Prevention of neonatal tetanus in India: a prospective cost-effectiveness analysis.

Abstract

Although the vaccine which effectively prevents tetanus has been available for some time tetanus remains a significant cause of mortality throughout the world with neonatal tetanus accounting for 1/4 to 1/2 of all tetanus deaths. Tetanus is associated with poor environmental sanitation and non-antiseptic birth practices. The incidence of tetanus tends to vary inversely iwith socioeconomic status. This paper investigates the feasibility in cost effectiveness terms of programs to intervene in neonatal tetanus. The geographical focus of the study in north India where in some rueal areas neonatal tetanus mortality rates are estimated to be 5300/100000 live births. Alternative intervention strategies are discussed 2 possible delivery models are developed and the cost per death is estimated. The information collected can assist decision-makers in choosing a program appropriate to their needs. Prevention of neonatal tetanus can be made by vaccinating the child in the 1st 3 days of life training indigenous midwives in aseptic birth practices or immunizing pregant women or women of childbearing age. Other than economic criteria the rapidity with which immunizations are delivered and the ease with which the proposed program may be integrated into existing health services are factors to be considered in determining cost-effectiveness. Immunization is found to be relatively inexpensive and therefore an economically feasible intervention in neonatal tetanus. The addition of a midwife training program and/or multi-valent vaccine would increase cost-effectiveness. It is important to consider alternative interventions in infant and child mortality given the other major causes of infant death e.g. pneumonia and diarrhea.