Eliminating maternal and neonatal tetanus in Sierra Leone

December 13, 2011
I was in Sierra Leone recently with Kristi Burnham, Vice President of Program and Strategic Partnerships at the U.S. Fund for UNICEF, and a group of donors and staff members from Kiwanis International to see first-hand the last leg of efforts to eliminate maternal and neonatal tetanus (MNT) throughout the country. Virtually unknown in the industrialized world, the disease is typically contracted through unhygienic childbirth practices in some of the poorest and most marginalized places on earth.

Delegation members attend an educational session about MNT in Sierra Leone. | © 2011 UNICEF/Sierra Leone/Thomas

In the United States, effective immunization programs and safe birthing practices have enabled deaths from tetanus to become a relic of history.  However, in countries where vaccination is not widespread, maternal and neonatal tetanus still claims the lives of nearly 60,000 babies and a significant number of women each year. Kiwanis International has joined forces with UNICEF for The Eliminate Project, which aims to protect every woman of child-bearing age and her newborns against maternal and neonatal tetanus in 38 countries where the disease is still a public health problem. UNICEF and its partners will accomplish this by immunizing women of reproductive age, providing vaccinations to pregnant women during antenatal care visits or outreach services, promoting clean delivery and cord care practices, and increasing the number of births attended by skilled attendants. Kiwanis International is joining many other public and private partners to provide the final push for global MNT elimination by raising the US$110 million necessary to accomplish this goal by 2015. During our week in Sierra Leone, we witnessed the third round of tetanus immunizations this year targeting more than half a million women in the five most at-risk districts across the country—no small feat in a nation struggling to rebuild after a decade of brutal civil war that killed tens of thousands of people and destroyed critical infrastructure. These immunization efforts were incorporated into the national Maternal and Child Health Week, or “Mami en Pikin Welbodi Week,” as it’s known in Krio, the local language. Sierra Leone is consistently ranked as one of the most dangerous places for a woman to be pregnant and a child to be born. Part of the reason is that so many deliveries in Sierra Leone are still done by unskilled birth attendants, mainly at home. However, a series of three tetanus vaccine doses administered to a woman is all that is needed to protect her and her newborns from the ravages of this terrible disease. We visited some of the country’s most remote districts to see how UNICEF and its partners are reaching the hardest to reach. We saw how the vaccinations are transported—often for hours on bicycle or motorbike over unpaved roads—to distant health units, watched vaccinators being trained, and witnessed women being immunized in clinics and schools. We also followed health workers door-to-door as they sought out women who had not yet been vaccinated and encouraged them to do so at their local clinics. Amazingly, this entire supply chain—vaccinations, syringes, safe storage, transportation, health worker training, and more—costs as little as US$1.80 per woman. Just five years ago, tetanus was the cause of more than one in five newborn deaths in Sierra Leone. This year, there have been only two reported deaths from neonatal tetanus throughout the entire country, meaning that MNT is literally on the brink of elimination.  To witness such remarkable progress was heartening, and it served as a reminder of how so many lives can be saved in such a short period of time. Sierra Leone is on the precipice of a truly historic achievement—one that The Eliminate Project is seeking to repeat in every last country where MNT remains a threat.