The Eliminate Project

 
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UNICEF announces dramatic milestone in newborn survival

Maternal and neonatal tetanus, which kills a baby every 9 minutes, eliminated in half of high-risk countries

NEW YORK (May 15, 2013) – Tetanus, one of the most deadly diseases a mother and her newborn can face, has been eliminated in more than half of affected countries targeted by UNICEF just 13 years ago. The milestone was announced today at the annual meeting of the Maternal and Neonatal Tetanus Elimination Initiative at UNICEF headquarters.

Tetanus kills one newborn baby every nine minutes and almost all of these babies are born in poor families living in the most disadvantaged areas and communities.

“As someone who has witnessed firsthand the suffering and death of a newborn from this horrific disease, I can’t overstate the importance of this moment,” said Caryl Stern, President and CEO of the U.S. Fund for UNICEF. “Since the U.S. Fund for UNICEF instigated this campaign back in 1998, it has always been about reaching the world’s poorest, most difficult to reach women and children.”

The disease, easily preventable with a vaccine administered to women of child-bearing age, is transmitted when babies are born in unhygienic conditions, and non-sterile materials are used to cut the umbilical cord, or are applied to the umbilical bump. At that point, the mother’s life is also in danger. With at least three protective doses that cost about US$2, the mother and her future newborns are protected for 5 to 10 years.

Since 1999, more than 118 million women have been vaccinated against tetanus. Many of these women received their tetanus vaccine as part of an integrated campaign, originated by the U.S. Fund for UNICEF, which included other life-saving interventions for children – such as immunization against measles, Vitamin A supplements, deworming tablets and information on umbilical cord care.

Tetanus was identified as one of the lead killers of children in the early 1990s, and at the time, polio and other preventable diseases were receiving the vast share of funding and donor interest. Recognizing the potential to eliminate a disease referenced in the Bible as the “seven-day death,” the U.S. Fund for UNICEF began approaching potential funding partners.  The program received its first substantial donation from the recently formed Bill & Melinda Gates Foundation in 1999. Gates’ $26 million donation was its first large-scale grant.

The Maternal and Neonatal Tetanus Elimination Initiative is a model of how partners can work together to achieve results. In 2000, one year after the initiative began, it was estimated that more than 200,000 deaths of newborns occurred annually from tetanus. By 2010, this number had dropped to an estimated 58,000 annually.

Despite the progress, more than 28 priority countries have still not reached the elimination goal. Key challenges include a lack of access to communities because of insecurity, cultural barriers, competing priorities, sustaining elimination after validation and inadequate funding.

The MNT Elimination Initiative is an international private-public partnership that includes National Governments, UNICEF, WHO, UNFPA, GAVI, USAID/Immunization Basics, CDC, UNICEF National Committees, the Government of Japan, Save the Children, PATH, RMHC, The Bill & Melinda Gates Foundation, Kiwanis International, Pampers – a division of Procter & Gamble, and BD.

The countries that have eliminated MNT are: Bangladesh; Benin; Burkina Faso; Burundi; Cameroon; China; Comoros; Congo (Republic of); Cote d' Ivoire; Egypt; Eritrea; Ghana; Guinea Bissau; Iraq; Liberia; Malawi; Mozambique; Myanmar; Namibia; Nepal;  Rwanda; Senegal; South Africa; Tanzania; Timor Leste; Turkey; Togo; Uganda; Vietnam; Zimbabwe and Zambia.

The countries that are still working toward elimination include Afghanistan; Angola; Cambodia; Central African Republic; Chad; Congo DR; Equatorial Guinea; Ethiopia; Gabon; Guinea; Haiti; India; Indonesia; Kenya; Lao People's Democratic Republic; Madagascar; Mali; Mauritania; Niger; Nigeria; Pakistan; Papua New Guinea; Philippines; Sierra Leone; Somalia; Sudan; South Sudan; and Yemen.

UNICEF/Adriane Ohanesian
UNICEF/Adriane Ohanesian

***Melanie Sharpe, UNICEF Canada's Media Relations Specialist, traveled to South Sudan in February with an editor from Elle Canada. They were there to observe a seven-day immunization campaign supported by UNICEF and partners, including Kiwanis International. The Eliminate Project, an ambitious partnership between Kiwanis International and UNICEF, aims to protect women and their future newborns around the world from maternal and neonatal tetanus.***

Kuajok feels like the middle of nowhere. Our journey began with an hour and half flight from South Sudan's capital city Juba to the town of Aweil. From Aweil we drove nearly five hours on dusty potholed roads. At times our driver would slow down to 6 miles an hour to maneuver the massive craters. There is one main unpaved road where a few shopkeepers sell whatever items happen to make it to Kuajok. Vehicles, motorbikes, people and goats move through town surrounded by small grass roofed huts.

This time of year the town is scorching hot, the air is dry and nothing moves quickly. During our second afternoon in Kuajok I met a woman named Ajok Madut. Ajok was with two of her three children - nine-month-old Mauout and three year-old Acol. She told me she's given birth seven times, but only three of her children are alive. Each time Ajok gave birth she was at home - in a small hut - by herself. She explained that before giving birth she would lay a blanket down on the floor to lie on during the delivery. Once the baby arrived she cut the umbilical cord herself with a razor blade.

