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
infants 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

Background
Deaths 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
200,000
180,000
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 infants
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
57
33
35
40
40
42
43
45
50
51
56
58
60
61
65
65
69
70
75
76
77
85
0 10 20 30 40 50 60 70 80 90 100
West and Central Af rica
Mauritania
Liberia
Equitorial Guinea
Chad
Central Af rican
Niger
Gabon
Mali
Nigeria
Guinea-Bissau
Congo Dem. Rep.
Cameroon
Togo
Burkina Faso
Congo
Benin
Ghana
Cte dIvoire
Sierra Leone
Guinea
Senegal
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