Life & Style | Health
Saving lives
Four cents. That is the cost of a vaccine that can prevent tetanus. But despite efforts by the United Nations Children's Fund (Unicef), a newborn dies of the disease every three minutes.
- By Carolina D'Souza, Lifestyle Features Coordinator
- Published: 00:18 September 19, 2008
- Image Credit: UNICEF/2007/Pirozzi
- A local woman in Mali is administered a dose of tetanus toxoid (TT) the intramuscular way. Three doses of TT provide at least 15 years of protection to cover the child-bearing years.
Unicef-trained vaccinators will travel on foot or animal back to reach some of the most remote areas in the world such as the salt mines in the desert of Mali and Niger to immunise women of childbearing age against tetanus.
The lack of a reliable transportation infrastructure is only the first hurdle. They'll have to overcome cultural, psychological and social constraints
as well.
They have to deal with caretakers like fathers, husbands or traditional leaders of the community who may be in conflict with or have suspicions about immunisation. They have to guide women who refuse to be immunised by a man or a stranger. They also have to convince ostracised ethnic minorities of the immunisation benefits.
Even after quelling fears and misconceptions, there are instances where nobody shows up. This explains why a newborn dies of tetanus every three minutes and 500,000 cases of this disease are still registered worldwide every year, according to the World Health Organisation (WHO) and Unicef. This is aside from the unreported figures of tetanus-related deaths in the developing world.
Tetanus doesn't have a cure and less than 20 per cent of patients survive. Yet prevention is simple. A vaccine called tetanus toxoid (TT), which is part of routine immunisation and costs about four cents through Unicef, has been available for the past 80 years. But the statistics are still cause for alarm.
Patients are often from high-risk rural areas of Africa, South and East Asia, beset with dominant issues of poverty, inadequate healthcare infrastructure, poor hygiene, low socio-economic status and illiteracy.
"Tetanus can be prevented and eliminated through vaccination. A woman of childbearing age who has been immunised with two doses at an interval of at least one month, will develop anti-tetanus antibodies that will be passed on to the foetus and protect the baby for the first two months of his or her life," says Saudi-based Dr Ayman A Abu Laban, the Unicef representative in the Gulf.
Dr Ayman joined UNICEF in 1995 and has since worked in Jordan, Libya and Pakistan before moving to Riyadh. In 2005 he worked for the Arab Council for Childhood and Development (ACCD) in Cairo.
His role is to liaise with governments, high authorities and other partners to put together policies and programmes to protect and support children and ensure that countries meet the priorities of the Convention on the Rights of
the Child.
The Gulf campaign was launched in July with the aim of building on the success of the global Maternal and Neonatal Tetanus Elimination Initiative that was re-introduced in 2002 by Unicef, WHO and the United Nations Population Fund (UNFPA).
Cause and extent
Tetanus is caused by the bacterium Clostridium tetani, the spores of which are widespread in the environment, including soil. The disease is caused by the activation of a potent neurotoxin produced during the growth of the bacteria in an infected wound or in an umbilical stump.
The bacterium grows in dead tissues like dirty wounds caused by soiled nails, knives, tools, wood splinters and animal bites or in the umbilical cord if it is cut with an unsterilised instrument.
Tetanus is common among people of all ages and is particularly serious in newborn babies who may exhibit fatal symptoms between three to 14 days.
All deaths occur between three and 28 days after birth.
The disease in newborn babies is called neonatal. In women during or up to six weeks of pregnancy, it is called maternal. It is also referred to as MNT (Maternal and Neonatal Tetanus).
"Neonatal cases are higher," says Dr Ayman, explaining that home deliveries take place in unsanitary conditions where the umbilical cord is cut with unsterilised instruments or treated with contaminated dressings. In addition, post-delivery practices are unsafe and terminations are done with inadequately sterile procedures.
"If the newborn gets infected, one of the first symptoms is the tightening of the jaw and facial muscles. This makes feeding difficult. The baby's body may stiffen or convulse when stimulated by light, sound or touch. Eventually, he or she may be unable to breathe," he says.
The disease, says Dr Ayman, is characterised by muscle spasms that attack the nervous system, cause generalised seizure-like activity or convulsions and lead to death in most cases. And because the bacterium exists in the environment, "it cannot be eradicated like polio."
Unicef initiatives
The initiative to eliminate tetanus was first set by The World Health Assembly in 1989. Then in 1999 and 2002 the goal was re-formulated to eliminate the disease from 58 countries where it was still a public health problem. As of June this year, 12 countries achieved MNT elimination, leaving another 46 where treatment is to be continued.
MNT elimination in a country is defined as neonatal tetanus rate of less than one case of neonatal tetanus per 1,000 live births in every district of the country.
There has been a dramatic reduction in annual newborn deaths from 215,000 in 1999 to approximately 140,000 in 2004. And more than 80 million women of childbearing age have been immunised with at least two TT vaccines.
Unicef is the world's largest provider of vaccines for developing countries. The organisation supports child health and nutrition, good water and sanitation, quality basic education and protection of children from violence, exploitation and HIV/Aids. The Unicef initiative focuses on finding viable means to fund and deliver vaccines on a routine basis.
"We procure and deliver the TT vaccines and injection supplies for the various campaigns. We maintain the cold chain, educate health workers and offer technical support to immunisation programmes. We also promote hygienic delivery through health education and stress the need for the upgrade of delivery equipment," says Dr Ayman.
– Carolina D'Souza is Lifestyle Features Coordinator, Friday
More from Health
More from Life & Style
The complete magazine
Life & Style editor's choice
-
Ten simple ways to love yourself
Just a few small changes to your day can make a big difference
-
Style story: Make waves with beachwear
Life's a beach in this summer's gorgeous new swimwear
-
2012 Ford Focus: Smashingly good
The all-new Focus turned Imran Malik Hulk-green with rage at one point
