Dhir Shashi Kant, Dewan Pooja, Gupta Piyush
Department of Pediatrics, Guru Gobind Singh Medical College, Punjab, India.
Department of Pediatrics, University College of Medical Sciences, Delhi, India.
Res Rep Trop Med. 2021 Nov 23;12:247-261. doi: 10.2147/RRTM.S201989. eCollection 2021.
The maternal and neonatal tetanus elimination (MNTE) program was envisaged by the World Health Organization to overcome the mortality and morbidity caused by maternal and neonatal tetanus (MNT). Although preventable by simple cost-effective practices like universal immunization, clean delivery practices, and healthy umbilical cord care, as of date MNT is still prevalent in 12 developing countries of Asia and Africa. Definitive approaches need to be microplanned by these countries to successfully accomplish the three stages of MNTE, ie, achieving, validating, and sustaining. Once a country achieves MNTE, this status is required to be validated and sustained according to the high-risk and low-risk categorization of the districts. The three-pronged strategies for achieving and sustaining MNTE include (a) rigorous immunization of women of reproductive age with tetanus toxoid-containing vaccines, (b) strengthening of clean delivery services for pregnant women, and (c) effective surveillance for MNT. Although the deadlines for achieving MNTE globally have been missed many times, yet there has been a significant progress to date as evident by 80% reduction in countries requiring validation for MNTE (59 countries in 1999 to 12 countries in 2020). Huge strides have been made in the overall coverage of two doses of tetanus toxoid (13.79% to 65.27%), neonates being protected at birth (12% to 88%), global coverage of third-dose DPT (more than doubled), and reduction of 88% estimated deaths due to NT in the last four decades. Identification of the most vulnerable populations, systematic planning at all levels of health care, involvement of local community support, tackling the implementation gap, strong political will, good financial support, and continued robust surveillance will go a long way in achieving MNTE.
世界卫生组织设想了消除孕产妇和新生儿破伤风（MNTE）计划，以克服由孕产妇和新生儿破伤风（MNT）导致的死亡率和发病率。尽管通过普遍免疫、清洁分娩做法和健康的脐带护理等简单且具成本效益的做法可预防MNT，但截至目前，MNT在亚洲和非洲的12个发展中国家仍然普遍存在。这些国家需要精心制定明确的方法，以成功完成MNTE的三个阶段，即实现、验证和维持。一旦一个国家实现了MNTE，就需要根据各地区的高风险和低风险分类对这一状况进行验证和维持。实现和维持MNTE的三管齐下战略包括：（a）为育龄妇女严格接种含破伤风类毒素的疫苗；（b）加强为孕妇提供的清洁分娩服务；（c）对MNT进行有效监测。尽管多次错过在全球实现MNTE的最后期限，但迄今为止仍取得了显著进展，需要进行MNTE验证的国家减少了80%（从1999年的59个国家降至2020年的12个国家）便是明证。在两剂破伤风类毒素的总体覆盖率（从13.79%提高到65.27%）、新生儿出生时得到保护（从12%提高到88%）、全球第三剂白百破疫苗覆盖率（增加了一倍多）以及过去四十年中估计因新生儿破伤风导致的死亡减少了88%等方面都取得了巨大进展。识别最脆弱人群、在各级医疗保健层面进行系统规划、让当地社区支持参与、解决实施差距、坚定的政治意愿、良好的财政支持以及持续有力的监测，对于实现MNTE将大有帮助。
