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Vaccines Protect Moms And Babies From Maternal And Neonatal Tetanus In Mali

In 2023, the World Health Organization announced that Mali had successfully eliminated maternal and neonatal tetanus (MNT), an excruciating disease that kills tens of thousands of infants every year. One mother shares how the tragic loss of her newborn son led her to become an advocate, encouraging all women of child-bearing age to get vaccinated to protect the health of their future children.

After losing her newborn son to tetanus, Aissata got the tetanus vaccine to protect herself and any future children, and began working as a community mobilizer encouraging other women of child-bearing age to get vaccinated.

By Fatou Diagne

Tetanus is vaccine-preventable, yet it kills tens of thousands of infants worldwide every year

The dawn was slowly rising over the village of Abaradjou in the health district of Sankoré in Mali's Tombouctou region. Once flourishing, the region was struggling with maternal and neonatal tetanus (MNT), an acute infectious disease that threatens the survival of mothers and their infants.

Caused by a bacterium found in the soil and in animal droppings, MNT results from the contamination of the umbilical stump during unhygienic cord care at childbirth. Symptoms usually occur from the third day in a newborn who was normal and suddenly becomes rigid, presenting with uncontrollable convulsions and muscle spasms. Without medical care, the mortality rate is nearly 100 percent.

Kadidia Cissé, a midwife at the Bellafarandi community health center in Mali, prepares a dose of the tetanus vaccine for a waiting patient.

In this neighborhood, as elsewhere in Mali, deliveries were often performed by traditional midwives, using contaminated equipment. This practice, coupled with adherence to ancient rituals, unfortunately made tetanus contamination all too common during deliveries.

Aissata, a resident of Abaradjou, was determined to change her fate. Having already lost a baby to this disease, she resolved not to let history repeat itself.

"They did everything they could, but the baby passed away. The doctor explained to me that it was tetanus and that if I had been vaccinated during pregnancy, it could have saved my baby. Losing a child is terrible and I wouldn't wish it on any parent."

Aissata, 46-year-old mother in Mali

"I gave birth at home assisted by a grandmother," says Aissata. "A few days later, the baby couldn't breastfeed, and his condition was getting worse. So, I took him to the health center. They did everything they could, but the baby passed away. The doctor explained to me that it was tetanus and that if I had been vaccinated during pregnancy, it could have saved my baby. Losing a child is terrible and I wouldn't wish it on any parent."

Aware of the risks, Aissata sought out information and learned from a women's group in her village about a new initiative by the Malian government, with support from UNICEF and WHO, targeting the elimination of maternal and neonatal tetanus. Inspired by the possibility of a different ending for her story, Aissata decided to actively protect any future pregnancies by getting the tetanus vaccine.

From time to time, 46-year-old Aissata (in red) raises awareness among the women in her neighborhood of the importance of tetanus vaccination so that they can avoid the terrible loss she experienced.

The very next day, as if in answer to her determination, an advanced strategy team arrived by motorcycle in Aissata's village to administer the tetanus vaccine to all women of reproductive age (pregnant or not). Aissata was among the first to receive her dose and made the significant choice to travel to the Sankoré community health center for the remaining doses of the vaccine. The road was long and arduous, but the hope of a better outcome for her future pregnancies sustained her.

"Today I am talking about my story to the women in my village and I am telling them to get vaccinated against tetanus and to have check-ups during pregnancy. When I talk about my story, some tell me that they have also lost babies following home births." recounts Aissata, after finishing an educational talk with other women from her village.

"Today I am talking about my story to the women in my village and I am telling them to get vaccinated against tetanus and to have check-ups during pregnancy."

Aissata

In 2023, the World Health Organization (WHO) announced that Mali had officially eliminated maternal and neonatal tetanus, a major advance for public health in a country where maternal and infant mortality rates are among the highest in the world. This status was confirmed following a detailed evaluation, which demonstrated that Mali meets WHO's standard of having less than one case of neonatal tetanus per 1,000 live births in each of its health districts.

Holding a book of illustrations, Kadidia Cissé, a midwife in Mali, raises awareness of the importance of tetanus vaccination among pregnant women and women of child-bearing age.

Mali's significant milestone is a testament to the collective efforts of the country and its partners, including UNICEF. A comprehensive strategy to strengthen systematic vaccination played a pivotal role. Health centers across Mali were equipped with solar refrigerators to store vaccines efficiently, and provided with motorcycles and vehicles to facilitate the delivery of vaccination services.

Vaccinations were administered through a well-organized approach: at health facilities for fixed strategies, by motorcycle for areas located between 5 and 15 kilometers away, and through mobile clinics for communities more than 15 kilometers from a health facility.

