Neonatal tetanus in the world today.

Neonatal tetanus is an important cause of avoidable morbidity and mortality. In the past this disease was overlooked by the health services of many developing countries, but recently the extent and magnitude of neonatal tetanus has become clearer and shown that it is a very serious health problem in the developing countries. The results of community-based surveys show that neonatal tetanus mortality rates range from less than 5 to more than 60 per 1000 live births; these deaths represent between 23% and 72% of all neonatal deaths. The results so far suggest that this disease claims the lives of over half a million new-born children every year. All forms of tetanus, and especially neonatal tetanus, remain substantially under-reported in many countries, and routine reporting systems identify only about 2-5% of the estimated number of tetanus cases (based on the results of community surveys). More reliable and accurate estimates of the incidence and mortality from tetanus are therefore required.The elimination of neonatal tetanus is an essential and attainable goal. It may be achieved by combining two approaches: (1) increasing the immunization coverage of women of child-bearing age, and especially pregnant women, with tetanus toxoid, and (2) improving maternity care, with particular emphasis on increasing the proportions of deliveries that are attended by trained persons.Neonatal tetanus mortality should serve as an index of the quality and the extent of utilization of the maternal health services, of the impact of immunization programmes, and of the progress being made in achieving the WHO goal of "Health for All by the Year 2000".The elimination of neonatal tetanus calls for a full commitment by governments and by other bodies, public and private, with a responsibility for the care of women and children. The occurrence of even a single case of neonatal tetanus is witness to failures in the health system, for prevention is possible through the actions of trained health staff in contact with the mother.