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The right thing to do: a mother learns about protecting women and newborns from tetanus

MNTE
© UNICEF Cambodia/2012/Cori Parks
Samnang and her husband surrounded by their four children. Over the years she has learned more about eliminating maternal and neonatal tetanus.

By Cori Parks

SVAY RIENG, Cambodia, January 2013 - Inn Samnang, aged 45, knows all too well the choices for women delivering a baby in Cambodia; she’s made them all. At her home in Bavet Leu village, Chipsu district, Svay Rieng province (south east Cambodia), surrounded by her husband and four children, she recounts personal decisions that reflect a progressive improvement in practices to keep women and newborns safe in childbirth and the critical first few weeks after birth.

Samnang’s eldest son, 20-year-old Sor Phalla, was born at home with no professional assistance.  She used traditional methods for tying off and cutting the baby’s umbilical cord with string and unsterilized household scissors.  In those days the end of the cord was also sometimes packed with ash or coal, significantly increasing the risk of developing tetanus, an infection which can kill newborns within the first few weeks of life with symptoms including the infant’s refusal to feed, muscle rigidity and spasms. 

Samnang’s second son, 18-year-old Sor Chita, was also born at home, however, on that occasion she was assisted by a midwife who used a home birth kit (a small pouch containing sterile, disposable equipment), which Samnang bought for 3,000 riel (about $0.75) in advance of her delivery date.

Roughly a decade later, in 2005, Samnang delivered her third baby, this time a daughter, Sor Kanha, now aged 7. The government-led Baby-Friendly Community Initiative launched in 2004 was in full swing with trained volunteers in Mother Support Groups at village level providing information and advice to new mothers. Samnang learned that her best option was to deliver her baby at the nearby health centre where clean umbilical cord care was practiced under the supervision of trained midwives. At the health centre Samnang received the first in a series of five doses of tetanus toxoid vaccination to protect her and her baby from the devastating effects of tetanus.

Vaccination protects mothers and babies

Since 2000 Cambodia’s Ministry of Health with support from UNICEF, WHO, and several other agencies has been working to eliminate maternal and neonatal tetanus across the country by vaccinating women of child bearing age with tetanus toxoid (TT); providing improved antenatal care; and encouraging mothers to deliver their babies at health facilities with skilled birth attendants using sterilized equipment and clean cord delivery practices. UNICEF with funding from the US Fund for UNICEF supported the training of health workers, outreach teams which provide key preventive services in high risk communities, and the purchase of vaccines.

The TT vaccine is provided free of cost to girls and women aged 15 to 44 (including pregnant women). It is delivered in five individual doses at various intervals. two doses offer three years’ protection; three doses offer five years’ protection; four doses offer ten years’ protection; and, ideally, the full five doses offer lifelong protection for the mother and her newborns with no harmful side effects for either mother or child.

MNTE
© UNICEF Cambodia/2012/Cori Parks
Samnang received her final TT vaccination when she took her 2 year old son, Sor Chhen, to be immunized at the health

“I was lucky with my first two boys” says Samnang, “They are healthy and strong.  But when I learned about the vaccine with my third pregnancy I knew it was the right thing to do.  I did not want to risk my or my baby’s life.” 

Mr. Sar Sarin, Immunization Programme Manager for Chiphu district in Svay Rieng says, “In the past, many rural people would not report either the pregnancy or the neonatal’s death. They did not know what tetanus was. If the baby died a few days after birth with the rigidity associated with tetanus, the accepted explanation was that the baby had been born to the wrong mother and had simply been reclaimed by the previous real mother.”

Completing the TT vaccination schedule

Though many women now know better, the aim is to get all women of childbearing age to complete the five dose schedule. Sarin says, “The compliance in our district is very good but we do have a big challenge in reaching our target…With the transient nature of the factory workers in this area, we sometimes do not know if a woman has moved away and finished her injections in some other location.”  However, Sarin points out, “With women who are already mothers, we can catch them when they bring their children in for their routine childhood vaccinations.”

Such was the case for Samnang. She received her final TT dose the morning that she took her 2-year-old son Sor Chhen Sopov for immunisation.  She explains that his birth was a starkly different experience from that of her first three children. 

“Because of my age, the midwife suggested that I consider delivering in a hospital.  My family and the village health support group agreed. It was a safe and easy delivery and my son is very healthy.  I was given iron folate tablets and a vitamin A capsule and told to breastfeed him, which I did.  I also take him to regular check-ups for vaccinations at the health centre down the road.” 

Samnang picks up her son and lifts his sleeve to show where he received his injection. Then she rubbed her arm where she got her tetanus injection.  “He didn’t cry… and neither did I.”

 

 
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