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Project Eliminate MNT

© UNICEF Philippines/2012/KPalasi
Maternal and neonatal tetanus deaths can be easily prevented by hygienic delivery and cord care practices, and/or by immunizing mothers with tetanus vaccine.

by Michelle Borromeo and Love Grace Garcia

Have you heard of MNT or Maternal and Neonatal Tetanus? Do you know that this disease is a “silent killer”? Read on to find out more about UNICEF’s work towards completely eliminating MNT in the Philippines.

Maternal and neonatal tetanus have been among the most common lethal consequences of unclean deliveries and umbilical cord care practices. When tetanus develops, mortality rates are extremely high, especially when appropriate medical care is not available. And yet, maternal and neonatal tetanus deaths can be easily prevented by hygienic delivery and cord care practices, and/or by immunizing mothers with tetanus vaccine

The MNT Elimination Initiative aims to reduce the number of maternal and neonatal tetanus cases to such low levels that MNT is no longer a major public health problem. Unlike polio and smallpox, tetanus cannot be eradicated (tetanus spores are present in the environment worldwide), but through immunization of pregnant and child bearing age women (CBAW) and promotion of more hygienic deliveries, MNT can be eliminated (defined as less than one case of neonatal tetanus per 1000 live births in every district)

WHO estimates that in 2008, 59,000 newborns died from NT, a 92% reduction from the situation in the late 1980s. While progress continues to be made, by February 2012, 34 countries including the Philippines have not reached MNT elimination status. Source: WHO MNTE Publication


One bright and early morning last April, we left Manila on a mission to Benguet. As UNICEF staff members, we are constantly encouraged to go out to the field to experience the importance of the work that we do for children. Such field visits give us a richer perspective on how UNICEF’s programs affect the lives of children and their families.

We were with a group of international donors from Kiwanis International, with delegates from the U.S., Malaysia and Taiwan, to visit areas covered under the UNICEF-supported national program on the elimination of MNT. In 2010, Kiwanis International pledged support to raise funds for the total elimination of the disease. Globally, there are only around 38 countries left where MNT has not been eliminated; the Philippines is one of them.

MNT is called a “silent killer” because of the seemingly small number of reported cases. In the 38 countries that continue to have incidences of MNT, one case is reported in every 1,000 live births. This may appear to be a negligible ratio, but given the availability and abundance of tetanus-related resources, this statistic becomes a significant problem that must be immediately addressed.


Areas at risk

In 2009, UNICEF, together with the World Health Organization, supported the Department of Health (DOH) in identifying high-risk areas in the Philippines relative to MNT.

Ten high-risk areas have been identified: Abra, Benguet, Basilan, Isabela City, Cotabato City, Lanao del Norte, Lanao del Sur, Maguindanao, Marawi City, and Sulu. The agreed global strategy is to give all women of reproductive age in these areas three doses of the lifesaving tetanus toxoid (TT) vaccine, which will protect them and their babies.

The first stop of our visit was the DOH’s regional office in Baguio City, where we met regional health officers who presented an overview of their expanded immunization program.  The vaccines for all the six provinces and the two cities of the Cordillera Administrative Region (CAR) are kept in a cold storage. From here, the vaccines are transported to municipal health clinics, and then to barangay health stations, where trained health workers administer the procedure.

Since all it takes is just three shots of vaccine to protect all women of child-bearing age from MNT, eliminating the disease totally in the Philippines sounds like a fairly simple task. This, however, is not the case, as there are varying factors that make this goal challenging to achieve.


Mylene at Benguet

Our next stop was the Benguet General Hospital in La Trinidad, which accommodated mothers and babies from all over the province. We got to meet mothers in the maternity ward, some of them resting from delivering their babies a few hours before we arrived.

One mother named Mylene, who had delivered her baby four days earlier, graciously talked to us about her experience being immunized for Tetanus prior to giving birth.

Mylene said she felt a painful sensation after the process. Most mothers experience pains after the shots, with some even experiencing headaches and fever. But even if she had to go through the procedure several more times, Mylene said she would willingly do it again, as she knew that it would protect her and her children from harm that could be easily prevented.

Factors affecting the eradication of MNT

Aside from the pain, health workers and officials told us that there are other reasons why women in rural areas are afraid to be immunized. These include the fear of needles and the misconception that the vaccines will either make them sterile or cause a miscarriage if they are already pregnant.

UNICEF staff Love Garcia interviews Mylene during the UNICEF US Fund and Kiwanis International visit for maternal and neonatal  tetanus monitoring. UNICEF Philippines/2012/KPalasi


Another crucial factor in eliminating MNT is the distance of health facilities from the homes of mothers in these high-risk areas. As such, some resort to their local manghihilot or untrained midwives, because it’s the most convenient and inexpensive method of giving birth. However, this exposes them to health risks, such as the use of unsterile equipment and unhygienic child-delivery environments. 

Local health workers therefore play a big role in educating and encouraging possible and expectant mothers in high-risk areas to go through tetanus immunization and to know how far they have to travel to reach a health facility.


Helen at Fabella

Our next stop at Fabella Hospital gave us the opportunity to talk to more mothers. Fabella is a government-run hospital known for having the most number of child deliveries among all hospitals in the country. Fabella usually conducts 60 to 80 out-patient maternal check-ups every day.

Here we met another mother, Helen, who just gave birth three days earlier to her son, John Timothy. Luckily, Helen had already been immunized, as she was informed about the importance of the procedure. According to Helen, she was happy that there are government-funded hospitals like Fabella that provide vaccinations for free or at minimal costs.

Access to free tetanus vaccinations is a challenge faced by mothers in huge cities, too, such as Metro Manila, where subsidized medical facilities and medicines are often limited due to overpopulation. 


 
Five-year old Janiel Oleja gives a waveat the PIDCU ward at San Lazaro hospital, Manila. US Fund and Kiwanis International visits hospitals in the country for maternal and neonatal tetanus monitoring. UNICEF Philippines/2012/KPalasi

MNT can continue to infect women and infants if it is not prevented through immunization and access to proper birthing facilities. In coordination with the national and local government, we at UNICEF are helping to eliminate MNT as fast as we can from the ten identified areas.

In the Philippines, UNICEF procures 90 per cent of all vaccines for the DOH. Globally, UNICEF supplies about 85 per cent of vaccines in various parts of the world.

With your help and assistance, we can achieve our goal of totally eradicating MNT in the quickest time possible. Support UNICEF in our drive to eliminate MNT and encourage the mothers in your family and among your friends to have their shots.

 

 

 
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