“The death of a child is a truly dramatic situation. It is a tragedy for the family and above all for the mother who carried that child for nine months and hoped that he or she would grow up and one day become someone on whom she could rely in her old age. You feel the pain of a child’s death,” says epidemiologist Robert Barrais, who has been Chief of the Epidemiological Surveillance Service of the Ministry of Public Health and Population (MSPP) since April 2010.
Approximately 264,000 children are born each year in Haiti. According to a 2014 statistical report, 40 % of births take place in a health institution; in rural areas most births still occur at home, and in urban areas the situation is not much different due to economic barriers. One of the risks associated with home birth, performed by untrained individuals and under unsanitary conditions, is infection of the newborn from the introduction of Clostridium tetani through the umbilical stump.
Despite the socio-environmental conditions and certain cultural practices, the Ministry of Public Health and Population (MSPP), with technical support from PAHO/WHO and UNICEF, made significant progress in preventing this disease. As a result, the Pan American Health Organization (PAHO) declared the elimination of neonatal tetanus in the country in 2017.
With a rate of less than 1 case per 1,000 live births, neonatal tetanus ceased to be a public health problem. The various divisions of the MSPP (Vaccination, Health Promotion, Women’s Health, and Epidemiology) helped bring about this significant national achievement.
Continuous efforts to promote and protect maternal health resulted in an increase in prenatal care, from 54% to 67% today. Awareness of the importance and safety of institutional delivery also led to changes: home births fell by 15 percentage points and the trend towards safe delivery has continued.
With regard to vaccination, DTP and dT coverage improved between 2017 and 2019. The National Coordination Unit of the Vaccination Program organized supplementary vaccination activities and mobilized teams of vaccinators to protect the population, mainly in high-risk areas.
In short, more families today are protected through comprehensive, multiprogrammatic primary health actions and newborns are less exposed to deadly infection.
Nevertheless, there are still significant challenges in sustaining the elimination of maternal and neonatal tetanus. Haiti will need to achieve and maintain dT vaccination coverage of over 80% in each department; systematically organize supplementary vaccination activities in high-risk areas; follow the recommendations of the Technical Advisory Group on Vaccine-preventable Diseases (TAG); improve the accessibility and quality of births attended by skilled personnel; strengthen maternal and community education for umbilical cord care; intensify epidemiological surveillance, and institute periodic MNT risk analysis in each district of the country.
In addition to these measures, investments must continue to be made in health promotion and in improving access to health services at the lowest possible cost to users. In other words, it is essential to shore up efforts to reduce the geographical and economic barriers that ultimately limit universal access.
“Achieving the elimination of neonatal tetanus in Haiti is a very rewarding achievement. However, we cannot rest on our laurels. The elimination of neonatal tetanus in Haiti means that we can still do better things, that we can move forward,” says Dr. Barrais.