Tetanos

IMPROVING EQUITY BY ELIMINATING MATERNAL AND NEONATAL TETANUS
Neonatal tetanus is a marker of poverty and health-care inequity: Two thirds of the world’s neonatal tetanus cases are in the poorest and least developed countries. The great majority of the countries that have yet to eliminate maternal and neonatal tetanus also rank among the 50 poorest countries on earth. Within these countries,past progress in vaccination coverage has driven the disease out of many districts, leaving it concentrated in small geographic areas within the poorest districts. Maternal and neonatal tetanus are most prevalent among the extremely poor. Conducting anti-tetanus campaigns for this traditionally underserved population within the 'high-risk' approach – i.e, expanding routine immunization activities,outreach services and disease surveillance – has the added benefit of improving equity in access to health care. In districts where tetanus remains a public health problem, the disease can be a major cause of newborn deaths. Neonatal tetanus was responsible for 42 per cent of the neonatal deaths in nine high-risk districts in the Lao People’s Democratic Republic in 2001. In Guinea, a study foundneonatal tetanus caused 32 per cent of all neonatal deaths in 1999 and was by far the most common cause of death among children younger than one month. The disease caused 36 per cent of all newborn deaths in 1996 in the urban slums of Lucknow, India. These examples illustrate the fact that any reduction or elimination of neonatal tetanus mortality can have a major impact on overall newborn mortality,particularly in high-risk countries.

$1.20 prevents
SUCCESS STORIES
Bangladesh
One of many success stories is that of Bangladesh, where intensified immunization activities raised the proportion of women immunized against tetanus from 4 per cent in 1986 to 90 per cent in 2001. Over the same period, the number of newborns dying of neonatal tetanus each year fell from about 40 per 1,000 livebirths to about 3 per 1,000 live births. Today in Bangladesh, some 12,000 newborn babies die each year from neonatal tetanus, compared with about 100,000 in the early 1980s.

Morocco
In Morocco, thanks to an anti-tetanus drive carried out between 1987 and 1992, the proportion of women of childbearing age immunized against tetanus rose from 32 per cent to 75 per cent. As a result, the number ofneonatal tetanus cases dropped significantly. Before the drive, tetanus was responsible for 20 per cent of neonatal deaths. It caused only 2 per cent of neonatal deaths after the drive. A 2002 survey found that the neonatal tetanus mortality rate had fallen to less than 1 death per 1,000 live births in all districts, signifying that Morocco had effectively eliminated the disease.

the death of amother and her babies from tetanus…

United Nations Children’s Fund (UNICEF) 3 United Nations Plaza New York, NY 10017, USA pubdoc@unicef.org www.unicef.org

Cover photo: ©UNICEF/HQ94-1257/PIROZZI © UNICEF, New York June 2004

ELIMINATING MATERNAL AND NEONATAL TETANUS
For every child Health, Education, Equality, Protection ADVANCE HUMANITY

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A GLOBAL INITIATIVE…
Why do we allow180,000 infants and 30,000 women to die in pain every year from tetanus when a mere $1.20 buys protection for a mother and her future babies? Tetanus is caused by the spores of Clostridium tetani, a bacterium that lives on dead or decaying matter and is present worldwide. For babies born in unhygienic or otherwise unsafe conditions, tetanus spores can enter the umbilical cord stump, causing theviolent spasms and stiffness that are characteristic of neonatal tetanus and fatal in more than 70 per cent of cases. In adults, tetanus generally enters through an open wound or even a tiny pinprick. Women may be infected during deliveries carried out in unhygienic conditions. But the disease can easily be prevented. In the case of neonatal and maternal tetanus, prevention lies in immunizing the...