Elimination of maternal and neonatal tetanus, defined as less than one case per 1000 live births in every district in every country, has been a key public health goal in the WHO South-East Asia Region since 2000. Achievement of the Regional goal with the validation of the remaining areas in Indonesia in May 2016, is another public health victory. Previously in April 2015 India’s achievement of elimination was validated. Both countries used a combination of innovative control strategies.

Tetanus is a life-threatening disease but easily preventable through vaccination. Neonatal tetanus (also called tetanus neonatorum) occurs in very young infants, usually due to umbilical infection. An acute, often fatal disease characterized by spasmodic contraction of voluntary muscles, especially one occurring in the neck and jaw, and is caused by the bacterium Clostridium tetani, which usually enters the body through an infected wound and produces a neurotoxin. Also called lockjaw tetanus is diagnosed by clinical symptoms and medical history. Without medical care, mortality from neonatal tetanus is close to 100%. Maternal tetanus is defined as tetanus during pregnancy or within 6 weeks of the end of pregnancy (birth, miscarriage, or abortion). No formal reporting system exists for maternal tetanus, although elimination is assumed to occur with neonatal tetanus elimination.

In 1988, the WHO World Health Assembly passed a resolution to eliminate neonatal tetanus globally by the year 2000. At that time it was estimated that the disease killed about 800 000 neonates a year, causing 6 to 7 deaths per 1000 live births. By the end of 1999, 57 countries including Bangladesh, India, Indonesia, Myanmar, Nepal were still to achieve the target. Renewed efforts were launched by WHO and partners, UNICEF and the UN Population Fund (UNFPA). Elimination of maternal tetanus was added because it is prevented by the same measures targeting neonatal tetanus. Implementation of the Maternal and Neonatal Tetanus Elimination Initiative has involved three main strategies: immunisation, clean deliveries and core care practices and surveillance.

 

Maternal immunisation has resulted in over 80% of today's newborn babies being protected from tetanus. As of May 2016, over 140 million women of child bearing age were reached with 2 doses of tetanus toxoid vaccine. 39 countries (plus Ethiopia except its Somali region and 16/17 regions in the Philippines) have been validated for maternal and neonatal tetanus elimination. WHO estimates that in 2013, about 49000 newborns died from neonatal tetanus, a 94% reduction from the situation in the late 1980s.

Currently, 20 countries have yet to eliminate maternal and neonatal tetanus. Several factors contribute to the challenges of eliminating maternal and neonatal tetanus. Firstly the disease does not come in "outbreaks" which usually attracts widespread attention. It is more a "silent" killer and often goes unnoticed by health services. Maternal and neonatal tetanus cases occur mainly in places that are difficult to reach; be it culturally, politically or geographically. Identifying and addressing socioeconomic and cultural barriers to seeking and receiving care can be complicated and requires coordination between different sectors. Maternal and neonatal tetanus tends to affect the most marginalized groups in society and is particularly an indicator of disparity and inequity for women.

Strategies to eliminate maternal and neonatal tetanus are delivered where births and deaths take place, not only in health facilities, but also in communities and in the home – places that Expanded Prorammes on Immunization (EPI) often manage to get to paving the way for other basic health service delivery like vitamin A and deworming or bednet distribution for malaria protection. Identifying pregnant women for tetanus vaccination allows for risk factor monitoring, planning for safe birthing practices and proper care for the newborn including future vaccination. As such strategies towards maternal and neonatal tetanus elimination do not only target for a specific diseases control status but can strengthen access of women to health care services and subsequently better development opportunities.