Eliminating neonatal tetanus : an annotated bibliography

Second only to measles, neonatal tetanus kills more children than any of the other diseases targeted by WHO"s Expanded Program on Immunization. While several countries have increased coverage of measles vaccine, coverage with tetanus toxoid remains inadequate. To eliminate neonatal tetanus, mothers must be immunized. WHO guidelines recommend five doses to insure protection throughout a woman"s reproductive years. In addition, the elimination of neonatal tetanus relies heavily on adequate reporting of immunization coverage and of neonatal tetanus mortality and on the practice of clean delivery. Many countries have not yet begun to measure the toll neonatal tetanus is taking. In many of these countries, births are carried out by attendants who may not always practice clean, safe delivery. Until these birth attendants are trained in sterile techniques and until they practice these techniques, neonatal tetanus will continue to strike down infants. The MotherCare Project has made the elimination of neonatal tetanus a focus in its efforts to improve pregnancy outcomes. This bibliography is assembled as a step toward promoting greater understanding of the issues involved in neonatal tetanus elimination. It is divided into nine chapters. The first chapter is a complete alphabetical listing of all references, of which there are more than 230 entries. The following chapters categorize these same references by headings representing major areas in neonatal tetanus, including: (1) the definition, history, and background of tetanus, including reviews of tetanus; (2) immunological aspects; (3) surveillance of tetanus, including techniques as well as the results of surveys conducted; (4) immunization coverage; (5) missed opportunities in the campaign for tetanus immunization; (6) going beyond immunization by training traditional birth attendants, determining perceptions, and building on cultural patterns; (7) cost analyses; and (8) workshops/meetings, including reports on several workshops or meetings that have been conducted throughout the world. After each section are abstracts of key articles. Key articles are noted in the reference list by a star beside the name of the first author. Articles abstracted were selected by experts as key to understanding the present status of policies, program interventions, levels of neonatal tetanus, and immunization coverage. (Author abstract)