Thomas QuinnIn another show that India is developing in to a world power and what we call a “First World Country”, they have eliminated another disease as a potential killer of its citizens.
Just one short year after eliminating another killer, polio, India has scored another enormous public health victory. This tremendous win did not happen overnight however; this has been a hard fought 15-year battle, but now the country has virtually eliminated tetanus as a killer of new-borns and mothers.
Tetanus, caused by bacteria commonly found in soil and animal faeces, usually infects new-borns when the umbilical cord is cut with an unsterilized blade, a thing which was, until the start of this campaign, surprisingly prevalent. Mothers on the other hand would often become infected by giving birth on dirty surfaces or being aided by midwives with unwashed hands. This one is far easier to explain considering that there is a custom of giving birth at one’s home in India.
The disease, commonly known as lockjaw, because of the muscle spasms it causes, usually sets in about a week after a birth and is unfortunately fatal if not promptly treated. Fifteen years ago, the World Health Organization estimated that almost 800,000 new-borns died of tetanus each year, a huge number no matter the disease, but one where the disease is as preventable as this is truly striking. Now though, things have changed, there are now fewer than 50,000 people dying of tetanus each year.
But the effort to reduce tetanus has been arduous. The World Health Assembly, the annual gathering of the world’s health ministers in Geneva, originally set 1995 as the target date for its global elimination as a health threat. Twenty years on and we may well be approaching the removal of the disease as a potential issue for humans.
Unlike polio or smallpox, tetanus can never be completely eradicated because bacterial spores exist in soil everywhere. This is according to Dr Poonam Khetrapal Singh, the director of the W.H.O.’s Southeast Asia region.
India has been able to reduce cases to less than one per 1,000 live births, which the W.H.O. considers “elimination as a public health problem.” That number could yet still decrease further considering the strides that India are making to modernise and sterilise their health organisations as well as some of the features that were used by the government to help limit these unnecessary deaths.
The country managed to succeed through a number of efforts; immunization drives were set across the nation with millions of mothers received tetanus shots, which also protect their babies for several weeks.
Some of the mothers would insist on giving birth at home, per local tradition, and were given health kits containing antibacterial soap, a clean plastic sheet, a sterile scalpel and plastic clamp for cutting and clamping the cord. Simple measures maybe but that is all it takes to help prevent this disease.
The country also created a program under which mothers were paid up to $21 to give birth in a clinic or hospital, it seems like such a small amount of money but it really can make a difference in an economy that hasn’t yet fully developed. “Lady health workers” from their neighbourhoods were also paid, this time up to $9 per mother and up to $4 for bus or taxi fare to make sure women in labour went to clinics. The workers earned that money only after visiting each baby at home and giving tuberculosis shots. Again a seemingly small change but if that is all it takes to make the difference why would they no do it?
The program succeeded despite corruption. The Times of India recently reported that an audit had found clearly fraudulent payments, including some to a 60-year-old woman registered as having been pregnant five times in 10 months. In spite of the corruption which has managed to penetrate this change the programme has been a phenomenal success and has saved truly countless lives.
These changes are here to stay, and that will save lives. At the end of the day isn’t that all that matters?