SANAA, 14 April 2008 (IRIN) - The Health Ministry has launched a national campaign against neonatal tetanus, often called the "silent killer" because the true extent of the death toll is not known: Many newborn babies and mothers die at home with neither the birth nor the death reported.

The campaign, which began on 12 April, is targeting 912,196 women of child-bearing age (15-45) in the governorates of Ibb, al-Dhalei, Lahj and al-Hudeidah. The first round is scheduled to run for five days; the second will start in May, and the third after six months.

Maternal and neonatal tetanus (MNT) killed at east 200,000 newborns and 300,000 mothers worldwide in 2001 alone. It is caused by unhygienic and unsafe childbirth practises. Tetanus bacteria can enter the infant at birth if the umbilical cord is cut with dirty instruments or if contaminated dressings are used.

According to a UN Children's Fund (UNICEF) document: "Once inside the body, the bacteria produce an extremely potent toxin, or poison, which attacks the nervous system causing spasms and tightening of muscles in the newborn's jaw and neck and later, in the back and abdomen. The baby's mouth grows so rigid that it becomes 'locked' (thus the name lockjaw given to tetanus) and the child will no longer be able to breastfeed, or ultimately, breathe. The fatality rate is high - between 70 and 100 per cent."

In adults, tetanus generally enters through an open wound or even a tiny pinprick. Women may be infected during deliveries carried out in unhygienic conditions. But the disease can easily be prevented. In the case of neonatal and maternal tetanus, prevention lies in immunising the mother and in conducting deliveries in hygienic conditions.

The campaign involves 575 fixed teams and 1,327 mobile teams. Some 3,804 health workers, mostly women, and another 456 supervisors, and is being funded by the government, UNICEF, the World Health Organization (WHO) and the Global Alliance for Vaccines and Immunisation (GAVI).

Surveillance

Ghadah al-Haboub, deputy head of the Ministry of Health's National Programme for Extensive Vaccination, said MNT surveillance was good up to 2005. "After that much emphasis was laid on combating polio and so tetanus surveillance lagged behind."

She said it was difficult to give exact figures on the number of people infected by the disease as not all tetanus cases were reported. "Our target is to eliminate neonatal tetanus by 2012," she added.

According to another UNICEF publication, "Neonatal tetanus is a marker of poverty and health-care inequity: Two thirds of the world's neonatal tetanus cases are in the poorest and least developed countries. The great majority of the countries that have yet to eliminate maternal and neonatal tetanus also rank among the 50 poorest countries on earth."

The UNICEF office in Sanaa said Yemen was among 47 countries in the world which have yet to eliminate MNT. In a statement on 13 April, it said countries such as Eritrea, Malawi, Namibia, Nepal, Rwanda, South Africa, Togo and Zimbabwe have already eliminated it.

"Tetanus threatens newborn babies and mothers during pregnancy and delivery, and vaccination against tetanus benefits them equally. We are determined to confer this much-needed protection on newborn babies, expectant and would-be mothers as a priority of our immunisation efforts," UNICEF country representative Aboudou Karimou Adjibade said.

Adjibade said Yemen urgently needed to reach women of child-bearing age as they are vulnerable to deadly diseases due to lack of effective ante-natal care and a lack of skilled birth attendants.

Low awareness

The Health Ministry's Al-Haboub said there was a lack of local awareness about tetanus: Most educated people thought the tetanus vaccine was only for pregnant women, while illiterate people had little or no idea about the disease.

"The vaccination is not effective if it is given to a pregnant woman in the last two months of her pregnancy," she said. According to her, in order to be immunised against tetanus, a woman needs five vaccines. The first vaccine does not give protection; the second vaccine (a month later) can give protection for three years; the third vaccine for five years; the fourth for 10 years; and the fifth gives protection for life.

"When a woman is pregnant, the vaccine reaches her baby through the umbilical cord. If the umbilical code is infected, then the baby's body is ready to resist neonatal tetanus," she said, adding that the vaccine had minor side-effects such as redness on the injection site and fever.

Home delivery

Al-Haboub said home delivery was one of the main causes of MNT. She said symptoms of tetanus start to appear three days after a child's birth. "The infected baby is unable to suckle or cry due to lockjaw. The pain develops into muscle stiffness, fever, muscle spasms in other parts of the body, and in the back muscles, leading to arching. The baby becomes unable to excrete," she said.

According to the UN Population Fund (UNFPA) office in Yemen, 84 percent of all births take place at home and only 20 percent of these births have skilled attendants present.

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