Djouma Keidalla, an obstetrician at the Sankoré community health center, carries a cooler containing tetanus vaccines in the village of Bakaiwait, Mali.

From 2002, Mali embarked on several vaccination campaigns against tetanus, adopting fixed, advanced and mobile strategies. These efforts were significantly supported by financial contributions from the United States, underscoring the global commitment to combatting MNT. The vaccination program proved to be a lifeline for thousands of women, including Aissata.

Childbirth practices in Mali also saw remarkable improvements through the gradual introduction of qualified personnel including gynecologist-obstetricians, midwives and obstetric nurses into health centers and district hospitals. This initiative was supported by the state and partners like the World Bank to enhance the quality of maternal care.

Traditional midwives, integral to many communities, received training on essential hygiene practices to further reduce the risk of tetanus contamination. The training emphasized the importance of maintaining clean surfaces, hands and clothes during childbirth, using a new blade for umbilical cord cutting, applying chlorhexidine for cord care and avoiding the application of potentially harmful substances on the umbilical wound. Through these comprehensive measures, Mali has made significant strides in safeguarding the health of mothers and newborns against tetanus.

"These practices have saved millions of women of childbearing age and newborns while protecting them against tetanus," explains Dr. Moumini Guindo, a physician at the Sankoré community health center.

Aissata (in red) and her children sit outside their house in the family yard in the village of Abaradjou, Mali.

Aissata's determination and resilience are a symbol of the possibility of change and the power of taking proactive steps towards health and safety. In this region of Mali, her fight against MNT, marked by courage and transformation, serves as an inspiration for many women — a new dawn for an era of health awareness and empowerment in the community.

UNICEF has immunized millions of women all over the globe, with support from partners like Kiwanis International and The Church of Jesus Christ of Latter-Day Saints, in an effort to eliminate tetanus in dozens of countries. As of December 2023, MNT remains endemic in just 11 countries.

Give a UNICEF Inspired Gift that helps UNICEF deliver vaccines to protect children from deadly diseases.

Life Without Vaccines: Americans Who Never Forget

Today, relatively few Americans grasp the seriousness of polio, measles and tetanus, thanks to the success of routine immunization. But those whose lives have been touched by these diseases can never forget how damaging they can be — and how important it is to keep vaccinating.

Top photo: Minda Dentler, a Rotary ambassador, administers the polio vaccine to a child during a national immunization campaign in India.

It was late February, 1960 when measles crash-landed into Emmi Herman's childhood, putting her 9-year-old sister Marcie into a coma and destroying her chances at a full life.

Marcie's measles turned into measles encephalitis — a dangerous swelling of the brain — a complication that occurs in roughly 1 in 1,000 cases. The condition left her with a permanent brain injury and long-term physical and emotional difficulties.

"My sister lived a full life — she was so talented, playing the piano, making art — but she was childlike in many ways, and could not live independently," Herman, a children's book author from Searingtown, NY, told UNICEF USA. "I often wonder what our lives would have been like had she been able to get the vaccine."

Marcie died in August 2020 at age 70, after suffering a stroke. "She was so looking forward to being one of the first to get the COVID vaccine," Herman says.

Emmi Herman (left), with her sister, Marcie, who suffered a permanent brain injury after contracting measles at age 9.

Most of America seems to have largely forgotten just how serious measles can be — that it's more than a rash, and can cause permanent hearing loss and even death from pneumonia. The reason they've forgotten: routine immunization.

Before the measles vaccine was introduced in 1963, nearly all children got measles by the time they were 15; tens of thousands of patients ended up hospitalized and more than 400 died every year in the U.S.

Four decades later, annual cases had dwindled to a few dozen. But then measles made a startling comeback — with vaccine hesitancy as a major culprit.

Measles makes a comeback amid vaccine hesitancy

It was after reading about a 2014 measles outbreak in California that Herman decided to become a vaccine advocate.

"I learned that the reason it spread so fast was that immunization levels in the area had dropped, because parents were opting out," she recalls. "I thought I might be able to get through to those who are on the fence about vaccinating their children, and help convince them how important it is." Herman often writes about the topic and is a longtime volunteer member of Voices for Vaccines.

In 2019, measles made an even bigger comeback, with 1,274 people infected in 31 states, over two-thirds of them children. The CDC concluded that a number of people had caught it while traveling abroad and brought it back home; measles remained common in many parts of the world, including countries in Africa, Europe, Asia and the Pacific.

But another reason for the upswing: the ease with which the disease can spread within communities where there are pockets of unvaccinated people. The majority of people who fall ill with measles are unvaccinated.

