Maternal and Neonatal Tetanus Elimination

(MNTE) in Kenya

Dr Collins Tabu,National Vaccines and Immunization Program

Ministry of Health, Kenya

Background• Caused by a bacteria, Clostridium Tetanii, Mainly found in the soil

• Affects all age groups, more common and Deadly in newborns, because of low immunity & umbilical cord wound

• Causes Painful muscles spasms & stiffness (Lock jaw disease), Fever, Sweating, inability to eat, swallow or function normaly

• 100% Die with no care, Even with hospital care 60% still die

• A case of Neonatal Tetanus represents multiple gaps in the health services to provide Routine immunization; Antenatal care and Clean delivery and umbilical cord care services

Tetanus Disease

MNTE Status• Globally 1 newborn dies every 9 minutes from Neonatal Tetanus• In Kenya, we lose one child every day from this Silent killer

• Less than 5% of neonatal tetanus cases are actually reported even from well-developed systems , Deaths therefore are much more than estimated- ‘It is the silent killer of Newborns’

• Goal of MNT Elimination is to reduce No of cases to less than 1 case of neonatal tetanus per 1,000 Live births, in every sub-county

• By end 2013, Kenya among 28 countries that are yet to achieve the MNT Elimination targets

The Journey to MNTE Elimination• Kenya initiated the Maternal and Neonatal Tetanus Elimination process

in 2001• Proportion of High risk Districts/ Sub-counties reduced from 38% in 2001

to 20% in 2013 and <10% in 2015• Key Pillars:

• Improved skilled attendance at delivery through Provision of Free maternity services

• Improved ANC Attendance through adoption of Focused Antenatal Care (FANC) package

• Improved Tetanus vaccination coverage through provision of vaccines free of charge, setting up more health facilities & provision of HR

• Provision of free medical care to children under 5 years of age• Improved diagnostic and Management capacity

• Tetanus vaccination campaigns conducted 2003, 2006, 2009, 2013/2014

The Journey to MNTE Elimination• A joint assessment by MOH/ WHO/ UNICEF and other Health

Partners in 2012 identified 60 districts at risk of NNT• These have further reduced to 24 • Determination of risk status:

– Incidence or rate of neonatal tetanus (< 1/1000 Live Births)– Clean delivery coverage rate (delivery by a physician, nurse or trained

midwife (≥ 70%)– Strength of surveillance system in detecting Neonatal Tetanus cases– Tetanus vaccine coverage rate in pregnant women & among girls and

women 14- 49 years of age (≥ 80%)

TT SIAs• Integrated with Measles Rubella Vaccination campaign• Targeting 800,000 Women of reproductive age in 11

High risk Counties– Mombasa Meru– Garisaa Wajir– Mandera Kilifi– West Pokot Turkana– Samburu Narok– Baringo

• Validation for elimination expected end of 2016

Thank you!