Three cases of neonatal tetanus in Papua New Guinea sets ground for development of national plan for maternal and neonatal tetanus elimination

Abstract

Problem:Maternal or neonatal tetanus causes deaths mostly in Asia and Africa and neonatal tetanus is the result of poor hygiene during delivery. In 2010, Papua New Guinea (PNG) reported around 50 suspected cases of neonatal tetanus.

Context: In 2011, two neonatal tetanus cases were reported by Port Moresby General Hospital and one from Rumginae Rural Hospital (RRH), Kiunga respectively. All the three cases were delivered at home by untrained relatives. The umbilical cords were cut with an unclean knife/blade and tied with strings from rice bags or from a grass skirt. The babies were normal at birth and developed spasm by the 8^th day. Accessibility of fixed facilities is inequitable across PNG and decentralization of government responsibilities has seriously compromised the quality of maternal health services.

Action: These three cases were amongst the first NNT cases adequately investigated cases by the hospitals in recent times. The confirmation of these cases led to the drafting of the PNG National Plan for Maternal and Neonatal Tetanus Elimination with plans to conduct three rounds of Tetanus Toxoid supplementary immunization campaigns targeting women of child bearing age (WCBA) and to strengthen other clean delivery practices.

Outcome: The first round of TT-SIA was conducted in April-May 2012 targeting 1.6 million WBCA and achieved coverage of 77%.

Discussion: A neonatal tetanus case must be viewed as a sentinel event indicating a failure of public health delivery services. The government of PNG should ensure detailed investigation of neonatal tetanus cases reported in the health information system and perform sub-provincial analysis following completion of the all three immunization rounds. It should also strengthen clean delivery practices towards its achievement of elimination of maternal and neonatal tetanus in Papua New Guinea.