 countries and territories, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023.EClinicalMedicine · 2026Article
- A multilevel modelling approach to understanding antenatal care utilisation in Uganda.BMC pregnancy and childbirth · 2026Article
- Tetanus Control in the United States and Global Disaster Settings: Public Health Disparities and Prevention Strategies.Medicina (Kaunas, Lithuania) · 2026Review
- Predictors of antenatal care service utilization among women of reproductive age in Somalia: a systematic review.Frontiers in reproductive health · 2026Review
- Maternal immunisation towards prevention of neonatal tetanus: insights from a cross-sectional study in Pru East Municipality, Ghana.BMJ public health · 2025Article
- Hotspot areas of tetanus-unprotected births and its associated factors in Ethiopia: Spatial analysis of EDHS data.Human vaccines & immunotherapeutics · 2024Article
- Association between maternal and child health care and neonatal death in Angola: a secondary analysis of Angola Demographic Health Survey 2015-16.Tropical medicine and health · 2024Article
- Progress Toward Achieving and Sustaining Maternal and Neonatal Tetanus Elimination - Worldwide, 2000-2022.MMWR. Morbidity and mortality weekly report · 2024Article
- Prevalence and factors associated with rural mothers' protection against tetanus: a cross-national analysis in 33 sub-Saharan African countries.International health · 2024Article
- Defining and reporting adverse events of special interest in comparative maternal vaccine studies: a systematic review.Vaccine: X · 2024Review
- Article
- Pakistan is failing in maternal and neonatal tetanus elimination.Nature medicine · 2024Article
- Assessment of tetanus Immunization among healthcare workers in Mogadishu, Somalia.Human vaccines & immunotherapeutics · 2023Article
- Spatial distribution and determinants of tetanus toxoid immunization among pregnant women in Ethiopia using data from Ethiopian demographic and health survey 2016.BMC pregnancy and childbirth · 2023Article
- Spatial distribution and determinants of tetanus toxoid immunization among pregnant women in Ethiopia using data from Ethiopian demographic and health survey 2016.BMC pregnancy and childbirth · 2023Article
- Antenatal care utilization and its associated factors in Somalia: a cross-sectional study.BMC pregnancy and childbirth · 2023Article
- Predictors of Tetanus Vaccine Uptake among Pregnant Women in Khartoum State, Sudan: A Hospital-Based Cross-Sectional Study.Vaccines · 2023Article
- Spatial distribution and associated factors of poor tetanus toxoid immunization among pregnant women in Ethiopia: spatial and multilevel analysis.Frontiers in global women's health · 2023Article
- Maternal Tetanus Toxoid Vaccination in Benin: Evidence from the Demographic and Health Survey.Vaccines · 2022Article
Corrections and comments
- Erratum issued
Authors and funding
14 authors at 6 institutions in 5 countries.
Funding
Abstract
This systematic review assessed the progress and barriers towards maternal and neonatal tetanus elimination in the 12 countries that are yet to achieve elimination, globally. Coverage of at least 80% (the coverage level required for elimination) was assessed among women of reproductive age for five factors: (1) at least two doses of tetanus toxoid-containing vaccine, (2) protection at birth, (3) skilled birth attendance, (4) antenatal care visits, and (5) health facility delivery. A scoping review of the literature and data from Demographic and Health Surveys and Multiple Indicator Cluster Surveys provided insights into the barriers to attaining maternal and neonatal tetanus elimination. Findings showed that none of the 12 countries attained at least 80% coverage for women of reproductive age receiving at least two doses of tetanus toxoid-containing vaccine or protection at birth according to the data from Demographic and Health Surveys or Multiple Indicator Cluster Surveys. Barriers to maternal and neonatal tetanus elimination were mostly related to health systems and socioeconomic factors. Modification to existing maternal and neonatal tetanus elimination strategies, including innovations, will be required to accelerate maternal and neonatal tetanus elimination in these countries.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.