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Scaling up Child Survival in Sierra Leone


The Sierra Leone Ministry of Health and Sanitation, WHO, UNICEF and other partners are launching a week long Integrated Child Survival Campaign on Maternal and Neonatal Tetanus, 16-23 April. The campaign will target 1.2 million women of child bearing age and 85,000 children aged six months to five years with tetanus toxoid vaccine, deworming and iron folate. An estimated 85,000 children (6 – 59 months) will also be targeted with vitamin A and deworming with Mebendazole.

The campaign aims to reduce morbidity and mortality due to neonatal tetanus, one of the country’s major childhood diseases. Sierra Leone has one of the highest infant and maternal mortality rates in the world, with 167 out of every 1,000 children dying before their fifth birthday and 1,300 women dying for every 100,000 live births. Eliminating maternal and newborn tetanus will help to improve mortality rates and the campaign is expected to increase community awareness on the importance of maternal and child health as well as strengthen Integrated Disease Surveillance.

UNICEF Representative Geert Cappelaere says that the integrated approach to child survival is UNICEF’s main focus, with the emphasis on achievements and results in Health and Education related to the Millennium Development Goals. Interventions such as HIV/AIDS, child protection and water sanitation have been designed to contribute to the achievement of goals for children in these two areas. Meaningful results for children require a concerted effort to address these two critical indicators in order to ensure children’s rights to life, survival, education and development.

In his remarks during a visit to a vaccination centre in Freetown, Cappelaere said “Sierra Leone cannot afford to be left behind in the global campaign to reduce infant deaths due to modern vaccines and medical breakthroughs.”

According to the Minister of Health and Sanitation, Abator Thomas, child and maternal mortality reduction are among the two key development priorities for the Government. Thomas stressed that the Integrated Child Survival Campaign will ensure that cost effective measures are applied to save children from unnecessary death due to vaccine preventable diseases such as neonatal tetanus and children will have unhindered access to the Pentavalent – five-in-one – vaccine . “If the number of vaccines we are currently giving children is the reason some parents avoid getting their children immunised, then this will help eliminate this roadblock to improving our immunisation rates,” Thomas emphasised. “The Government is concerned about the high rate of child and maternal mortality and the position Sierra Leone continues to occupy within the global human development indices and we are determined for a change”

The campaign will be conducted in three rounds: April 16 – 25; May 21-30; and November 2007. All women aged 15 – 49 years, will receive free iron folate and deworming tablets in addition to the tetanus vaccine and all children aged six to 59 months will receive Vitamin A and deworming tablets.

The Campaign is fully funded by UNICEF, which is providing more than 1.1 million doses of tetanus toxoid vaccine, almost 1,900 tins of vitamin A, more than 20,500 tins of deworming tablets and 8,800 tins of iron, as well as support for social mobilisation, technical aspects and the training of volunteers, worth in total more than US$1.4 million. More than 7,000 personnel (vaccinators and volunteers) from the Ministry of Health and Sanitation (MOHS) are deployed in 900 peripheral health units and other temporary fixed points, including schools across the country to support the campaign. The involvement of District Councils will ensure that no child is left out.

Tetanus is a disease that can be prevented through vaccination. Each year about 180,000 newborn babies die from neonatal tetanus worldwide. Maternal tetanus also takes the lives of about 30,000 mothers every year and is responsible for the death of at least one in every 20 mothers. Every women of child bearing age is at risk of contracting tetanus which is found in dirt and animal or human excrement. However, mothers and newborn babies are the most at risk during pregnancy and delivery due to limited antenatal care, unavailability of unskilled delivery attendants and unhygienic delivery practices, and so the elimination of tetanus benefits both equally. It can be prevented by immunizing all pregnant women and all women of child-bearing age, while improving delivery practices and surveillance.

Neonatal tetanus accounts for 14 per cent of all deaths in newborn babies in Sierra Leone as a result of unhygienic birth practices, especially when tetanus contaminates the baby’s umbilical cord at the time it is cut or dressed after delivery. Symptoms usually appear around three days after birth, when an apparently healthy baby will stop breastfeeding, become very stiff and have painful convulsions which lead to death.

Maternal tetanus strikes a woman during pregnancy or within six weeks of the termination of pregnancy. It is caused by a contamination from tetanus bacteria through wounds linked to deliveries that are unsafe or unclean or abortion. Symptoms are similar to those of newborn babies, including tightness in the jaw (lock jaw) aching muscles, difficulty in swallowing and convulsions.

The campaign will be complementing an increase in routine immunization of children with three doses of the new five-in-one Pentavalent vaccine, launched earlier this year. The vaccine is a combination vaccine therapy that aims to prevent five diseases, hepatitis B, haemophilus influenza B, tetanus DPT and whooping cough, via a single dose for children under the age of one. This is a significant breakthrough in the fight against childhood killer diseases and a substantial boost to the reduction of infant mortality in Sierra Leone. The introduction of the Pentavalent vaccine in the routine immunization programme may increase vaccination rates and make parents more willing to let children get all the shots they need in one visit, rather than scheduling multiple appointments, which can lead to late vaccinations or drop out.

Sierra Leone recorded a 75 per cent increase in immunization coverage during its push toward Universal Child immunization in 1990. The civil war and the resulting destruction of the health infrastructure led to a massive drop in coverage to less than 6 per cent by 1995. However, much has been achieved in ensuring the revitalisation of the health sector and extension of the immunization services to all parts of the country. There has been a drastic reduction in mortality and morbidity due to catch up Measles campaigns over the last couple of years. Currently immunization coverage for all antigens stands at 66 per cent.


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