Major success in health sector

The announcement that India has eliminated maternal and neonatal tetanus (MNT) marks a major public health achievement. Prime Minister Narendra Modi made the announcement last week and the World Health Organisation (WHO) finally declared the country free of the health problem months before the target date set in December this year. MNT used to be a major killer of newborn infants and posed a threat to the life and health of mothers too. About two lakh children used to die of tetanus till a few decades ago but the number of casualties has been progressively coming down after the anti-tetanus programme was launched in 2003 as a public-private initiative with support from the WHO, Unicef and other agencies. Neonatal tetanus deaths result from unhygienic delivery practices and inadequate umbilical cord care. These in turn had much to do with lack of awareness of the need for institutional deliveries and of the facilities for them.

The fight against MNT involved several measures. A systematic scheme for vaccination of all pregnant women with tetanus toxoid was implemented but this would not have been enough. Families were given incentive for delivery of babies at health care facilities.

Institutional facilities had to be strengthened and extended to cover remote areas also. Personnel had to be trained to attend to deliveries in healthy conditions. An awareness programme was also launched about the need for healthy umbilical cord care practices. The National Rural Health Mission (NRHM) was used to implement the programme because it had to focus more on rural areas where facilities had to be set up or improved and awareness had to be created. It was more than a medical action limited to vaccination and was in fact, a social programme which involved changing of attitudes and practices.

The success of the programme should give no reason for complacency. It is a continuous programme and poses more challenges than in the case of the polio eradication programme, because it involves many uncertain situations and attitudes. It was babies born in poor and illiterate families who were most affected by neonatal tetanus infections and the programme has to continue its focus on these most vulnerable sections of the population. It should also be noted that the fight against neonatal tetanus has eliminated only one cause of the high rate of maternal and infant mortality rates in the country. Malnutrition and other factors also account for the large number of death of mothers and infants. But the success of the programme is an important landmark, after the eradication of polio in March last year.

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