Date of Conferral





Public Health


Patrick B. Williams


Although tetanus is not a contagious disease, it can be deadly for people who are exposed and do

not have protective immunity against tetanus, which can be acquired only through vaccination.

Most studies on adult tetanus protective immunity are from high-income countries; limited

studies occur in Africa, and none has been reported from the Democratic Republic of the Congo

(DRC). This study sought to determine protective immunity against tetanus among adults in

DRC in relation to their age, sex, place of residence, and for women, antenatal care. The primary

purpose of this observational cross-sectional study using a nested serosurvey within the

Demographic Health Survey was to assess protective immunity against tetanus among adults in

DRC from November 2013 to February 2014. The secondary purpose was to identify

characteristics of populations at greatest risk of tetanus infection. The health belief model was

the theoretical foundation for this study, and multivariate logistic regression for complex samples

was used to analyze data from 8,602 participants. Women in the DRC were 10 times as likely to

be protected against tetanus, but both sexes ages 15–19 had lower immunity as teens, with 75%

not protected against tetanus. As women were targeted for antenatal care during pregnancy,

immunity against tetanus increased in women over age 20. This evidence will allow the Ministry

of Health to make informed policy decisions regarding adolescent and adult immunization. There

is potential for positive social change by influencing immunization policy, providing equity in

preventive health services in DRC and preventing death from a disease that has an efficacious


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