The silent killer, otherwise known as maternal and neonatal tetanus, is a life-threatening bacterial infection in newborns and their mothers that is associated with nonsterile delivery and cord-care practices. Although it is vaccine-preventable, when tetanus develops, mortality rates are extremely high. This is especially true when the appropriate medical care is not available, which is often the case in low-income counties. In 1999, there were 57 countries where tetanus posed a considerable risk for women giving birth. Today, that number has dropped significantly, but maternal and neonatal tetanus remains a public health threat in 13 countries: Afghanistan, Angola, Central African Republic, the Democratic Republic of the Congo, Guinea, Mali, Nigeria, Pakistan, Papua New Guinea, Somalia, South Sudan, Sudan and Yemen.

Kenya has put in great effort to eliminate maternal and neonatal tetanus where it once was a common problem. The commitment the country made has drawn global attention and is inspiring other countries to do the same.

Kenya’s Initiative

As of 2018, Kenya has been removed from the list of countries that sees maternal and neonatal tetanus as a public health threat by attaining elimination status. Elimination is only attained when there is a reduction of neonatal tetanus incidences to below one case per 1,000 live births per year. Kenya’s progress towards achieving this important public health milestone began in 2001, proving that this process takes time. A pre-validation assessment took place in Kenya in September 201 by the Ministry of Health with the support of the World Health Organization (WHO) and UNICEF. A WHO-led validation process took place in 2018 to confirm the elimination of the disease.

Eliminating maternal and neonatal tetanus takes a lot of planning, and Kenya has set a great example. In 2002, Kenya introduced a five-dose tetanus toxoid vaccination schedule and in 2003, the country began to implement immunization campaigns in high-risk areas. Kenya also focused on providing free maternity services to increase skilled birth attendants. Over time, they began including tetanus toxoid vaccines into the routine antenatal care packages. Today, Kenya is still working on strengthening health facilities and resources and plans to provide free medical care to children under five years of age.

The involvement of schools is another factor that helped Kenya eliminate maternal and neonatal tetanus. Aliaphonse’s Katuit primary school is a prime example of the success seen from the campaign. Ann Talam, one of Katuit primary school’s teachers, explained in an interview with UNICEF that the campaign not only reaches members of the student body but also their sisters or relatives who may not attend school. Education ensures that all girls, even those from poverty-filled communities, are immunized.

Kenya’s Impact

Reducing deaths from neonatal tetanus is one of the simplest and most cost-effective ways to reduce the neonatal mortality rate. As of 2012, Kenya’s immunization coverage for newborns protected against tetanus reached 73 percent — and it continues to rise. WHO estimates a 94 percent reduction in neonatal deaths from 1988, when an estimated 787,000 newborn babies died of tetanus within their first month of life.

As Kenya eliminates maternal and neonatal tetanus, it has inspired the country to combat other diseases as well. They plan to identify the unreached and design an innovative approach to reach these populations with immunizations. On February 22, 2019, WHO representative, Dr. Rudi Eggers, addressed the recent measles outbreak in the country, attributing it to lapses in the routine immunization system since the previous measles and rubella outbreak in 2016.

“There is an urgent need for all stakeholders to come together and work to increase immunization coverage and address inequities,” Eggers said.

The Kenya campaign also aims to vaccinate nearly 14 million children between the ages of nine months and 14 years — nearly 40 percent of the population — for other common viruses.

Since Kenya’s elimination of maternal and neonatal tetanus, more than 153 million women around the world have been immunized with two or more doses of vaccines fighting against tetanus. The Eliminate Project, funded by the Kiwanis Children’s Fund, plans to learn from Kenya’s success and use it to inspire other countries to follow their lead. In 2018, The Eliminate Project raised a total of $502.282.72 to save and protect mothers and their babies worldwide.

Along with planning and taking initiative, Kenya recommends planning outreach activities for remote places, promoting delivery in health facilities and strengthening knowledge of health workers on the immunization schedule. Kenya sets an example of how small changes can overcome the silent killer of maternal and neonatal tetanus.

– Grace Arnold
Photo: Flickr