Press conference by Senior Health Adviser

UNICEF Head Quarters, New York
Sunday, 2 February 2003, 10:30
Dr. Francois Gasse, Senior Health Adviser and Head of Maternal and Neonatal Tetanus Elimination Programme

Dr. Francois Gasse is the Senior Health Adviser and the Head of Maternal and Neonatal Tetanus Elimination for UNICEF. He will spend sometime here in Afghanistan to monitor the launch of the campaign. Prior to joining UNICEF, Dr. Gasse worked for seventeen years with the World Health Organization, including serving as team leader of WHO's Neonatal Tetanus Elimination Initiative. He has worked as medical doctor here in Afghanistan, France, Gabon and Zambia.

Dr. Francois Grasse

First, I would like to say that I am very pleased to be here in Afghanistan at the start of this campaign to immunize women in order to eliminate tetanus. I would like to say that this is a global initiative and I am very pleased to see the Afghan Government committed to try to reach women. What we know about newborn tetanus in Afghanistan is that it is a disease that kills rapidly the newborn. The preliminary estimates show that about 11,000 new born die from tetanus in Afghanistan every year. This is a result of the survey you have heard about. That has also the issue of maternal death. We have also an issue with newborn tetanus. You may not be familiar with the disease. It is a disease that occurs in population with women who deliver at home without a trained birth attendant and far from any health facilities. In Afghanistan only five percent of women deliver in the institution with a trained birth attendant. The other ones are at risk of getting a new born who die because of hygienic conditions of tetanus. We all think (inaudible). We never think that tetanus can kill just after birth because of birth practice. The simple way to eliminate the disease is to immunize the mother. When we think of immunization, we think of immunizing kids. But you cannot prevent tetanus at birth by immunizing kids (inaudible). The child dies after the seventh day of life. You have to immunize the mother and it protects the mother against tetanus and the newborn through the transfer of antibodies during the pregnancy. And if you immunize the mother before pregnancy she will also protect the baby for the first two months of life.

It is a challenge in Afghanistan, and I am really pleased that they have taken up this challenge. Because to reach each women in Afghanistan it takes to overcome cultural constraints. Access to women is not easy. To access women you need female workers and female workers are few in Afghanistan. We need to reach most of the women in Afghanistan. Today, if you go in town, you will find hundreds of female workers going house by house. Furthermore there are not enough female workers, the issue is how to overcome the manpower constraint to be given access and talk to women.

I think that is extremely new is that in Afghanistan, we are going to use for the second time in Neonatal tetanus control a new device. This device is a very simple device. Someone with a minimal training can administer safely the vaccine to anybody, in particular women. You do not need a literate person you need someone with practical skills and very little time to be trained. [Dr. Gasse proceeded to show how simple device it is and how there are no long needles that most of people feel frightened by].

The first experiment is to use in town. (inaudible) should be critical in rural areas of Afghanistan. We are looking forward to see if we are able to reach 90 per cent of women. I think, we are not solving all the problems of newly born and women, but this is an entry point. Today, almost ten per cent of new born die from tetanus, also some mothers. (inaudible) UNICEF is totally committed to address women's health issue. I think this is a first entry point in Afghanistan. This exercise today is due to also general support of partners in this government-led effort. The main partners is UNICEF, WHO, also JICA, Bill and Melinda Gates Foundation, Ronald McDonald Foundation, these devices are donated by the manufactures. This, I hope, will be continuous support, because today and the next week 740, 000 women will be targeted in four main cities in Afghanistan. This is the easiest task, before moving to rural areas. The preliminary estimates show that we need to target four million women over the next three years and there is a commitment of the government to target these four million women.

Furthermore, I would like to stress the fact that this is a very effective and simple intervention and cheap. I want you to realize that three doses of tetanus (inaudible) administered with an injectable device to a woman protect her and the baby to be born for fifteen years. And it costs 1.1 US dollars between the supply and the operation cost to protect someone for fifteen years (inaudible). I think this is one of the simplest and most cost effective intervention that you can think of. Of course during the course of the week there will be a lot of supervisors and monitors. It is really a challenge to have acceptance of all women. I have experience in other countries where many eligible women refuse to be immunized, with all sorts of fear. We need to monitor closely and make sure that communication messages reach women and they accept to be immunized. And this will be closely monitored. And you will have the chance to see what is going on in town today.

Today in the world 200,000 babies die from newborn tetanus, 11,000 in Afghanistan. This represents about 5 percent of the deaths, which occur today in about 55 countries in the world. The progress in Afghanistan against this disease is also part of the global progress in this global initiative.

Questions and Answers

Question: How many percent of women are at risk of getting tetanus?

Dr. Gasse: Because of the situation in Afghanistan we can say that almost 90 per cent of women are at risk of having a baby suffering and dying from tetanus during the first months of life. The percentage of women today who are protected through immunization is hardly 20 per cent. You could say in real terms that 80 per cent [of women in Afghanistan] are at risk of getting this disease. This represents about 4 to 5 million women in Afghanistan.