Until a few decades ago, India reported 150 000 to 200 000 neonatal tetanus cases annually, before the decline to about 31 500 neonatal tetanus deaths in 2005, and below 500 in 2013 and 2014. This is against the backdrop of a cohort of 26 million births every year.
Unlike polio or smallpox, tetanus can’t be fully eradicated as the tenacious spores of bacteria causing tetanus – clostridium tetani – are widespread in the environment. WHO considers neonatal tetanus as eliminated from a country when its incidence becomes below one case per 1000 live births per year in every district of the country.
Concerted efforts by the government in routine immunization over the years paved the way for the successful validation of the entire country for MNTE by mid-April 2015. This validation was conducted with the help of partners such as WHO, UNICEF and others.
This is a huge achievement. After having successfully eradicated the wild poliovirus, Maternal and Neonatal Tetanus Elimination is another momentous landmark in India’s public health history.
The thrust of the programme was on improving tetanus toxoid (TT) vaccine coverage during pregnancy; improving clean delivery practices through promoting institutional births and providing skilled birth attendants; and improving routine immunization coverage of tetanus- containing vaccines in infants and children.
Subsequently, safe motherhood programmes started promoting clean cord care practices and health workers were trained to promote the ‘five-cleans’ practice, namely, clean hands, clean cord tie, clean cord, clean surface and clean blade. The focus on cleanliness resonates strongly with Prime Minister Modi’s Swachh Bharat Mission.
The programmes also targeted traditional myths and practices associated with child-birth in order to wean people away from unsafe practices.
Since 2003, WHO has supported Government of India’s (GoI) efforts for developing the strategy for phased validation of states for MNT elimination. WHO global guidelines and tools for validation were also adapted and technical support provided for training and field surveys for validation.
Application of polio learnings and greater participation by WHO-NPSP accelerated the process of MNTE validation surveys. The intervention included: use of polio microplans to develop MNTE validation survey microplans; intensive training of surveyors and supervisors; daily debriefings to ensure standardization of methodology; intensive supervision and monitoring.
The launch of the National Rural Health Mission (NRHM) in 2005 helped strengthen these initiatives. The programme also got a boost with schemes specifically designed to promote safe motherhood, such as Janani Suraksha Yojana (JSY) and Janani Sishu Suraksha Karyakram (JSSK). The ‘high-priority’ district strategy, adopted by GoI in 2013, with a focus on improving health care services for mothers and children in poor performing districts, also helped in accelerating validation efforts.
India’s re-energized Universal Immunization Programme, the special immunization weeks, and the most recent Mission Indradhanush campaign, helped ensure that children and pregnant women are reached with vaccines, particularly in low-performing districts as well as underserved and unreached regions.
Increasing awareness about availability, safety and efficacy of life-saving vaccines, need for safe deliveries and providing financial protection for pregnant women and children have contributed a great deal in achieving MNTE.
WHO has played a significant role in each of these programmes.
To sustain the gains and MNT elimination status, it is essential that the core strategies of providing access to safe and skilled attendance at birth and protecting all mothers and children through TT immunization are maintained.
This makes the task of healthcare providers more challenging to reach the goal of universal immunization and providing access to mothers to good quality care around birth, especially those in underserved and vulnerable sections of society
The life of every mother and child is precious. They must be saved.