India is free of Maternal and Newborn Tetanus

What's the news?

• India has successfully eliminated maternal and newborn tetanus (MNT), an infection that at its peak killed some two lakh infants and women in the country
• Describing the achievement as yet another health milestone for India after eradication of polio last year, the PM paid rich tributes to the UPA government’s flagship programme the National Health Mission (NHM). (good example to quote)
• 52% of India’s under-5 mortality is contributed to by deaths of newborns in the first month of life. Under NHM, our approach emphasises a continuum of newborn care both at the community and facility level 

Details about Tetanus

• What is maternal and newborn tetanus? 
• Tetanus, infection by the bacterium Clostridium tetani, can occur whenever there is an open wound in the body. 
• A newborn, or the mother, can be infected due to unhygienic birthing practices — such as the use of unsterilised instruments or operating tables, or contaminated dressings. 
• It is one of the biggest causes of maternal and newborn mortality — and also one of the earliest identified causes of such deaths. It finds mention even in the Old Testament as the “seventh day death”. 

• What are the symptoms? 
• The first signs appear when the facial and jaw muscles of an apparently healthy baby begin to tighten, and the newborn has difficulty in feeding.
• Finally, the newborn may no longer be able to breathe because of the tightening of respiratory muscles. 
• 70% to 100% of deaths occur between three days and 28 days after birth

• What does Maternal and Neonatal Mortality Elimination (MNTE) mean? 
• It is defined as fewer than one neonatal tetanus case per thousand live births per year in every district of a country. 
• All districts have to meet that target for a final certification. 
• In India, the last four states/UTs that had laggard districts were Jammu and Kashmir, Nagaland, Meghalaya and Dadra and Nagar Haveli. All of them cleared a joint inspection by WHO and UNICEF earlier this year. 

• What was the extent of India’s MNT challenge? 
• At its peak, MNT was said to be responsible for the deaths of an estimated two lakh adults and children every year. 
• In the second half of the last decade, it was in the 50 per 1,000 live births bracket. 
• NHM, ASHA and JSY played important role in this
• Mandatory tetanus vaccination of pregnant women under universal immunisation programme (UIP) has helped. 
• Over the last few years, even as the figure was decreasing, MNT accounted for 15% of maternal and neonatal deaths in India. 

• What is the global picture on MNT? 
• In the late 1980s, the estimated annual global neonatal tetanus mortality rate was approximately 6.7 NT deaths per 1,000 live births — clearly a substantial public health problem. 
• In 1989, the 42nd World Health Assembly called for elimination of neonatal tetanus by 1995. 

• How far is the world from MNTE? 
• India certified in June 2015
• Now 22 countries in world are left which have not met the MNTE goal. 

NHM, JSY, JSSK, MCTS, SBA and BBBP

• Launched in 2005 as the National Rural Health Mission (NRHM) by then PM Manmohan Singh.
• NHM came into existence through a Cabinet decision in 2013 and NRHM was subsumed in it. 
• PM did make references to his own pet projects like Swacch Bharat Abhiyan and Beti Bachao, Beti Padhao, 
• He also praised several other UPA initiatives, including Janani Suraksha Yojana (JSY) and Janani Shishu Suraksha Karyakram (JSSK). 
• JSY gives incentives for institutional deliveries
• this helped in 75% institutional delivery rate
• JSSK provides free health care to every woman delivering in a public health institution as well as the newborn. 
• Modi also praised the Maternal and Child Tracking System (MCTS) that tracks vaccination and other needs of mother and child through the mobile phone network. 

General things

• All above was declared at 3rd Global Call to Action Summit 2015, being hosted for the first time in India, and outside the US.
• Significantly, Polio and MNT elimination successes owe to systems rather than scientific innovation. 

How was Polio eradicated?

• The polio eradication programme is a global initiative led by the WHO and last case was reported a case in 2011 - This is the result of the cumulative work of a legion of health workers, educators, activists and government staffers, working for over two decades in the oral polio vaccine programme, which was run as efficiently and diligently as an election or a census, and vaccinated 172 million children under the age of five. 
• It was a social rather than medical project, in the sense that the children administered the oral vaccine were not themselves completely protected from polio, but over time, the community as a whole was rendered immune to the disease. 

Elimination of MNT

• India has been rid of MNT by NHM using a similar strategy that focused on the administration and delivery of health instead of relying on technical innovation. 
• Pregnant women were given tetanus toxoid, but other measures aimed at behavioural change. 
• Cash incentives for delivery in formal health facilities ensured the basic guarantee of sanitation barriers, the aid of trained attendants and the possibility of referral to better-equipped centres, if necessary. 
• At the same time, a strong communications programme discouraged unhealthy practices involving the care of the severed umbilical cord, which was a frequent source of infection. 
• This victory over an old killer is also an equaliser, since MNT struck the most vulnerable families — poor, illiterate, unaware of basic preventive health practices and without access to formal health services. 
• A study released by the medical journal Lancet in early August had shown that the death rate in India increases with the distance that patients have to travel to the nearest health centre. That access to healthcare increases the quality and expectancy of life was always known anecdotally. Significantly, while announcing the end of MNT, the PM had also drawn attention to 184 districts with the poorest health outcomes. 
• He announced that the government had identified 184 poorest performing districts in terms of health outcomes where special efforts will soon be made to dedicate resources in focussed programmes.

What next

• Indeed, district-level infrastructure development, skilling and outreach could power the next wave in healthcare. 

Reference: The Indian Express