Thinking about neonatal tetanus

I like this definition / description of neonatal tetanus, borrowed from Ehiopia reports ….

When a newborn is infected by tetanus during the first 28 days of life it is called neonatal tetanus (NT). When a woman delivers her baby in unsanitary conditions, a newborn baby may become infected if a contaminated knife, razor or any other sharp instrument is used to cut the umbilical cord. Infection may also occur if cow dung or ash is used to dress the stump; it is contaminated by soil or it enters the baby’s navel. If the hands of the person
delivering the baby are not clean infection may occur. Infants and children may also contract tetanus when dirty instruments are used for circumcision, scarification and skin piercing, and when dirt, charcoal or other unclean substances are rubbed into a wound. Newborns with neonatal tetanus usually die a painful death. Typically, an apparently healthy baby will stop nursing after a couple of days due to lockjaw, developing stiffness,
arching of the body and violent convulsions. Ultimately, breathing becomes difficult, spasms occur more frequently, and in 70 to 100 percent of the cases, infants die a tortuous death.

Neonatal tetanus, an entirely preventable disease, kills about 200,000 infants in the first month of life. Ninety percent of these deaths occur in 27 developing countries, making this disease a leading cause of death in the poorest part of the world. However, the disease is largely invisible, because most of the deaths occur at home before the baby reaches two weeks of age. Oftentimes, neither the birth nor the death is reported. Maternal tetanus is responsible for at least 5% of maternal deaths, approximately 30,000
deaths annually (Faveau, 1991) with an astonishing 100 million women at risk, despite the fact that it can be easily prevented through immunization.  [NOTE: I’m not certain as to what year these numbers are from, as the report from which I borrowed this paragraph did not have a published date on it … ]

The WHO approach to dealing with neonatal tetanus is to recommend that all pregnant women receive three (with five being optimal) doses of tetanus vaccine.  !!!! WOW !!!!  I love that tetanus is preventable, but I do not love the idea of trying to get every woman multiple doses of a vaccine in pregnancy.  Some areas have been successful in implementing this approach. Kudos!  But, as always, reality reality reality … and going back to the practices of the traditional birth attendants.  Rather than treating the symptom (infection), why not treat the problem (unclean birth practices) … teach TBAs how to severe cords in a sanitary manner, provide them with a method of cutting the cord.   Clean birth kits !!! GET CLEAN BIRTH KITS AND THE TRAINING TO USE THEM INTO THE HANDS OF THE MIDWIVES !!!

Neonatal tetanus (well, tetanus in any person) is a horrible disease. I weep when I think of the pain the babies are in and their inability to understand why they hurt so badly.  Hundreds of thousands of babies are affected by tetanus each year.  How many of those hundreds of thousands could be spared the pain and (typically) death of this disease if we could get the tools and training into the hands of those amazing women and men who are attending the births. Pictures, basic supplies.

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