UN declares Myanmar free of maternal and neonatal tetanus

Years of persistent efforts to vaccinate all pregnant women in Myanmar against maternal and neonatal tetanus have borne fruit with the country now declared free of the disease, the second East Asian nation to have achieved that milestone status, the United Nations Children’s Fund (UNICEF) reported today.

“The achievement came as a result of joint efforts of all the partners collaborating with the Ministry of Health, who worked hard for many years to reach this stage,” said Ramesh Shrestha, UNICEF Representative in Myanmar. “But it is also a reminder that the momentum needs to be sustained and routine immunization must be further strengthened to ensure maintenance of the elimination status,” he added.

Myanmar’s status as a maternal and neonatal tetanus elimination country was confirmed last month by international experts through a process led by the UN World Health Organization (WHO). Viet Nam is the only other country in the region to have achieved that status.

The achievement followed Myanmar’s systematic efforts for several years to reach all pregnant women with tetanus toxoid (TT) vaccines and making provisions for safe and clean deliveries throughout the country, as well as conducting extensive supplemental TT immunization activities with strong support from UNICEF since 1999 that targeted women of child-bearing age.

The status validation process included a community-based survey of neonatal mortality rates due to tetanus in all children born from April 2009 to April this year in the townships selected for the survey.

The community-based survey used standard WHO methodology and was conducted in the townships of South Okalappa (Yangon Division), Singaing (Mandalay Division) and Saw (Magway Division). The townships were chosen for survey through an extensive review process that indicated they were likely to have the highest maternal and neonatal tetanus burden.

On 18 May, the results of the survey revealed that neonatal tetanus mortality was reduced to less than 1 case per 1,000 live births in the surveyed townships. The survey confirmed that the disease has been eliminated as a public health problem in those townships, as well as Myanmar as a whole.

Neonatal tetanus is a form of generalized tetanus affecting infants during the first month of their life and is estimated to cause approximately 59,000 deaths per year worldwide. Maternal tetanus has a similar nature and affects women during pregnancy and, more often, following unclean deliveries and abortions. Since both share the same risk factors and means of prevention, neonatal tetanus elimination acts as proxy for maternal tetanus eradication.

Between 1999 and 2006, some 6.7 million women of child-bearing age in Myanmar were targeted and more than 80 per cent of them were protected with two doses of TT. In 2007, review of relevant health indicators led to the identification of 60 and 27 townships respectively for receiving one and three rounds of intensified TT immunization activities for about 3 million women of child-bearing age. In 2008 and 2009, the targeted areas were further narrowed down and corrective supplementary immunization was administered in seven townships. The final 1 million eligible women were reached by additional mass TT campaigns.

While the validation of maternal and neonatal tetanus elimination status by WHO experts is an important milestone, the partners will now need to make sure that this status is maintained. The Ministry of Health has already developed plans to sustain the elimination status by maintaining high protection levels against tetanus in mothers and newborns and controlling chances of contracting tetanus during and after delivery and birth.

Despite the progress made since the late 1980s, maternal and neonatal tetanus continues to be a public health problem in many developing countries and can account for a considerable proportion of maternal and neonatal deaths in high-risk areas. Since 2000, 18 countries have eliminated the problem. Elimination efforts will now focus on 40 other countries.