UPDATE ON MATERNAL NEONATAL TETANUS ELIMINATION AS OF OCTOBER 2010 WHO/CHERG estimates for causes of child mortality show that Maternal and Neonatal Tetanus (MNT) was responsible for 59,000 neonatal deaths in 2008.Though the figure shows a 92% reduction in mortality from the 800,000 deaths estimated in the 1980s, MNT continues to be a public health problem in many countries. UNICEF and WHO colleagues bring us an update on progress made so far during 2010 towards the global MNT elimination goal: 1. Validation Surveys MNT elimination is defined as less than 1 neonatal tetanus (NT) case per 1000 live births in every district of a country. During 2010 to date, validation surveys have been done in 4 countries namely Benin, Indonesia, Myanmar and Sierra Leone, These were WHO-led confirmatory community-based validation survey using lot quality assessment –cluster survey methodology. MNT elimination was validated in 2 countries, namely Benin and Myanmar, and 5 provinces in the Java and Bali regions of Indonesia, bringing the total number of countries to have validated MNT elimination since 2000 to 18, leaving 40 countries that have not yet eliminated MNT.: Sierra Leone: The country did not pass the validation survey conducted in March 2010 despite reporting high coverage with at least 2 doses of Tetanus Toxoid (TT2+) among surveyed mothers (88%). Koinadugu District was selected for the survey as it was considered at highest MNT risk in the country. 2 NT deaths were identified among the 1,364 surveyed live births, resulting in the conclusion that MNT has not been eliminated yet in Koinadugu nor in Sierra Leone as a whole. Sierra Leone is working on a new plan of action to include additional strategies to reduce unclean delivery and cord care practices, and to extend TT immunization to women who have not yet received at least 2 doses.Myanmar: The country passed the validation survey conducted in 3 high risk townships, South Okkalapa, Singaing, and Saw. Among the 1,404 surveyed live births, 26 neonatal deaths were detected, none of which were caused by tetanus, leading to the conclusion that MNT had been eliminated in the surveyed townships, and therefore in Myanmar as a whole. The exceptionally high clean delivery rate and TT coverage revealed by the study attest to Myanmar's strong commitment and efforts to achieve MNT elimination over the last decade.Benin: The country passed the validation survey conducted in mid-May in the Sakété-Ifangny Health District, the district selected as at highest risk for MNT in Benin. Fifteen (15) neonatal deaths were identified among the surveyed 1,399 live births, none of which was caused by NT. Indonesia: Joint WHO/ UNICEF review missions in 2009 and 2010, facilitated discussions on validation process to be adopted in Indonesia. Because of its large population (237 million inhabitants making it the 4th largest country in the world) and vast geographic spread, it was agreed that the Indonesia would be divided into 4 regions for the purposes of validating MNT elimination. The first region, encompassing Java and Bali and accounting for 59% of the country’s population, was shown to have achieved MNT elimination by a validation survey performed in Lebak district, Banten Province, Java in late July and early August.The following countries are ready for validation survey in the next few months: Mozambique, Uganda and part of Indonesia 2. TT Vaccination As of October 2010, 18 countries have implemented Tetanus Toxoid Supplementary Immunization Activities (TT-SIAs) targeting over 10 million women of reproductive age: (Afghanistan, Burkina Faso, Cameroon, Cambodia, Cote d’lvoire, DR Congo, Ethiopia, Gabon, Indonesia, Mauritania, Nigeria, North Sudan, Pakistan, Senegal, Somalia, Tanzania, Timor Leste and Yemen.The following countries have completed planned MNTE activities as of October 2010 and data and field review are scheduled/ are being scheduled to reassess district MNT risk status: Central African Republic, Cote d’lvoire, Guinea Bissau, Gabon, Equatorial Guinea, Liberia, Mauritania, Senegal and Tanzania.Globally TT2+ coverage, according to WHP/UNICEF estimates, remains at 75% as of 2009 3. Partnerships In June 2010, Kiwanis and UNICEF entered into a partnership to eliminate MNT by 2015. Kiwanis’ announcement of their new worldwide service project that is expected to raise funds for MNTE efforts globally and Procter &Gamble (P&G) for Pampers’ continued support of MNTE is helping bring old and new partners to rally behind MNTE again.
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