Landmark reached in fight against tetanus, as over half of 59 priority countries declare victory, partners say

Flag of UNICEF (Photo credit: Wikipedia)

Landmark reached in fight against tetanus, as over half of 59 priority countries declare victory, partners say

NEW YORK, 15 May 2013 – Tetanus, one of the most deadly diseases a mother and her newborn can face, has been eliminated in over half of 59 priority countries, the Maternal and Neonatal Tetanus Elimination Initiative partners announced today.
Tetanus kills one newborn baby every nine minutes and almost all of these babies are born in poor families living in the most disadvantaged areas and communities. 
The disease, easily preventable with a vaccine administered to the mother, is transmitted when children are born in unhygienic conditions, and non-sterile materials are used to cut the umbilical cord, or are applied to the umbilical bump.  At that point, the mother’s life is also in danger. With at least three protective doses that cost about US$2, the mother and her future newborns are protected for five years.
Since 1999, more than 118 million women of child-bearing age have been vaccinated against tetanus in 52 countries. Many of these women received their tetanus vaccine as part of  an integrated campaign which included other life- saving interventions for children – such as immunization against measles, Vitamin A supplements, deworming tablets and information on umbilical cord care.
The announcement came during the annual MNT Initiative stakeholders’ meeting.
The Maternal and Neonatal Tetanus Elimination Initiative is a model of how partners can work together to achieve results.  In 2000, one year after the initiative began, it was estimated that over 200,000 deaths of newborns occurred annually from tetanus. By 2010, this number had dropped to an estimated 58,000 annually.
Despite the progress, more than 28 priority countries have still not reached the elimination goal. This is a formidable challenge in the quest to reach the global target of elimination of MNT in all priority countries by 2015.
The main challenges to MNT elimination are a lack of access to communities because of insecurity, cultural barriers, competing priorities, sustaining elimination after validation and inadequate funding.
The MNT Elimination Initiative is an international private-public partnership that includes National Governments, UNICEF, WHO, UNFPA, GAVI, USAID/Immunization Basics, CDC, UNICEF National Committees, the Government of Japan, Save the Children, PATH, RMHC, The Bill & Melinda Gates Foundation, Kiwanis International, Pampers – a division of Procter & Gamble, and BD.
The countries that have eliminated MNT are: Bangladesh; Benin; Burkina Faso; Burundi; Cameroon; China; Comoros; Congo (Republic of); Cote d' Ivoire; Egypt; Eritrea; Ghana; Guinea Bissau; Iraq; Liberia;  Malawi; Mozambique; Myanmar; Namibia; Nepal;  Rwanda; Senegal; South Africa; Tanzania; Timor Leste; Turkey; Togo; Uganda; Vietnam; Zimbabwe and Zambia.
The countries that are still working toward elimination include Afghanistan; Angola; Cambodia; Central African Republic; Chad; Congo DR; Equatorial Guinea; Ethiopia; Gabon; Guinea; Haiti; India; Indonesia; Kenya; Lao People's Democratic Republic; Madagascar; Mali; Mauritania; Niger; Nigeria; Pakistan; Papua New Guinea; Philippines; Sierra Leone; Somalia; Sudan; South Sudan; and Yemen.
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About UNICEF
UNICEF works in more than 190 countries and territories to help children survive and thrive, from early childhood through adolescence. The world’s largest provider of vaccines for developing countries, UNICEF supports child health and nutrition, good water and sanitation, quality basic education for all boys and girls, and the protection of children from violence, exploitation, and AIDS. UNICEF is funded entirely by the voluntary contributions of individuals, businesses, foundations and governments. For more information about UNICEF and its work visit: http://www.unicef.org

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Health Technol Assess. 2007 Aug;11(32):1-168, iii-iv.

Current practice, accuracy, effectiveness and cost-effectiveness of the school entry hearing screen.

Bamford J, Fortnum H, Bristow K, Smith J, Vamvakas G, Davies L, Taylor R, Watkin P, Fonseca S, Davis A, Hind S.

