Neonatal tetanus: review of progress.

The target set for elimination of neonatal tetanus (NT) is less than one case par 1000 live births in every district of the world. NT will then be considered to have been removed as a major public health problem and fewer than 150 000 cases are expected to occur annually worldwide if the achievements are maintained. It is estimated for 1993 that over 700 000 neonatal deaths due to tetanus were in fact prevented by maternal immunization and clean delivery practices. About 480 000 (70%) of them were averted in only three countries: India, Bangladesh and Indonesia. Meanwhile, 91 others already have an estimated NT rate below 1 per 1000 live births nationwide. Of these, 50 countries may already have achieved the target in each of their districts. According to 1993 estimates half a million newborn deaths due to tetanus are still occurring worldwide, 80% of them in 12 countries. Out of 14 others where NT remains a major public health problem, 12 are in the African Region. Together, these 26 countries contribute 90% of the global incidence of NT. By 1995, major strides towards the elimination of NT can be made by using the high risk approach and immunization, including organizing Days of Tranquility where necessary. But for this to be accomplished, there must be sufficient political commitment and financial support of some US$ 30 million to carry out the program in the 26 priority countries.