Wednesday, November 2, 2011

Winning the battle against Tetanus

A surveyor interviews a mother during the survey
© UNICEF Timor-Leste
Ermera, Timor-Leste. “I had to leave my work and walk for an hour to receive the TT vaccination during the health ministry’s campaigns. But I know it has protected my children from tetanus. I am happy I took the vaccine,” said Joana as she tried hard to remember the dates of vaccination.

“Unfortunately, I have misplaced the LISIO (Immunisation card),” Joana continued.

Joana was talking about her experience when she participated in the tetanus toxoid campaign conducted in the months of October – November 2010 by the Ministry of Health in Timor-Leste with the support of UNICEF, WHO and other partners. This campaign was conducted as a follow up activity of similar campaigns conducted in 2008 and 2009 for accelerating the progress towards elimination of maternal and neonatal tetanus.

These efforts are now bearing fruit.  A recent mission in November 2011, supported by UNICEF and WHO, assessed the existing situation and to verify the reported cases of neonatal tetanus and concluded that Timor-Leste was ready to conduct the validation exercise for Maternal and Neonatal Tetanus Elimination (MNTE). This assessment also identified the districts of Ermera, Manufahi and Ainaro as the districts with the highest risk for neonatal tetanus.

But reaching to this stage was not easy.

“We face various challenges in delivering immunisation services, especially in some areas of my sub district, Turiscai. Some mothers do not want to be immunised. And during the rainy season, it is especially difficult for the midwives to reach some aldeias (Hamlets) due to strong currents in the mountain streams.” Mr. Domingus Tavares explained. He is the Community Health Centre manager responsible for maternal and child health services in Turiscai, one of the sub-districts of District Manufahi. 

The tetanus campaigns have played a major role in accelerating the progress towards achieving elimination of maternal and neonatal tetanus.  The Ministry of Health and UNICEF collaborated with other partner agencies, NGOs and the church to support the campaign and advocate on the safety of the vaccine. The church leaders actively supported the campaign and helped in tackling the rumours and allaying the fears of the people regarding the vaccine.

The Promotor Saude Familia (PSF) or community health volunteers were also instrumental in mobilising the women for immunisation and for the door-to-door approach of informing women of the benefits of the tetanus toxoid immunisation.

“I definitely feel that Timorese children should not die from a disease such as tetanus. I always advise mothers to go to the hospital for delivery and to use a clean blade for cutting the cord. I also tell them that they should apply nothing on the cord. I learned this during my training. However, some women still give birth at home and apply “po” or bamboo powder on the cord. This can harm the child,”said Afonso, a PSF from Aldeia Grotu.

Despite these constraints, the country is making progress towards achieving the goal of elimination of maternal and neonatal tetanus. The Demographic Health Survey of 2009-2010 revealed that almost 76% of mothers aged 15-49 had received two or more tetanus toxoid (TT) injections during the last pregnancy.

These findings hold great promise for the future. ”We have won the battle, but the war is not over, We have to focus on improving TT immunisation coverage of adolescent girls and women of child bearing age to have a lasting impact.  The community members have to be educated on proper newborn care practices. The SISCa (Serviso Integradu Saude Communitaria) is an excellent opportunity to educate adolescent girls and women, ” Mr. Jose Lima, EPI Field Officer from the Ministry of Health said.

Indeed, Timor-Leste’s efforts to eliminate maternal and neonatal tetanus have been truly challenging, considering the difficult geographic terrain and the shortage of human resources for delivering services. But in spite of these challenges, the country seems to be making rapid strides and more babies and mothers’ lives are now protected against tetanus.

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