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Niger: fighting against a silent killer called tetanus

© UNICEF/Niger/2009/Oumarou
Kalthouma demonstrating her interpersonnal communication skills.

Niamey, Niger, 07 July 2009 -“When a newborn baby  or a mother dies in the weeks following delivery, after suffering from muscular rigidity, spasms, light or noise fearing, the blame is put on evil spirits”, says Kalthouma Daoud, a midwife in her fifties. “But not on tetanus, although the symptoms left no doubt”.

She still remembers the case of a woman who was hospitalized four years ago in the village’s health center. “Her jaw was getting so rigid that they put a spoon between her teeth to make her avoid cutting her tongue”, she recalls.

In 2000, the health services reported 55 cases of neonatal tetanus (NT), an incidence of one case per 1000 live births, a figure that went down to 15 cases (5 deaths) in 2008. However, the incidence of the disease is probably underreported as most cases and deaths occur at home, while the monitoring of the disease takes place at health facility level.

It is estimated that Maternal and Neonatal Tetanus is responsible for fourteen per cent of deaths among children below the age of one month, and for five per cent of maternal deaths.

However, these deaths can be easily prevented by either improving the hygienic conditions of the delivery and/or by immunizing the.women of childbearing age, either during pregnancy or outside of pregnancy.

This protects the mother and - through a transfer of tetanus antibodies to the fetus - also her baby. Good hygiene practices (cord cut with a sterile instrument, and a clean environment for example) when a mother is delivering a child are also important to prevent neonatal and maternal tetanus.

Towards tetanus elimination
Between 2005 and 2008 to this end approx. 1,650,000 women of child bearing age were vaccinated against MNT, of which only 55% received the three doses of the vaccines, which will immunize them for a period of ten years against the disease.

UNICEF’s specific role is to ensure a high level of advocacy and to provide quality information, as well as ensuring the quality of the vaccination campaign.

UNICEF contributes to the supply of technical equipment and vaccines, their transportation to training activities and vaccination waste management, and to the strengthening of supervision and social mobilization.

This year, a further 300.000 women are expected to be vaccinated, thanks to the GAVI (Global Alliance for Vaccines and Immunization) who will provide the vaccines, and the Pampers funding resulting from the campaign “1 pack = 1 vaccine” that will cover the operational costs.

Community mobilization, key to success
“The key to success of an immunization campaign is community mobilization” admits Dr. Mamoudou Adamou, chief of the Téra health district, which is one of the four targeted districts for this year’s vaccination campaign.

“People find suspicious that only childbearing women are targeted and think that authorities are trying to sterilize girls and women, and with the help of health authorities we are interacting with our male audience, through our radio programs, to restore the truth about tetanus immunization and we are wining communities’ trust”, adds Soumaila Adamou, the manager of the community-based radio of Garbey Kourou.

In the past years, 46 rural and public radio stations were effectively utilized to broadcast educational messages about the current campaign.

These networks were also used to allow traditional chiefs, religious leaders and locally elected representatives to present information and conduct debates promoting tetanus elimination. 

A large commitment of community workers
Kalthouma Daouda, who has been a midwife for 14 years, is one of the social mobilizers working ahead of the tetanus vaccination campain to get as many women of child bearing age vaccinated against this often deadly disease.

These last weeks, she hardly misses a wedding or a naming ceremony so she can interact with the women of her community. As of 2005, more than 1,300 mobilizers like her and 1,500 community workers were recruited and trained to sensitize and mobilize the target population in their communities.

Tetanus remains an unreal disease for many in her community. Since she is considered as a trustworthy person gifted with ice breaking and effective teasing skills, it seems easy for her to make women accept the immunization.

One of them is Sipty Morou, a woman in her mid-thirties. She long ago gave up the hope of having a second child, but she did not hesitate to get immunized in order to encourage Fatouma, her only teenage girl, not to fear the pain associated with the vaccine shot.

“When I asked a woman the meaning of tetanus in Songhai language, her mother tongue”, says Kalthouma, “she chucked knowing that she doesn’t have the correct answer.”
“Tet’tanosso”, said her girl, triggering a collective laughter in the house. “Goffi!” shouted Kalthouma. “All your body becomes rigid like a fried chicken paw”.

Kalthouma Daouda will continue her house to house visits, during the immunization campaign running in four administrative health districts from June 23 to July 6. By April 2009, 44 countries remained that had not eliminated MNT.

The goal is that Niger will not be part of them by end 2010… thanks to people like Kalthouma.

By Seydou Amadou Oumarou



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