Health

Elimination of Maternal and Neonatal Tetanus

An adolescent Afghan girl receives a tetanus vaccination outside her home. UNICEF- trained vaccinators visit women of childbearing age in their homes, where 90 per cent of all deliveries take place.

The Challenge:

Maternal and neonatal tetanus (MNT) is a swift and painful killer disease that killed 128,000 newborns in 2004 alone. Annually up to 15,000 - 30,000 mothers also die of maternal tetanus.

Maternal and neonatal tetanus represents a very high proportion of the total tetanus disease burden due mainly to inadequate immunization services, limited or absent clean delivery services and improper post-partum cord care. The majority of mothers and newborns dying of tetanus live in Africa and Southern and East Asia, generally in areas where women are poor, have little access to health care and have little information about safe delivery practices.

Once the disease is contracted the fatality rate can be as high as 100% without hospital care and between 10 to 60% with hospital care. The true extent of the tetanus death toll is not known as many newborns and mothers die at home and neither the birth nor the death is reported.

The Solution
Maternal and neonatal tetanus (MNT) is easily preventable through:

immunization of women with TT vaccine for protection against Tetanus – a child born to a woman protected against tetanus is also protected from the disease in the first few months of its life
hygienic birth practices to ensure infection is not contracted by mother or newborn during the birth process
proper cord care to ensure that contamination of cord does not put the newborn at risk

Maternal and Neonatal Tetanus Elimination Initiative:
The World Health Assembly first called for elimination of neonatal tetanus in 1989. In 1999, the goal was re-invigorated with expansion of goal to include elimination of the maternal tetanus as well. At that time 57 countries remained where MNT had not been eliminated. The figure was revised to 58, in 2002 to include Timor Leste.

The goal of the initiative is to eliminate maternal and neonatal tetanus (MNT) from the 58 countries, where it was still a public health problem in 1999, through implementation of the recommended strategies with focus on the TT-SIAs. As of June 2008, 12 of these countries had achieved MNT elimination leaving 46 countries that still have not eliminated the disease. MNT elimination in a country is defined as neonatal tetanus rate of less than one case of neonatal tetanus per 1000 live births in every district of the country. UNICEF and WHO’s role in this global effort is:

To advocate with partners including the national governments to commit to the goal of MNT elimination and support it through allocation of needed resources
To fund raise for the initiative to meet the gaps in funding needs for the target countries
To support national ministries of health in preparing technically and financially sound plan
To procure and deliver the TT vaccines and injections supplies for the campaigns and ensure cold chain maintenance
To provide technical assistance for implementation of high quality campaigns
To monitor progress towards MNT elimination
To validate (usually through community based mortality surveys) if elimination level has been reached in a country following the country’s claim of elimination.
To work with countries on strategies for maintaining MNT elimination including strengthening of routine immunization

Progress
Through the joint efforts of partners much progress has been made between 1999 and June 2008:

45 countries implemented TT-Supplemental Immunization Activities
More than 81 million women have been immunized with two or more doses of TT vaccine
12 countries (Egypt, Eritrea, Malawi, Namibia, Nepal, Rwanda, South Africa, Togo, Vietnam, Zambia and Zimbabwe) and 15 Indian states have been validated to have eliminated MNT.
The WHO estimates show a decline in neonatal tetanus death from 215,000 in 1999 to 180,000 in 2002.

Partners
UNICEF is committed to eliminating MNT as a public health problem, a goal shared by our partners, including the World Health Organization (WHO), the United Nations Population Fund (UNPFA), Becton Dickinson (BD), USAID, CDC, Immunisation Basics, Government of Japan and JICA, Save the Children, GAVI, Proctor and Gamble's Pampers brand, PATH, RMHC, the Gates Foundation, UNICEF National committees and governments throughout the world.