Full Text 

Source

Human Communication and Deafness, University of Manchester, UK.

Abstract

OBJECTIVES:

To describe and analyse in detail current practice of school entry hearing screening (SES) in the UK.

DATA SOURCES:

Main electronic databases were searched up to May 2005.

REVIEW METHODS:

A national postal questionnaire survey was addressed to all leads for SES in the UK, considering current practice in terms of implementation, protocols, target population and performance data. Primary data from cohort studies in one area of London were examined. A systematic review of alternative SES tests, test performance and impact on outcomes was carried out. Finally, a review of published studies on costs, plus economic modelling of current and alternative programmes was prepared.

RESULTS:

The survey suggested that SES is used in most of England, Wales and Scotland; just over 10% of respondents have abandoned the screen; others are awaiting national guidance. Coverage of SES is variable, but is often over 90% for children in state schools. Referral rates are variable, with a median of about 8%. The test used for the screen is the pure tone sweep test but with wide variation in implementation, with differing frequencies, pass criteria and retest protocols; written examples of protocols were often poor and ambiguous. There is no national approach to data collection, audit and quality assurance, and there are variable approaches at local level. The screen is performed in less than ideal test conditions and resources are often limited, which has an impact on the quality of the screen. The primary cohort studies show that the prevalence of permanent childhood hearing loss continues to increase through infancy. Of the 3.47 in 1000 children with a permanent hearing loss at school screen age, 1.89 in 1000 required identification after the newborn screen. Newborn hearing screening is likely to reduce significantly the yield of SES for permanent bilateral and unilateral hearing impairments; yield had fallen from about 1.11 in 1000 before newborn screening to about 0.34 in 1000 for cohorts that had had newborn screening, of which only 0.07 in 1000 were unilateral impairments. Just under 20% of permanent moderate or greater bilateral, mild bilateral and unilateral impairments, known to services as 6-year-olds or older, remained to be identified around the time of school entry. No good-quality published comparative trials of alternative screens or tests for SES were identified and studies concerned with the relative accuracy of alternative tests are difficult to compare and often flawed by differing referral criteria and case definitions; with full pure tone audiometry as the reference test, the pure tone sweep test appears to have high sensitivity and high specificity for minimal, mild and greater hearing impairments, better than alternative tests for which evidence was identified. There is insufficient evidence regarding possible harm of the screen. There were no published studies identified that examined the possible effects of SES on longer term outcomes. No good-quality published economic evaluations of SES were identified and a universal SES based on pure tone sweep tests was associated with higher costs and slightly higher quality-adjusted life-years (QALYs) compared with no screen and other screen alternatives; the incremental cost-effectiveness ratio for such a screen is around 2500 pounds per QALY gained; the range of expected costs, QALYs and net benefits was broad, indicating a considerable degree of uncertainty. Targeted screening could be more cost-effective than universal school entry screening; however, the lack of primary data and the wide limits for variables in the modelling mean that any conclusions must be considered indicative and exploratory only. A national screening programme for permanent hearing impairment at school entry meets all but three of the criteria for a screening programme, but at least six criteria are not met for screening for temporary hearing impairment.

CONCLUSIONS:

The lack of good-quality evidence in this area remains a serious problem. Services should improve quality and audit screen performance for identification of previously unknown permanent hearing impairment, pending evidence-based policy decisions based on the research recommendations. Further research is needed into a number of important areas including the evaluation of an agreed national protocol for services delivering SES to make future studies and audits of screen performance more directly comparable.

PMID:

17683682

[PubMed - indexed for MEDLINE]

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Pediatrics. 2008 Jul;122(1):143-8. doi: 10.1542/peds.2007-2210.

Universal screening for hearing loss in newborns: US Preventive Services Task Force recommendation statement.

US Preventive Services Task Force.

