China achieves maternal and neonatal tetanus elimination
On 30 October 2012, the World Health Organization (WHO) confirmed that China has successfully eliminated maternal and neonatal tetanus.
WHO considers neonatal tetanus to have been eliminated when the incidence is <1 case/1000 live births in every district in a country. Maternal tetanus is considered to be eliminated when neonatal tetanus has been eliminated.
Following a comprehensive risk assessment exercise carried out in July 2012 that included all prefectures ("district" level), community-based validation surveys were conducted this month by China's Health Authorities with support from WHO and the United Nations Children's Fund (UNICEF) in two prefectures: in Hechi (Guangxi Zhuang Autonomous Region) representing the western group of provinces and in Jiangmen (Guangdong Province) representing the eastern group of provinces. These prefectures were chosen for survey through an extensive review process that indicated they were most likely to have the highest neonatal tetanus disease burden.
A total of 103 survey teams composed of interviewers and local guides, supported by 27 supervisors and 12 national and international monitors, visited 45 088 households and investigated 2306 live births. No neonatal tetanus case or death from tetanus was discovered in either survey, confirming that maternal and neonatal tetanus has been eliminated as a public health problem in these prefectures and therefore in prefectures with lower risk of neonatal tetanus; as well as China as a whole.
The primary strategies in China for eliminating maternal and neonatal tetanus are implemented through the Maternal and Child Health programme through improved antenatal care and promotion of clean and institutional deliveries. This approach is supported by upgrading infrastructure and equipment in county and township hospitals improving skills of obstetrical staff at each level, subsidizing hospital delivery in poor areas, providing transportation to hospitals in remote areas as well as through health education and social mobilization.
Since China began its intensive promotion of hospital delivery in 2000, nearly all babies (98% in 2011) are now born in hospitals compared to 65% when the programme started. The validation survey found that hospital-delivery rates among the 1441 women interviewed was 99%. Antenatal care coverage (more than one visit) increased from 86% to 94% in the same period. Subsequently, the maternal mortality rate decreased from 53/100 000 live births in 2000 to 26/100 000 in 2011. Mortality rates among neonates (deaths within the first month of life) fell by almost two thirds.
In addition to the maternal and child health efforts, the Expanded Programme on Immunization (EPI) contributes to protection against tetanus through routine vaccination of infants and children. Both programmes conduct surveillance for neonatal tetanus.
“The achievement came as a result of a number of different programmes in the Ministry of Health, other government sectors and partners working together for a joint goal; to improve the health of mothers and children and enhance the wellbeing of families and communities” said Dr Michael O’Leary, WHO Representative in China. “The focus of the safe motherhood programme in the less advantaged areas of the country is another example of political commitment to improve the health of all people in China; no matter where they live.”
Dr O’Leary continued “maternal and neonatal tetanus elimination does not mean that activities can stop, rather it is the start of a new phase to sustain elimination through continued strong government commitment to the leadership of the maternal and child health programme.”