South Sudan has the highest maternal death rate in the world. For every 100,000 births more than 2,000 women will die. This means women have about a 1 in 7 chance of dying from pregnancy-related complications in their lifetime. So Ajok is one of the lucky mothers - statistically, she should be dead by now. I met Ajok under a huge tree behind the Kuajok primary health care unit where UNICEF had set up one of its tetanus vaccination points. UNICEF was in the middle of a seven-day vaccination campaign to protect women from maternal and neonatal tetanus across the country. People of all ages can get tetanus, but it's particularly serious for newborn babies and for women who have no choice but to give birth in unclean environments - women like Ajok. The effects are devastating - within days tetanus spreads through a baby's body, causing convulsions and difficulty breathing. Without hospital care, as many as 95% of babies will die.

But thanks to partnerships like The Eliminate Project, UNICEF, Kiwanis International and other partners are working to eliminate the disease worldwide by 2015. Reaching women like Ajok in remote communities is absolutely vital to achieving this goal.

UNICEF/Adriane Ohanesian
UNICEF/Adriane Ohanesian
UNICEF/Adriane Ohanesian
UNICEF/Adriane Ohanesian

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Maternal and neonatal tetanus eliminated in China

Higher hospital delivery rate, improved mother and baby health play a major role

BEIJING, 5 November 2012 – China has been declared free of one of the world’s major causes of preventable death of mothers and newborns. Following a maternal and neonatal tetanus (MNT) elimination validation exercise carried out last month, the World Health Organization (WHO) formally declared that China has eliminated MNT on 30 October 2012. 

The validation exercise was carried out by 103 monitoring teams that conducted cluster surveys in Hechi Prefecture of Guangxi Province and Jiangmen Prefecture of Guangdong Province – chosen because of their high proportion of rural poor and migrant worker populations, who have limited access to clean delivery practices. The survey teams visited 45,088 households and investigated 2,306 live births and found zero cases of MNT.

WHO considers elimination of MNT to be achieved when there is less than one case of neonatal tetanus per one thousand live births in every district. If neonatal tetanus is eliminated, maternal tetanus elimination is assumed. The validation was coordinated by the Ministry of Health with support of UNICEF and WHO and now confirms that all prefectures in China have less than one case of the disease per one thousand live births.

China now joins the 161 countries that have eliminated neonatal tetanus.

Tetanus is a painful and often fatal disease that affects mothers and newborn babies. It causes muscle stiffness and spasms, sometimes called “lockjaw.” In newborns and mothers it is generally caused by unclean delivery conditions and umbilical stump infections.

Neonatal tetanus can be prevented by hygienic childbirth, careful handling of the umbilical cord during and after childbirth or maternal vaccination with tetanus toxoid vaccine.

“We are extremely happy that WHO has validated China’s elimination of maternal and neonatal tetanus, one of the world’s major preventable causes of maternal and infant death,” said Gillian Mellsop, UNICEF Representative for China. “With this announcement a major step toward the global goal of MNT elimination has been taken. We congratulate China and its Ministry of Health for this noteworthy achievement for children.”

China’s success in eliminating MNT is also noteworthy because it is due primarily to significant increases in its hospital delivery rate, especially in remote rural counties. Other countries working on MNT elimination have placed emphasis on scaling up tetanus toxoid immunization efforts. China does not have a policy of immunizing pregnant mothers with tetanus toxoid.

The commitment to global elimination of maternal and neonatal tetanus was launched by World Health Assembly in 1989. By 2010, it was estimated that worldwide MNT deaths had been reduced by more than 90 per cent.

“UNICEF has been working with the Ministry of Health for more than thirty years now on improving maternal and child health. In recent decades the Ministry of Health has put special emphasis on safe motherhood, or keeping mothers and babies safe and healthy during pregnancy and childbirth,” said Dr Robert Scherpbier, UNICEF Chief of Health and Nutrition. “China’s elimination of MNT is a wonderful story because, while most of the world is also immunizing pregnant mothers to fight this terrible disease, China has done it the “hard way” so to speak, by massive investment and attention on improving hospital delivery rates and rural maternal and child health outcomes more broadly.” 

Historically, hospital delivery was quite low in China, especially in poor rural districts. Prior to 1995 China’s rural hospital delivery rate was below 25 per cent, and in some of the poorest counties it barely reached 10 per cent.

In 1999, UNICEF helped launch the safe motherhood initiative in 40 of the poorest counties in China, in cooperation with the Ministry of Health and the National Working Committee for Children and Women (NWCCW). The aim was to encourage women to deliver their babies in hospital instead of at home for increased access to hygienic delivery conditions and potentially life-saving care.

The safe motherhood approach as implemented by the Government of China emphasizes community health education, small subsidies for hospital delivery, provision of clean childbirth kits to rural health facilities, improved obstetric care infrastructure at county and township hospitals, capacity building for rural health workers and midwives and establishing the “fast channel” referral mechanism for pregnant women near birth.

