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Tetanus Toxoid
MICS3 Data Analysis and Report Writing Workshop
International Goals & Targets
MDG 5: Reduce by three quarters the maternal mortality ratio
Strategy: Elimination of maternal and neonatal tetanus
Target: Reduce incidence of neonatal tetanus to less than 1 case of neonatal tetanus per 1000 live births in every district
International Goals & Targets
By 2005, Reduction in infant and under-five mortality rate by at least 1/3, in pursuit of the goal of reducing it by 2/3 by 2015
Eliminate maternal and neonatal tetanus by 2005
Background
• Caused by tetanus spores, a bacteria found everywhere in the environment
• Transmission occurs when there is contact with broken skin such as an infant’s umbilical cord
• Poverty, poor hygiene and limited access to health services increase the risk for transmission during childbirth
Background
Prevention is possible by:
1. Immunization of pregnant women with at least 2 doses of tetanus toxoid vaccine (TT2+), passing protection to the newborn for up to first two months of life
2. Immunization of women of childbearing age who live in areas of high risk for transmission (delivery of immunizations usually through campaigns)
3. Promotion of clean delivery and cord care practices
BackgroundDeaths of children by cause for vaccine preventable diseases
(As of March 2004; source WHO)
Cause 2002
Under 5 Over 5
Diphtheria 4,000 1,000
Measles 540,000 71,000
Poliomyelitis .. ..
Tetanus (excluding NT) 18,000 15,000
Neonatal Tetanus 180,000 ..
Pertussis 294,000 …
Yellow Fever 15,000 15,000
Haemophilus Influenzae B 413,000 …
Total 1,464,000 102,000
Note: The boundaries and the names shown and the designations used on these maps do not imply official endorsement or acceptance by the United Nations.
MNT not eliminated
Countries with TT campigns
MNT eliminated * includes Timor-Leste
1997 2000 2002
248,000
200,000180,000
Neonatal Tetanus death reduction
Situation of Maternal and Neonatal Tetanus(Remains a problem in 48 countries)
Indicator
Neonatal tetanus protection
(protection at birth against tetanus)
Numerator Number of mothers of live births in the previous year with at least two doses of TT within appropriate interval prior to infant’s birth
Denominator Total number of women surveyed aged 15-49 years with a birth in the year preceding the survey
Methodological issues
-Data collected for all births during the 2 years before the survey – indicator includes only those during the last one year-Complex algorithm for the estimation of the numerator
Methodological issues
o two TT doses during the pregnancy (TT3>=2)o one TT dose during the pregnancy and at least
one TT dose prior to the pregnancy (TT3=1 AND TT6>=1)
o at least two TT doses prior to the pregnancy of which the last dose was less than 3 years before the birth
o with 3 doses within the 5 years before the pregnancy
o with 4 doses with the last dose less than 10 years before the pregnancy
o with 5 doses or more ever (TT6>=5).
Country data – CEE/CIS
Neonatal tetanus protection (%), 2004
Turkey 41%
Country data – Eastern and Southern Africa
Neonatal tetanus protection (%),2004
62
45
45
46
53
55
60
60
61
62
67
70
70
70
75
76
83
90
0 10 20 30 40 50 60 70 80 90 100
Eastern and Southern Africa
Burundi
Ethiopia
Comoros
Uganda
Madagascar
Mozambique
Somalia
South Africa
Eritrea
Namibia
Kenya
Malawi
Zimbabwe
Angola
Rwanda
Zambia
Tanzania
Country data – West and Central Africa
Neonatal tetanus protection (%), 2004
5733
354040
4243
455051
5658
6061
6565
6970
757677
85
0 10 20 30 40 50 60 70 80 90 100
West and Central AfricaMauritania
LiberiaEquitorial Guinea
ChadCentral African
NigerGabon
MaliNigeria
Guinea-BissauCongo Dem. Rep.
CameroonTogo
Burkina FasoCongoBenin
GhanaCôte d’IvoireSierra Leone
GuineaSenegal
Country data – MENA
Neonatal tetanus protection (%), 2004
21
37
70
71
0 20 40 60 80 100
Yemen
Sudan
Iraq
Egypt
Country data – LAC
Neonatal tetanus protection (%), 2004
Haiti 52%
Country data – South Asia
Neonatal tetanus protection (%), 2004
70
35
42
45
45
80
0 10 20 30 40 50 60 70 80 90 100
South Asia
Afghanistan
Nepal
Bangladesh
Pakistan
India
Country data – East Asia and the Pacific
Neonatal tetanus protection (%), 2004
10
30
51
54
70
85
85
0 10 20 30 40 50 60 70 80 90 100
Papua New Guinea
Lao PDR
Cambodia
Indonesia
Philippines
Myanmar
Vietnam
