Three cases of neonatal tetanus in Papua New Guinea sets ground for development of national plan for maternal and neonatal tetanus elimination

Abstract

Maternal or neonatal tetanus causes deaths primarily in Asia and Africa and is usually the result of poor hygiene during delivery. In 2011, three neonatal tetanus cases were investigated in Papua New Guinea, and all three cases were delivered at home by untrained assistants. The babies were normal at birth but subsequently developed spasms. A neonatal tetanus case must be viewed as a sentinel event indicating a failure of public health services including immunization, antenatal care and delivery care. The confirmation of these cases led to the drafting of the Papua New Guinea National Action Plan for Maternal and Neonatal Tetanus Elimination. This included three rounds of a tetanus toxoid supplementary immunization campaign targeting women of childbearing age (WBCA) and strengthening of other clean delivery practices. The first immunization round was conducted in April and May 2012, targeting 1.6 million WBCA and achieved coverage of 77%. The government of Papua New Guinea should ensure detailed investigation of all neonatal tetanus cases reported in the health information system and perform subprovincial analysis of tetanus toxoid coverage following completion of all three immunization rounds. Efforts also should be made to strengthen clean delivery practices to help eliminate maternal and neonatal tetanus in Papua New Guinea.

Maternal and neonatal tetanus

“…In Nepal, immunisation coverage increased from 45% of women receiving the recommended dose of tetanus toxoid to more than 80% after SIA activities during 2000–04 14. Similar coverage rates were reported in Papua New Guinea in a programme targeting 1·6 million women 15. Because tetanus arises from a combination of poor birth hygiene and deficient immunisation, immunisation initiatives are likely to have the biggest effect in communities with high rates of home births or births with traditional attendants.…”

“…In some areas, improvements in the speed, accuracy, and detail of data collection have been achieved by linking neonatal tetanus to other surveillance programmes, such as the acute flaccid paralysis monitoring system 14,21. Improved data dissemination and the availability of additional detail, such as geographical and demographic information, has enabled the design and implementation of SIA programmes to target at-risk populations more effectively 15…”

Risk factors of neonatal tetanus in Wenzhou, China: a case control study

“…8,9 The incidence and mortality of neonatal tetanus differ between regions and countries and between urban and rural areas within countries. 8, 10 The incidence of neonatal tetanus in China has dramatically decreased from 0.2 cases per 100 000 population in 2005 to 0.05 cases per 100 000 population in 2012. 11 Risk factors of neonatal tetanus in Wenzhou, China: a case-control study Zhou Zu-Mu, a Shi Hong-Ying, b Xu Yi, a Hu Cai-Song, a Zhang Xiao-Ming, a Zhao Li-Na a and Xie Zuo-Kai c Correspondence to Zhou Zu-Mu (email: zhouzumu@126.com).…”

Breastfeeding and the Risk of Infant Illness in Asia: A Review

“…Implementation of a program of two injections of tetanus toxoid during pregnancy eliminated the problem. However, recently, a shortage of resources and a decline rural health services, has resulted in the disease reappearing [90]. Worldwide, it is estimated that 58,000 neonates from 24 countries still die unnecessarily from the disease every year [91].…”