Full Article in Pediatrics

Collaborators (16)

Source

US Preventive Services Task Force, Agency for Healthcare Research and Quality, Rockville, MD 20850, USA. uspstf@ahrq.hhs.gov

Abstract

DESCRIPTION:

This is the 2008 update of the 2001 US Preventive Services Task Force recommendation on universal newborn hearing screening.

METHODS:

The US Preventive Services Task Force weighed the benefits and harms of universal newborn hearing screening, incorporating new evidence addressing gaps identified in the 2001 US Preventive Services Task Force recommendation statement. Published literature on this topic was identified (by using Medline and Cochrane databases) and systematically reviewed.

RECOMMENDATION:

Screen for hearing loss in all newborn infants (B recommendation).

Comment in

Pediatricians and the US Preventive Services Task Force: a natural partnership to enhance the health of children. [Pediatrics. 2008]

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Prophylactic oral betamimetics for preventing preterm labour in singleton pregnancies.

Causes of death by age group (see List of causes of death by rate) (Photo credit: Wikipedia)

Background

Preterm birth occurs in up to 6% to 10% of all births and is the major complication of pregnancy associated with perinatal mortality and morbidity. Previous preterm delivery is a strong predictor for preterm labour, and the earlier the birth, the more likely it is to be repeated at the same gestation. In the acute setting, betamimetics can decrease contraction frequency or delay preterm birth by 24 to 48 hours.

Objectives

To assess the effectiveness of prophylactic oral betamimetics for the prevention of preterm labour and birth for women with singleton pregnancies at high risk of preterm delivery.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (October 2010) and reference lists.

Selection criteria

Randomised controlled trials in singleton pregnancies at high risk of preterm labour comparing prophylactic oral betamimetics with placebo or any intervention with the specific aim of preventing preterm birth.

Data collection and analysis

Two authors independently assessed trial quality and extracted data.

Main results

One trial (64 singleton pregnancies) was included. The trial compared the oral betamimetic agent isoxuprine with placebo. No difference was seen for perinatal mortality rate (risk ratio (RR) 4.74, 95% confidence interval (CI) 0.50 to 45.00). There was no evidence of an effect of oral betamimetic agents in reduction of spontaneous onset of preterm labour (RR 1.07, 95% CI 0.14 to 8.09) or preterm birth, less than 37 weeks' gestation. There was no significant association between the use of oral betamimetics and side effects sufficient to stop therapy (RR 2.51, 95% CI 0.59 to 10.76). No differences were found for infant outcomes; birthweight less than 2500 grams (RR 1.74, 95% CI 0.44 to 6.87) or neonatal death (RR 4.74, 95% CI 0.50 to 45.00). This trial had adequate methodological quality; however the sample size was inappropriate to determine any significance in neonatal outcome differences between the treatment groups.

Authors' conclusions

There is insufficient evidence to support or refute the use of prophylactic oral betamimetics for preventing preterm birth in women at high risk of preterm labour with a singleton pregnancy.

 

Prophylactic oral betamimetics for preventing preterm labour in singleton pregnancies

There are insufficient data on use of betamimetic drugs given by mouth to reduce preterm birth in women at increased risk of preterm labour and carrying one baby.
Women sometimes go into labour early and babies are born prematurely (before 37 weeks). These babies are at increased risk of health problems and the earlier a baby is born the higher the risk. Babies born before 32 weeks have considerable problems, with those born before 28 weeks being at most risk. These babies can suffer from problems with breathing, bleeding, gut and intestines. They are also at increased risk of cerebral palsy or long-term handicap, and some babies do not survive even the early weeks. Babies need special care, sometimes intensive care, and this can be quite traumatic for parents. Preterm birth occurs in around 6% to 10% of births. Many interventions have been assessed to try to improve outcomes for these babies; this review looks at a group of drugs called betamimetics given by mouth in women at increased risk and carrying one baby. These drugs aim to reduce and inhibit labour contractions. However, they do have side effects which include nausea, vomiting, tremor, headaches and shortness of breath. The review of studies found only one trial involving 64 women. There is therefore insufficient evidence to support the use of these drugs to reduce preterm labour and birth.

