India declared free from maternal and neonatal tetanus

In yet another major achievement, India has been declared free of maternal and neonatal tetanus. 

Calling it a "significant public health milestone", the World Health Organization (WHO) congratulated Indian health workers for achieving the feat which comes almost a year after the country eliminated the scourge of polio.

India was finally declared free of maternal and neonatal tetanus on May 15, 2015. WHO Deputy Regional Director for South East Asia Poonam Khetrapal Singh said Nagaland was the last Indian state to achieve maternal and neonatal tetanus elimination.

In 1990 neonatal tetanus accounted for almost 80,000 deaths. India was finally declared free of maternal and neonatal tetanus on May 15, 2015.

She said the launch of the National Rural Health Mission in 2005 helped to facilitate safe deliveries by training auxiliary nurse midwives and other trained birth attendants who work at the village level.

Polio eradication in India had acted as a model to follow for health workers. "Since 2012, the Government of India has been applying the best practices of polio eradication for routine immunisation strengthening, focusing on areas with low immunisation coverage," she added.

In 1983 the Indian government introduced two doses of tetanus toxoid vaccine to all pregnant women during each pregnancy as nationwide expanded programme on immunisation. But in 1990 neonatal tetanus still accounted for almost 80,000 deaths, said UNICEF. But Poonam pointed out that in 2013 and 2014 fewer than 500 cases were reported.

New Delhi's All India Institute of Medical Sciences (AIIMS) neonatology professor Dr Vinod Paul expressed happiness over the achievement and added that he was proud that India had eliminated a disease that was at one point of time responsible for almost 15% of neonatal deaths in the country. "This is truly a huge goal because at one point in time there were tens of thousands of deaths due to maternal and neonatal tetanus," he said.

He cited three reasons why he believed India had achieved the goal. "First and foremost, maternal tetanus immunisation rates have gone up. They are not universal, but they are very high," he said.

"Secondly, we introduced cash incentives for institutional deliveries; and lastly, delivery kits that reduce contamination along with safe umbilical cord practices have been important. In the last seven years, facility births have increased, even in rural India. We have moved from homes where deliveries are unhygienic to facility births where we are dealing with nurses and doctors where there are greater chances of better care and practices," he added.

The elimination of neonatal tetanus is defined as less than one case in 1000 live births in every district across the country, said the WHO.

The disease usually occurs in newborns through infection of the unhealed umbilical stump, especially when the stump is cut with a non-sterile instrument. Maternal tetanus is considered eliminated once neonatal tetanus elimination has been achieved.

WHO had on March 27, 2014 officially declared India 'Polio Free'.

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