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Elimination of Maternal and Neonatal Tetanus

© UNICEF Mali/2016/Ben-Mohamed
Mali, 2016 - Mariam, one beneficiary, is receiving her fifth dose of vaccine against tetanus.

The Challenge:

Maternal and neonatal tetanus (MNT) is a swift and painful killer disease that killed 30,848 newborns in 2017 alone. A significant number of women also die to due to maternal tetanus every year.

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 Td 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 expanded to include elimination of the maternal tetanus. At that time, there were 57 countries that had still not eliminated MNT. The figure today stands at 59 with inclusion of Timor Leste in 2002 and South Sudan in 2011.

The goal of the initiative is to eliminate maternal and neonatal tetanus (MNT) through focus on the TT-SIAs. As of March 2019, 46 of these countries had achieved MNT elimination leaving 13 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 viable plans
  • To procure and deliver the Td 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


Through the joint efforts of partners much progress has been made between 1999 and March 2019:

  • More than 153 million women have been immunized with two or more doses of TT containing vaccines
  • 46 countries (Bangladesh, Benin, Burkina Faso, Burundi, Cambodia, Chad, China, Cameroon, Comoros, Congo (Republic of), Cote d'Ivoire, Egypt, Equatorial Guinea, Eritrea, Ethiopia, Gabon, Ghana, Guinea Bissau, Haiti, India, Indonesia, Iraq, Kenya, Liberia, Laos PDR, Madagascar, Malawi, Mauritania, Mozambique, Myanmar, Namibia, Nepal, Niger, Philippines, Rwanda, Senegal, Sierra Leone, South Africa, Tanzania, Timor Leste, Turkey, Togo, Uganda, Vietnam, Zambia and Zimbabwe), and Punjab province of Pakistan, South-East zone of Nigeria and Southern Mali have been validated for MNTE.
  • As of 2018, approximately 96% reduction of Neonatal Tetanus mortality has been achieved since 1988. 


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, Immunization Basics, Government of Japan and JICA, Save the Children, Gavi – the Vaccine Alliance, P&G (Pampers), PATH, RMHC, the Gates Foundation, UNICEF National committees, Kiwanis Foundation and Kiwanis International, and the national governments throughout the world. 




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The Silent Killer

MNTE - the silent killer
- fact sheet

Watch a short film from the U.S. Fund for UNICEF.

© UNICEF video 
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Progress on MNT Elimination

As of March 2019, 

  • 46 countries validated as having achieved MNT elimination.
  • In Pakistan, Punjab province validated as having eliminated MNT.
  • In Nigeria, South East zone validated as having eliminated MNT.
  • In Mali, the southern region validated for achieving MNTE.
  • 13 countries still at risk.

TT to Td Replacement Documents, New York 28 June 2018

WHO UNICEF Joint Communique

Guidance Note - [Eng] [Fr]

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