Over the next four years, cases in the U.S. Would drop back down, landing between a low of 13 in 2020 and a high of 121 in 2022, as routine vaccinations were disrupted due to the COVID-19 pandemic.

Now measles is trending upward in the U.S. Yet again — As of April 11, 2024, there were 121 measles cases reported in 18 states since the beginning of the year, more than double the number reported in all of 2023 — with experts continuing to cite vaccine hesitancy as a contributing factor.

"My sister got sick before there was a vaccine," Herman says. "Now that there is one, no child or family should have to endure the lifelong hardships that we have."

"My sister got sick before there was a vaccine. Now that there is one, no child ... Should have to endure the lifelong hardships."

From polio survivor to vaccine advocate

Polio, part of every parent's nightmare more than a half century ago, has been similarly vanquished stateside; the last case of wild poliovirus in the U.S. Was in 1979.

But polio is not a distant memory for Minda Dentler. Born in India in 1978, before polio immunizations were widely available there, Dentler contracted the disease as an infant and her legs became permanently paralyzed. Adopted from an orphanage by an American family and raised in Spokane, WA, she remembers having to sit out while her siblings played sports.

Minda Dentler, who was paralyzed by polio when she was a baby, competed in Challenge Roth in Roth, Germany in 2015. Her role as Rotary ambassador and vaccine advocate is simple: "I can't change what happened to me, but I can help make sure other children are spared."

Dentler didn't sit out for long. As a young adult, she began training and in 2013, she became the first female wheelchair athlete to complete the Ironman championship course. She has since completed three more Ironman triathlons, plus a half Ironman triathlon on six continents. Married with a 9-year-old daughter, Dentler works full-time in the financial services industry. In March, she published an autobiographical children's book, The Girl Who Figured It Out.

"The day my daughter got her first polio vaccine, it hit me how completely different her life will be from mine," Dentler told UNICEF USA. "Watching her running, hopping, kicking — doing all the things I can't do — only reinforces for me the need to keep vaccinating, to keep going until polio is gone for good."

"The day my daughter got her first polio vaccine, it hit me how completely different her life will be from mine."

As an ambassador for Rotary International, a UNICEF partner and leader in the global polio eradication effort, Dentler traveled to India with other Rotarians in 2015 to participate in a national immunization campaign. (India eliminated polio within its borders in 2014; only two endemic countries remain: Afghanistan and Pakistan.)

Teaming up with local health workers in poor communities near Kolkata and Delhi, and administering polio drops to some of the children, "felt like I was coming full circle," Dentler says. "I can't change what happened to me, but I can help make sure other children are spared. No one should have to live with the effects of polio when it's completely vaccine-preventable."

"I can't change what happened to me, but I can help make sure other children are spared."

While in India, Dentler was struck by the fact that many parents had to walk for miles and wait hours to get their kids vaccinated. In the U.S., she says, "my generation seems to take vaccine access for granted."

A child's life touched by tetanus

Neonatal tetanus is another disease that has been effectively wiped out in the United States. Most people think of a tetanus shot as something you need when you step on a rusty nail, not a critical step in prenatal care. Caused by unsanitary conditions during childbirth, tetanus is almost always fatal in newborns and still kills tens of thousands of babies every year, globally.

Carrie Rhodes-Nigam will never forget how her daughter nearly died from tetanus. Rhodes-Nigam was working at a children's hospital in China in 1997 when she met a 2-month-old baby girl who had had tetanus but was treated and, against all odds, survived. The nurses told her that the baby's parents had brought her in, but had left when she was still convulsing, probably believing she would not make it.

"When I think of the nightmare those poor parents endured, how helpless they must have felt ... I ache."

"When I think of the nightmare those poor parents endured, how helpless they must have felt ... I ache," Rhodes-Nigam wrote in a moving account of how she came to adopt the baby. She named her Dani and brought her home to Seattle, where she grew up healthy and strong.

"It's gratifying to see that we're that much closer [to eliminating tetanus] and that fewer mothers and children will suffer," says Carrie Rhodes-Nigam of Seattle, center, pictured here with her daughter Dani (far left), who survived tetanus as a baby, and two of her other children, Lily and Eli.

Rhodes, a UNICEF USA Northwest regional board member, is a longtime supporter of Kiwanis International and the UNICEF-supported global partnership to end maternal and neonatal tetanus (MNT) worldwide.

Thanks to worldwide immunization efforts targeting women of reproductive age – just three doses of an inexpensive vaccine protects a mother and her future babies for the majority of her childbearing years – the number of newborn deaths from tetanus declined by 88 percent between 2000 and 2018 (the most recent year for which estimates are available). And since 1999, 47 out of 59 at-risk countries have successfully eliminated MNT.

