Maternal and neonatal tetanus elimination accomplished from the south-east Asian Region: World Health Organization

Despite the fact that the goal of maternal and neonatal tetanussi elimination has passed, the progress made so far has been slow. However, in the last few years, we have seen a huge decline in cases and tetanus deaths. As of December 2016, 37 out of the 49 member states of the WHO African, Caribbean and Pacific Region had eliminated tetanus. There are still 10 countries that need assistance to reach their target of eradication.

The WHO South-East Asia region has been working towards the elimination of tetanus as a key public health goal since 2000. The target was to have less than one case per 1000 live births in each district. In May 2016, Indonesia became the first country to validate elimination. India achieved elimination in April 2015, using a combination of control measures, including increased skilled birth attendance.

Despite this progress, several challenges remain. Increasing coverage of the tetanus toxoid vaccine and increasing antenatal care services is key to maintaining the elimination goal. In 2014, a study in Benin City, Nigeria found that the coverage of TT2+ and PAB (two vaccines against tetanus) vaccination among pregnant women increased from 44% to 69%. Similarly, in Zimbabwe, MNTE was reached in only 60% of the population.

The MNTE has three stages. After attaining elimination status, a country applies for validation status, confirming that the country has reached the minimum level of infection by achieving a case per 1000 live births. This process is based on district-level data, core indicators, and supplementary indicators. Each stage involves a different implementation strategy, with a different focus on the country’s specific numbers.

Maternal and neonatal ttanus elimination is possible if the health system is strong. The World Health Organization’s global vaccine action plan 2011-2020 has been updated in July 2016 to reflect new data on global coverage. Currently, the disease is eliminated in 80% of countries in the WHO South-East Asia Region. The WHO has been committed to achieving these goals.

The elimination target date for MNTE was originally set to the year 2000. The disease affects more than eight hundred thousand neonates each year, and seven to eight deaths per thousand live births per year. As of May 2011, the WHO has made a global commitment to eliminate tetanus. The elimination target was delayed to 2020. This means that it took several years to reach the target for maternal tetanus elimination.

The MNTE initiative uses two immunization approaches. In the most developed countries, routine immunization of pregnant women will result in two tetanus toxoid doses delivered one month apart. In low-income countries, supplementary immunization activities are conducted outside of the antenatal setting. These activities have been vital in achieving significant progress in many countries between 1999 and 2013.

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