Progress towards the global elimination of neonatal tetanus.

Neonatal tetanus (NT) can be effectively prevented through immunization and clean delivery practices. However, NT claimed the lives of over 433,000 infants in 1991. It is endemic in 90 countries throughout the world. Community-based neonatal tetanus mortality surveys helped to determine the true incidence of NT and revealed that, before immunization and clean delivery programmes were well established, approximately 1 million children contracted NT each year, of which 800,000 died. Mortality rates varied markedly by locale, ranging from 0 to 70 NT deaths per 1,000 live births. NT is still one of the most underreported notifiable diseases, and routine reporting systems identified only 4% of the NT cases estimated to have occurred in 1990. Based on WHO estimates, tetanus toxoid (TT) immunization and clean delivery practices prevented over 793,000 infant deaths in 1991. Of the 433,000 infants who died of NT that year, approximately 212,000 died in South-East Asia; 127,000 in Africa; 46,000 in the Western Pacific; 37,000 in the Eastern Mediterranean; and 1,300 in Europe. The Pan American Health Organization, using a separate methodology to estimate mortality, calculated that 10,500 newborns died of NT in the Region of the Americans. NT consistently clusters in geographical areas and population groups where shared practices or the environment enhance the risk of cord contamination. 80% of the newborns who died of NT in 1991 were born in South-East Asia or Africa. Of the 90 countries endemic for NT, 10% produce 80% of the world's NT deaths. NT also clusters at country level.(ABSTRACT TRUNCATED AT 250 WORDS)