A big boost for public health
Maternal and neonatal tetanus (MNT) is no longer a major public health problem in the World Health Organisation (WHO) South-East Asia region. As immunisation coverage and access to maternal and newborn health care has increased, agonising(causing great physical or mental pain) deaths on account of the disease have declined to below one in every 1,000 live births at the district level.
In 1989, when the fight against neonatal tetanus (and, consequently, maternal tetanus) began, tetanus toxins were claiming the lives of approximately 7,87,000 newborns across the world. Unhygienic conditions during delivery and inadequate umbilical cord care saw to it that these toxins could infect mother and child, causing muscle spasms, lockjaw, and often death.
With recent elimination successes in India and Indonesia, the South-East Asia region has reached a milestone.
Unlike polio and smallpox, the risk of MNT will always exist. Tetanus spores (type of bacteria)are always a part of the environment. Thus “elimination” must be seen as an enduring(remain in existence; last.) pursuit.
Innovative strategies
Sustaining and enhancing access to quality maternal and newborn health care is critical. By providing expectant mothers the ability to access quality antenatal(before birth) and safe-birthing services, health systems throughout the region diminish (make or become less.)the risk of tetanus infection, as well as other potentially lethal complications. Though important gains have been made in the region, the momentum must be accelerated. There must be increased training of skilled birth attendants at community-level facilities, or providing cash transfers to every mother who has an institutional delivery.
Immunisation coverage must be maintained and enhanced. Expectant mothers must receive the tetanus toxoid vaccine, or combination vaccine, and at the appropriate stages of pregnancy.
Indonesia’s campaign to vaccinate brides-to-be demonstrates that positive initiatives need not be confined to the pregnancy or neonatal periods. Just as newborns receive tetanus immunisations as part of their routine immunisation schedule, children must receive booster doses when appropriate. A good place for this to happen is at school. Despite the region’s newly validated status, health authorities must ensure that preventing maternal and neonatal tetanus remains prominent and that opportunities to immunise against tetanus are grasped.
Effective engagement with communities is essential. Messages related to tetanus immunisation and safe-birthing must remain integrated with other outreach activities, and disseminated among the most vulnerable. Harmful traditional practices should be discouraged, while at the same time continuing to build relationships that promote trust, respect and inclusiveness.
Tracking progress
Along with conducting routine vaccine-preventable disease surveillance, WHO is committed to realising the unfinished Millennium Development Goal agenda as it relates to maternal and newborn health. Efforts to achieve Universal Health Coverage — a priority area of WHO in the South-East Asia region — will similarly enhance health equity, ensuring that tetanus’s tendency to prey on the most vulnerable is rebuffed. It is no coincidence that the first countries in the region to eliminate the problem also had the strongest health systems.
Newborns across the region are now safer from the disease than at any other time in history, but we must not be misled by our successes.
Dr. Poonam Khetrapal Singh is Regional Director, WHO
South-East Asia.
