The Progress of Nations

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 The power of immunization
 Data briefs: Progress and disparity
Tetanus: Infants and mothers at high risk

Each year about 200,000 infants die in the first month of life from neonatal tetanus, an entirely preventable disease; 90% of these deaths occur in 27 developing countries.

India accounts for the highest number of deaths – more than 48,000 in 1999. Nigeria has the second highest toll, followed by Pakistan. Together these three countries account for more than half of the world’s neonatal tetanus deaths.

Tetanus occurs in newborns as a result of unsanitary birth practices, such as when the umbilical cord is cut with an unclean blade.

In mothers, tetanus causes about 30,000 deaths annually, with an astonishing 100 million women at risk, despite the fact that it can be easily prevented through immunization.

Maternal and neonatal tetanus is a public health problem in 57 countries. It occurs where poverty, poor health care, low levels of immunization and unsanitary delivery conditions all converge.

Immunization of women of childbearing age with at least three doses of tetanus toxoid vaccine (TT) provides complete protection against both maternal and neonatal tetanus. A mother protected against tetanus will pass her immunity on to her newborn child for the first two or three months. To sustain immunity, a child must receive three doses of DPT (diphtheria/pertussis/tetanus) through routine immunization services.

As high as the neonatal tetanus toll is, it represents a marked decrease from the 800,000 newborn deaths in 1985, thanks to immunization of pregnant women and promotion of hygienic delivery practices. In 104 developing countries that have met the criteria to eliminate maternal and neonatal tetanus, rates have dropped to less than 1 neonatal tetanus case per 1,000 live births in each district of the country.

Work is now concentrated on administering three doses of tetanus toxoid to women of childbearing age in areas with no access to antenatal care or routine immunization services and on promoting clean delivery practices everywhere.

  The tetanus toll
Estimated neonatal deaths*
India 48,600
Nigeria 34,600
Pakistan 21,600
Ethiopia 13,400
Bangladesh 10,400
Congo, Dem. Rep. 10,000
Somalia 8,800
China 8,600
Afghanistan 4,200
Indonesia 4,100
Niger 3,600
Mozambique 3,000
Nepal 3,000
Angola 2,700
Chad 2,500
Mali 2,400
Senegal 2,300
Yemen 2,300
Sudan 2,200
Ghana 2,000
Burkina Faso 1,600
Cambodia 1,500
Cameroon 1,500
Côte d’Ivoire 1,100
Liberia 600
Mauritania 200
Guinea-Bissau 100

Total 196,900

* The numbers of deaths in the table are estimated, as most neonatal deaths occur at home, before the baby reaches two weeks of age, and neither the birth nor the death is reported.

Source: WHO, 1999 estimates.


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