Selective primary health care: strategies for control of disease in the developing world. XXII. Tetanus: a...

Tetanus, although an eminently preventable disease, remains common and uncontrolled in many developing countries. The persistence of tetanus is attributable to health service policies that ignore the disease because of a dearth of reliable epidemiologic and economic information. In many developing countries there have, as yet, been few public or professional demands for preventive action. For the prevention of neonatal tetanus, the immediate priority is immunization timed to produce and maintain protective levels of maternal antitoxin during pregnancy. This strategy should be accompanied by the extension and improvement of scientific standards of midwifery. To protect the rest of the population from wound tetanus, the strategy of first choice consists of continuous multiple-antigen immunization in infancy and childhood. Such a program should be reinforced by the routine administration of a toxoid booster following all accidental wounds as well as before all ritual procedures known to carry risk. These strategies, which are of proven efficacy and adaptable to local conditions of the large populations still in need of protection, together provide powerful justification for the expansion of primary maternal and child health services. Careful measurement of the incidence of neonatal tetanus would provide a good indicator of the degree of effectiveness such services have attained in many rural communities.