Between 2000 and 2009 the safe motherhood strategy modeled by UNICEF consistently demonstrated improved maternal and child health outcomes and increased hospital delivery rates in the counties where they were piloted.

Based on this extensive body of evidence accumulated, the Government of China funded and progressively expanded the safe motherhood strategy to all central and western rural counties in China, with the subsidized hospital delivery policy extended to all 2,297 rural counties in China. China’s hospital delivery rate is now above 96 per cent in most rural areas.

“In addition to bringing about a substantial reduction in maternal and newborn mortality, China’s hospital delivery policy has now also led to the elimination of maternal and newborn tetanus as a public health problem,” observed Dr. Robert Scherpbier of UNICEF. “

“The microorganism causing tetanus is a spore forming organism that is present everywhere in the environment and can survive under harsh conditions. So while tetanus has been eliminated as a public health problem, due to the resilience of the bacterium, it can reemerge if these successful public health policies are relaxed,” he added.

“Thus it is important to sustain these enormous achievements and ensure almost universal hospital delivery rates are sustained, and improved wherever possible.”

Passion and drive to eliminate maternal and neonatal tetanus at Kiwanis family conventions

By Kate Weber, Director, The Eliminate Project, U.S. Fund for UNICEF

I have just returned to New York after attending three inspiring Kiwanis family conventions – the Kiwanis International (KI) and Circle K International conventions, held in New Orleans, Louisiana, and the Key Club International convention, held in Orlando, Florida. This year I had the honor of attending the conventions as an official U.S. Fund for UNICEF Kiwanis club delegate. These annual gatherings provide time to conduct organizational business, offer learning opportunities and a chance to reconnect with friends. 

As you may already know, Kiwanis and their family of clubs have joined UNICEF and partners in the global fight to eliminate maternal and neonatal tetanus (MNT). It was exciting to see that The Eliminate Project:  Kiwanis eliminating maternal and neonatal tetanus was front and center at all of the conventions. The passion and commitment from every level of the Kiwanis family to eliminate MNT was apparent and took many forms. I watched an inspirational video from Alan Penn, KI’s President, in which he noted that as the son of missionaries he helped his mother during vaccination campaigns. He described how these memories resurfaced when he traveled with UNICEF to Cambodia to observe MNT immunization activities. There was an energizing 6 a.m. fundraising walk along the Mississippi River attended by more than 500 Kiwanis family members. Kiwanis youth continued to showcase their energy through projects dedicated to the theme of eliminating MNT, such as a shoe box float competition created by K-Kids and a video competition for Circle K and Key Club members. 

Cynthia McCaffrey, UNICEF Chief of Staff, and Dr.  François Gasse, MNT expert,  retired UNICEF Senior Officer and first recipient of Kiwanis' Humanitarian Award, joined the events, as keynote speakers at a special luncheon. Both provided updates and further inspiration to a room of more than 1,000 supporters of the project. Flint Zulu, UNICEF’s program officer, also joined us for a series of technical workshops about elimination efforts. 

The 4,000 Kiwanis members and more than 1,700 youth members who attended the events continue to enthusiastically raise funds and advocate for The Eliminate Project. Kiwanis members who had attended field visits with UNICEF served on panels and spoke about their experiences. They highlighted the urgency of raising funds: time is ticking to meet the global MNT elimination goal of 2015.

I’ve been with the U.S. Fund since 2001, and eliminating MNT was one of the first programs I worked on. Incredible strides have been, and continue to be, made by UNICEF and its partners—since 2000, 25 countries have eliminated MNT. Yet there are still 34 countries where mothers and newborns die of tetanus. Every nine minutes, a newborn dies of this entirely preventable disease. Additional resources are sorely needed.  

I would never have thought in 2001 that one day I would witness a room full of teenagers dancing to eliminate MNT, wearing T-shirts with “Dance, baby, dance,” and creating a new dance move to celebrate The Eliminate Project! These same youth raised more than $688,000 this past year for the campaign. Young people are supporting all kinds of fundraising activities. They are dedicating their 18th birthday celebrations to the cause by asking family and friends to donate. One young man is using his graduation gift funds to match other clubs’ contributions and another is creating jewelry out of buttons to raise funds (I came home with two charming rings!). 

I can’t write about these kids or Kiwanis’ commitment without getting emotional. This is what acting locally and globally is all about. By “changing the world, one child and one community at a time,” Kiwanis is the perfect example of global citizenship.

Over the past few months, the World Health Organization (WHO) has announced that maternal and neonatal tetanus (MNT) has been validated as eliminated in Liberia, Senegal and Burkina Faso.  The reduces the number of countries in which MNT remains a public health threat to 35.  We congratulate the governments of the three aforementioned countries on their tremendous success.  This good news continues to demonstrate that programs to eliminate MNT can and do work.  The sooner that additional funding is received, the faster that other countries can implement their immunization activities and reach women of childbearing age.  With the support of generous individuals from around the globe, we can realize the day when MNT is eliminated in every country of the world.

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