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Field diary: A first-hand look at maternal and neonatal tetanus elimination in Cambodia

UNICEF Cambodia/2011

A woman in Prokeap village gets her vaccination during the tetanus immunization campaign

UNICEF Communication Officer, Carly Witheridge, recently visited neonatal tetanus elimination activities in Cambodia’s Kampong Thom province. Below is her first-hand account.

By Carly Witheridge

PHNOM PENH, April 2011 – In 2005, around six per cent of newborn babies in Cambodia died from tetanus. While the number of deaths is sharply declining, several challenges must be addressed before Cambodia can reach its goal of eliminating maternal and neonatal tetanus by 2012.

To understand the difficulties first hand, I accompanied a UNICEF Health Officer and local health centre staff to one of the country’s high risk areas to see how supplementary campaign activities are hoping to take elimination efforts the extra mile.

Reaching the hard to reach

Deep inside Kampong Thom province in central Cambodia lies the scattered village of Prokeap. The village is so remote and hard to reach that routine vaccination outreach simply doesn’t happen.

With limited access to information about health, most women in the village know little about the benefits of immunization, putting themselves and their babies at risk.

“Because they live in remote areas, there is less opportunity for villagers to get information about health”, Thong Eng Chay explained, a nurse from the nearest health centre. “Villagers here know little about vaccines so they are often scared to have them”.

Women in areas like this are instead being reached through targeted immunization campaigns, organized by the Ministry of Health, with support from UNICEF. The first round of the 2011 campaign took place in April and will be followed by two further rounds in May and November, aiming to provide the minimum coverage of protection to women and their babies in villages identified as “high risk”—villages in remote locations, with large mobile populations, minority groups, and a high proportion of home deliveries.

Women are more susceptible

The campaign targets women of childbearing age who are more susceptible to tetanus infection due to the high risks associated with childbirth.

In Cambodia, many women—especially those in remote areas—still give birth at home without assistance from a skilled birth attendant. This increases the risk of unclean delivery and improper umbilical cord care and can cause infection for both mothers and babies.

One woman we met in Prokeap village was eight months pregnant and told us about the difficulties she faced. She would like to deliver her baby at home in her village with a traditional birth attendant, but she works over three hours away on barely passable roads. She may be forced to deliver the baby alone with her husband.

“We are scared to deliver the baby on our own,” she said, “but we have no other choice if we can’t make it back to the village”.

With few opportunities to earn a living locally, many women choose to work away from home and are forced to take huge risks when it comes to their health and the survival of their newborn babies.

A helping hand

Village Health Support Groups, made up of community volunteers, have been instrumental in mobilizing women and girls for the campaign. As members of the villages themselves, they know their communities well and go door to door to inform women and their families about the benefits of tetanus immunization.

On the morning of the campaign, the health volunteer in Prokeap village had gathered together a steady stream of women, who eagerly awaited their turn. One by one the immunization team vaccinated the women and marked down their vital statistics in their records. This information will feed into national statistics and will help to ensure their follow up in the next round.

To ensure no one was missed, we then accompanied the immunization team and health volunteer as they marched around the village, blurting out the campaign’s messages through a loudspeaker. By checking the vaccination cards of each and every woman, they soon found more candidates who were swiftly vaccinated on the spot.

Making progress

The Ministry of Health, with support from UNICEF, has reached over 1.3 million women of child bearing age through immunization campaigns at both the village level and in the workplace, whilst strengthening routine immunization activities across the country.

Promotion of ante natal care and delivery at health facilities is also crucial, and one of the ways that UNICEF and partners are working with the government to reduce maternal and neonatal tetanus. Reaching mobile populations and those in remote areas is still a real challenge. But increased efforts through the national tetanus campaign are helping Cambodia to overcome these difficulties and ensure that more mothers and babies are protected from what can be a fatal disease.



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