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AVC en Pediatria Basada en la Evidencia: González de Dios J, Molina Arias M. Resultados de los corticoides prenatales en el límite de la viabilidad. Evid Pediatr. 2012;8:12.

JAMA. 2011 Dec 7;306(21):2348-58.

Association of antenatal corticosteroids with mortality and neurodevelopmental outcomes among infants born at 22 to 25 weeks' gestation.

Carlo WA, McDonald SA, Fanaroff AA, Vohr BR, Stoll BJ, Ehrenkranz RA, Andrews WW, Wallace D, Das A, Bell EF, Walsh MC, Laptook AR, Shankaran S,Poindexter BB, Hale EC, Newman NS, Davis AS, Schibler K, Kennedy KA, Sánchez PJ, Van Meurs KP, Goldberg RN, Watterberg KL, Faix RG, Frantz ID 3rd,Higgins RD; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network.

Collaborators (198)

Source

Department of Pediatrics, University of Alabama, 9380 Women and Infants Center, 1700 Sixth Ave S, Birmingham, AL 35249, USA. wcarlo@peds.uab.edu

Abstract

CONTEXT:

Current guidelines, initially published in 1995, recommend antenatal corticosteroids for mothers with preterm labor from 24 to 34 weeks' gestational age, but not before 24 weeks due to lack of data. However, many infants born before 24 weeks' gestation are provided intensive care.

OBJECTIVE:

To determine if use of antenatal corticosteroids is associated with improvement in major outcomes for infants born at 22 and 23 weeks' gestation.

DESIGN, SETTING, AND PARTICIPANTS:

Cohort study of data collected prospectively on inborn infants with a birth weight between 401 g and 1000 g (N = 10,541) born at 22 to 25 weeks' gestation between January 1, 1993, and December 31, 2009, at 23 academic perinatal centers in the United States. Certified examiners unaware of exposure to antenatal corticosteroids performed follow-up examinations on 4924 (86.5%) of the infants born between 1993 and 2008 who survived to 18 to 22 months. Logistic regression models generated adjusted odds ratios (AORs), controlling for maternal and neonatal variables.

MAIN OUTCOME MEASURES:

Mortality and neurodevelopmental impairment at 18 to 22 months' corrected age.

RESULTS:

Death or neurodevelopmental impairment at 18 to 22 months was significantly lower for infants who had been exposed to antenatal corticosteroids and were born at 23 weeks' gestation (83.4% with exposure to antenatal corticosteroids vs 90.5% without exposure; AOR, 0.58 [95% CI, 0.42-0.80]), at 24 weeks' gestation (68.4% with exposure to antenatal corticosteroids vs 80.3% without exposure; AOR, 0.62 [95% CI, 0.49-0.78]), and at 25 weeks' gestation (52.7% with exposure to antenatal corticosteroids vs 67.9% without exposure; AOR, 0.61 [95% CI, 0.50-0.74]) but not in those infants born at 22 weeks' gestation (90.2% with exposure to antenatal corticosteroids vs 93.1% without exposure; AOR, 0.80 [95% CI, 0.29-2.21]). If the mothers had received antenatal corticosteroids, the following events occurred significantly less in infants born at 23, 24, and 25 weeks' gestation: death by 18 to 22 months; hospital death; death, intraventricular hemorrhage, or periventricular leukomalacia; and death or necrotizing enterocolitis. For infants born at 22 weeks' gestation, the only outcome that occurred significantly less was death or necrotizing enterocolitis (73.5% with exposure to antenatal corticosteroids vs 84.5% without exposure; AOR, 0.54 [95% CI, 0.30-0.97]).

CONCLUSION:

Among infants born at 23 to 25 weeks' gestation, antenatal exposure to corticosteroids compared with nonexposure was associated with a lower rate of death or neurodevelopmental impairment at 18 to 22 months.

PMID:

 

22147379

 

[PubMed - indexed for MEDLINE]

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