1. Tetanus Toxoid MICS3 Data Analysis and Report Writing Workshop

2. International Goals & Targets MDG 5: Reduce by three quarters the maternal mortality ratio Strategy: Elimination of maternal and neonatal tetanus Target: Reduce incidence of neonatal tetanus to less than 1 case of neonatal tetanus per 1000 live births in every district

3. International Goals & Targets By 2005, Reduction in infant and under-five mortality rate by at least 1/3, in pursuit of the goal of reducing it by 2/3 by 2015 Eliminate maternal and neonatal tetanus by 2005

4. Background Caused by tetanus spores, a bacteria found everywhere in the environment Transmission occurs when there is contact with broken skin such as an infants umbilical cord Poverty, poor hygiene and limited access to health services increase the risk for transmission during childbirth

5. Background Prevention is possible by: 1. Immunization of pregnant women with at least 2 doses of tetanus toxoid vaccine (TT2+), passing protection to the newborn for up to first two months of life 2. Immunization of women of childbearing age who live in areas of high risk for transmission (delivery of immunizations usually through campaigns) 3. Promotion of clean delivery and cord care practices

6. Background Deaths of children by cause for vaccine preventable diseases (As of March 2004; source WHO) Cause 2002 Under 5 Over 5 Diphtheria4,0001,000 Measles540,00071,000 Poliomyelitis.. Tetanus (excluding NT)18,00015,000 Neonatal Tetanus180,000.. Pertussis294,000… Yellow Fever15,000 Haemophilus Influenzae B413,000… Total 1,464,000102,000

7. Note: The boundaries and the names shown and the designations used on these maps do not imply official endorsement or acceptance by the United Nations. MNT not eliminated Countries with TT campigns MNT eliminated * includes Timor-Leste 248,000 200,000 180,000 Neonatal Tetanus death reduction Situation of Maternal and Neonatal Tetanus (Remains a problem in 48 countries)

8. Indicator Neonatal tetanus protection (protection at birth against tetanus) NumeratorNumber of mothers of live births in the previous year with at least two doses of TT within appropriate interval prior to infants birth DenominatorTotal number of women surveyed aged 15- 49 years with a birth in the year preceding the survey

9. Methodological issues -Data collected for all births during the 2 years before the survey – indicator includes only those during the last one year -Complex algorithm for the estimation of the numerator

10. Methodological issues otwo TT doses during the pregnancy (TT3>=2) oone TT dose during the pregnancy and at least one TT dose prior to the pregnancy (TT3=1 AND TT6>=1) oat least two TT doses prior to the pregnancy of which the last dose was less than 3 years before the birth owith 3 doses within the 5 years before the pregnancy owith 4 doses with the last dose less than 10 years before the pregnancy owith 5 doses or more ever (TT6>=5).

11. Country data – CEE/CIS Neonatal tetanus protection (%), 2004 Turkey 41%

12. Country data – Eastern and Southern Africa Neonatal tetanus protection (%),2004

13. Country data – West and Central Africa Neonatal tetanus protection (%), 2004

14. Country data – MENA Neonatal tetanus protection (%), 2004

15. Country data – LAC Neonatal tetanus protection (%), 2004 Haiti 52%

16. Country data – South Asia Neonatal tetanus protection (%), 2004

17. Country data – East Asia and the Pacific Neonatal tetanus protection (%), 2004