What is maternal and newborn tetanus?
Tetanus, infection by the bacterium Clostridium tetani, can occur whenever there is an open wound in the body. A newborn, or the mother, can be infected due to unhygienic birthing practices — such as the use of unsterilised instruments or operating tables, or contaminated dressings. It is one of the biggest causes of maternal and newborn mortality — and also one of the earliest identified causes of such deaths. It finds mention even in the Old Testament as the “seventh day death”.
What are the symptoms?
The first signs appear when the facial and jaw muscles of an apparently healthy baby begin to tighten, and the newborn has difficulty in feeding. Finally, the newborn may no longer be able to breathe because of the tightening of respiratory muscles. 70% to 100% of deaths occur between three days and 28 days after birth.
What does Maternal and Neonatal Mortality Elimination (MNTE) mean?
It is defined as fewer than one neonatal tetanus case per thousand live births per year in every district of a country. All districts have to meet that target for a final certification. In India, the last four states/UTs that had laggard districts were Jammu and Kashmir, Nagaland, Meghalaya and Dadra and Nagar Haveli. All of them cleared a joint inspection by WHO and UNICEF earlier this year.
What was the extent of India’s MNT challenge?
At its peak, MNT was said to be responsible for the deaths of an estimated two lakh adults and children every year. In the second half of the last decade, it was in the 50 per 1,000 live births bracket. That figure has been steadily reducing over the years with the National Health Mission, advent of ASHAs and the concerted push for promoting institutional deliveries. Mandatory tetanus vaccination of pregnant women under universal immunisation programme has helped. Over the last few years, even as the figure was decreasing, MNT accounted for 15% of maternal and neonatal deaths in India. A strategy paper drawn up in 2012 found India alone needed more than half of the global funds for MNTE.
What is the global picture on MNT?
In 1988, WHO estimated that 787,000 newborns died of neonatal tetanus (NT). Thus, in the late 1980s, the estimated annual global neonatal tetanus mortality rate was approximately 6.7 NT deaths per 1,000 live births — clearly a substantial public health problem. In 1989, the 42nd World Health Assembly called for elimination of neonatal tetanus by 1995.
How far is the world from MNTE?
Before India was certified in June this year, it was among only 23 countries in the world that had not met the MNTE goal. WHO estimates that in 2013 (the latest year for which estimates are available), 49,000 newborns died from NT, a 94% reduction from the situation in the late 1980s.
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