"I get excited when I hear that another country has eliminated MNT," Rhodes-Nigam told UNICEF USA. "It's gratifying to see that we're that much closer and that fewer mothers and children will suffer. I am surprised when people here in the U.S. Don't vaccinate their children when they have the option to. I can't believe that we even need to say it — that vaccines are important and save lives."

Immunization's worldwide impact

UNICEF works with partners to bring immunization to children around the world, and to make sure that children everywhere, not just in the U.S., can benefit. These efforts have helped reduce child mortality by 60 percent since 1990, saving an estimated 2 million to 3 million lives every year.

There are other gains as well: every dollar invested in immunization yields close to $20 in annual health savings, according to one analysis that looked at the return on investment from immunization against 10 pathogens in 94 low- and middle-income countries.

But to sustain these gains, full coverage, known as herd immunity — defined as a vaccination coverage rate of 95 percent or above — must be maintained.

A young girl in Nepal displays her pinky, which has been inked to show that she has been vaccinated for measles, rubella and polio during a UNICEF-supported emergency immunization campaign following the April 2015 earthquake.

Through advocacy, education and fundraising, UNICEF USA helps increase the impact of UNICEF's global efforts to ensure children are protected against vaccine-preventable diseases. Your tax-deductible contribution can help make a difference. Donate today.

World Immunisation Week 2024: 5 Most Important Vaccines For Infants And Children

Vaccines have been instrumental in preventing numerous infectious diseases, saving millions of lives worldwide. As World Immunisation Week 2024 is observed today, April 24, it's essential to emphasise the importance of vaccination in safeguarding the health and well-being of our children. For infants and children, certain vaccines are particularly crucial in protecting them from potentially life-threatening illnesses.

Ensuring that infants and children receive these essential vaccines according to recommended schedules is vital in protecting their health and the health of the community at large. By prioritising vaccination efforts, we can continue to prevent disease, save lives, and build healthier communities for future generations. Here, we highlight five of the most important vaccines every parent should ensure their child receives.

1. Measles, Mumps, and Rubella (MMR) Vaccine

The MMR vaccine is a combined vaccine that protects against three highly contagious diseases: measles, mumps, and rubella (German measles). Measles, in particular, can lead to severe complications such as pneumonia and encephalitis, while mumps can cause deafness and meningitis. Rubella infection during pregnancy can result in congenital rubella syndrome, leading to birth defects in infants. Administering the MMR vaccine provides immunity against these diseases and helps prevent their spread within communities.

2. Polio Vaccine

Polio, caused by the poliovirus, can lead to paralysis and even death. Thanks to widespread vaccination efforts, polio has been nearly eradicated globally. However, the disease still poses a threat in regions where vaccination coverage is insufficient. The oral polio vaccine (OPV) and the inactivated polio vaccine (IPV) are both effective in preventing polio infection. Timely administration of the polio vaccine is crucial in ensuring lifelong immunity against this debilitating disease.

3. Diphtheria, Tetanus, and Pertussis (DTaP) Vaccine

The DTaP vaccine protects against three bacterial infections: diphtheria, tetanus (lockjaw), and pertussis (whooping cough). Diphtheria can lead to severe respiratory problems and heart failure, while tetanus causes muscle stiffness and spasms. Pertussis, especially dangerous in infants, can result in prolonged coughing fits and respiratory complications. The DTaP vaccine is typically administered in a series of doses during infancy and early childhood, providing robust protection against these infectious diseases.

4. Haemophilus Influenzae Type b (Hib) Vaccine

Haemophilus influenzae type b (Hib) is a bacterium responsible for various severe infections, including pneumonia, meningitis, and epiglottitis. Hib infections can be particularly dangerous in young children, often leading to serious complications or even death. The Hib vaccine effectively prevents these infections by stimulating the immune system to produce antibodies against the bacterium. Including the Hib vaccine in routine immunisation schedules has significantly reduced the incidence of Hib-related diseases worldwide.

5. Hepatitis B Vaccine

Hepatitis B is a viral infection that affects the liver, potentially leading to chronic liver disease, liver cancer, and death. Infants and young children are especially vulnerable to hepatitis B infection if exposed. The hepatitis B vaccine is administered in a series of doses shortly after birth and during infancy, providing long-lasting immunity against the virus. Vaccination against hepatitis B is crucial in preventing transmission from mother to child and reducing the overall burden of this infectious disease.

ALSO READ: World Immunisation Week 2024: Date, theme, history, significance and all you need to know

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