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  • Title: Control of neonatal tetanus in India.
    Author: Sokhey J, Bhargava I.
    Journal: Indian Pediatr; 1984 Jul; 21(7):515-9. PubMed ID: 6519778.
    Abstract:
    Neonatal tetanus (NNT), a disease preventable by immunization, is a major problem and a leading cause of neonatal mortality. Sample surveys were organized in 1981 and 1982 by the Directorate General of Health Services in India, in collaboration with the state health authorities, to collect reliable baseline data on NNT. The surveys were carried out by the 30 cluster sampling technique. Rural and urban populations were surveyed separately. The survey was conducted by restrospective house to house visits. In each unit, a sample of 2000 live births was studied; 67 live births being recorded in each cluster. Based on the survey results, it is estimated that 2.3-2.5 lakh infants died within the 1st month of life due to NNT during 1981; nearly 2/3 of these were in Uttar Pradesh. Although the NNT mortality rates varied from state to state, they were consistently higher in the rural areas. Tetanus as a cause of neonatal deaths ranged from 0-68.7% in the urban areas and from 16.4-72.5% in the rural areas. The control of tetanus in general and neonatal tetanus, in particular, is receiving a high priority in the government programs. 2 major programs are in operation for the prevention of NNT in the country -- the immunization of pregnant women with tetanus toxoid vaccine (TT) under the expanded program on immunization (EPI) and the training of dais under the rural health program. NNT will be prevented if the women and the dais (who are still associated with almost 70-75% of the deliveries in many areas with high NNT mortality rates) are convinced of the need for TT vaccination during the antenatal period and practice the basic principles of cutting cord and keeping the umbilical stump free of unclean dressings. The vaccination of pregnant women was started as a national program in 1975-76 with a modest coverage of 14.5 lakhs. The number of pregnant women given either 2 or a booster dose in 1982-83 had risen to 74.0 lakhs. The plan is to cover 110 lakhs pregnant women in 1983-84 and 130 lakhs in 1984-85. Besides the vaccination of pregnant women, TT immunization services are provided to infants and children. Since the protection received from the mother will last only for a few months, infants are given TT as a combined vaccine with diphtheria toxoid and pertussis vaccine (DPT) at 3 months of age. The immunization program is a part of primary health care and the services are provided through the existing health delivery systems. The vaccination services are available at the hospitals, maternal and child health clinics, and dispensaries in the urban areas and in the primary health centers and the subcenters in the rural areas. The effectiveness of the control measures will be evaluated by determining the vaccination coverage of the eligible population and by the documentation of the reduction of NNT mortality rates in the area.
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