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India Virtually Eliminates Tetanus as a Killer

India Virtually Eliminates Tetanus as a Killer

A year after eliminating polio, India has scored another public health victory. Following a 15-year campaign, the country has virtually eliminated tetanus as a killer of newborns and mothers.

Tetanus, caused by a bacterium common in soil and animal dung, usually infects newborns when the umbilical cord is cut with a dirty blade. Mothers often receive the infection by giving birth on dirty surfaces or being aided by midwives with unwashed hands.

The disease — also known as lockjaw, after its muscle spasms — usually sets in about a week after a birth and is invariably fatal if not promptly treated. Fifteen years ago, the World Health Organization estimated that almost 800,000 newborns died of tetanus each year; now fewer than 50,000 do.

But the effort to reduce tetanus has gone slowly. The World Health Assembly — the annual gathering of the world’s health ministers in Geneva — originally set 1995 as the target date for its global elimination as a health threat.

Unlike polio or smallpox, tetanus can never be eradicated because bacterial spores exist in soil everywhere, said Dr. Poonam Khetrapal Singh, the director of the W.H.O.’s Southeast Asia region.

India has reduced cases to less than one per 1,000 live births, which the W.H.O. considers “elimination as a public health problem.” The country succeeded through a combination of efforts.

In immunization drives, millions of mothers received tetanus shots, which also protect babies for weeks.

Mothers who insisted on giving birth at home, per local tradition, were given kits containing antibacterial soap, a clean plastic sheet, and a sterile scalpel and plastic clamp for cutting and clamping the cord.

The country also created a program under which mothers were paid up to $21 to give birth in a clinic or hospital. “Lady health workers” from their neighborhoods were paid up to $9 per mother and up to $4 for bus or taxi fare to make sure women in labor went to clinics. The workers earned the full amount only after visiting each baby at home and giving tuberculosis shots.

The program succeeded despite corruption. The Times of India recently reported that an audit had found clearly fraudulent payments — including some to a 60-year-old woman registered as having been pregnant five times in 10 months.

SOURCE: THE NEW YORK TIMES

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