MATERNAL AND NEONATAL TETANUS

              MATERNAL AND NEONATAL TETANUS

Neonatal tetanus is a form of generalized tetanus that occurs in newborns. Infants who have not acquired passive immunity because the mother has never been immunized are at risk. It usually occurs through infection of the unhealed umbilical cord, particularly when the cord is cut with a non-sterile instrument. In many countries, deliveries take place in unhygienic circumstances, putting mothers and their new-born babies at risk for a variety of life-threatening infections. Neonatal tetanus mostly occurs in developing countries, particularly those with the least developed health infrastructure. It is rare in developed countries. When tetanus develops, mortality rates are extremely high, especially when appropriate medical care is not available.

Symptoms:

A new-born infected with tetanus may appear perfectly healthy. The first sign usually comes two to three days later, when the baby’s jaw and facial muscles may tighten due to the tetanus poison. The baby’s mouth will continue to grow more rigid so that it becomes “locked” (thus the name “lockjaw” given to tetanus) and the new-born will no longer be able to breastfeed. The new-born’s body may stiffen or arch and he or she may convulse when stimulated by light, sound or being touched. Finally, the new-born may no longer be able to breathe and may die. Between 70 and 100 per cent of deaths occur between three days and 28 days after birth.

PREVENTION OF MATERNAL AND NEONATAL TETANUS

The Maternal and Neonatal Tetanus (MNT), Elimination Initiative aims to reduce MNT cases to such low levels that the disease is no longer a major public health problem. Unlike polio and smallpox, tetanus cannot be eradicated (tetanus spores are present in the environment worldwide), but through immunization of pregnant women and other women of reproductive age (WRA) and promotion of more hygienic deliveries and cord care practices, MNT can be eliminated (defined as less than one case of neonatal tetanus per 1000 live births in every district).

HEALTH EFFECT OF ADOLESCENT PREGNANCY

            

               HEALTH EFFECT OF ADOLESCENT PREGNANCY

     In low- and middle-income countries, almost 10% of girls become mothers by age16years, with the highest rates in sub-Saharan Africa and south-central and south-eastern Asia. The proportion of women who become pregnant before age 15 years varies enormously even within regions. Births to unmarried adolescent mothers are

Far more likely to be unintended and are more likely to end in induced abortion. Coerced sex, reported by 10% of girls who first had sex before age 15 years, contributes to unwanted adolescent pregnancies.

Dangers of adolescent pregnancy

Many health problems are particularly associated with negative outcomes of pregnancy during adolescence. These include anaemia, malaria, HIV and other sexually transmitted infections, postpartum haemorrhage and mental disorders, such as depression. Although adolescents aged 10-19 years account for 11% of all births worldwide, they account for 23% of the overall burden of disease (disability- adjusted life years) due to pregnancy and childbirth. Fourteen percent of all unsafe abortions in low- and middle-income countries are among women aged 15–19 years. About 2.5 million adolescents have unsafe abortions every year and adolescents are more seriously affected by complications than are older women. Up to 65% of women with obstetric fistula develop this as adolescents, with dire consequences for their lives, physically and socially.

Adolescent pregnancy is dangerous for the child

Stillbirths and death in the first week of life are 50% higher among babies born to

mothers younger than 20 years than among babies born to mothers 20–29 years old.

Deaths during the first month of life are 50–100% more frequent if the mother is an Adolescent versus older, and the younger the mother, the higher the risk. The rates of preterm birth, low birth weight and asphyxia are higher among the children of adolescents, all of which increase the chance of death and of future health problems for the baby. Pregnant adolescents are more likely to smoke and use alcohol than are older women, which can cause many problems for the child before and after birth.

Adolescent pregnancy adversely affects communities

Studies have shown that delaying adolescent births could significantly lower population growth rates, potentially generating broad economic and social benefits, in addition to improving the health of adolescents. Many girls who become pregnant have to leave school. This has long-term implications for them as individuals, their families and communities.

Progress to date

Rates of adolescent childbearing have dropped significantly in most countries and

regions in the past two to three decades. Age at first marriage is increasing in many Countries, as are rates of contraceptive use among both married and unmarried Adolescents. Educational levels for girls have risen in most countries, and job opportunities have expanded. Low education levels are closely associated with early childbearing.

COMPLEMENTARY FEEDING PRACTICE

               COMPLEMENTARY FEEDING PRACTICE

Complementary feeding is defined as the process starting when breast milk alone is no longer sufficient to meet the nutritional requirements of infants, and therefore other foods and liquids are needed, along with breast milk. The transition from exclusive breastfeeding to family foods referred to as complementary feeding,   typically covers the period from 6 - 24 months of age, even though breastfeeding may continue to two years of age. This is a critical period of growth during which nutrient deficiencies and illnesses contribute globally to higher rates of undernutrition among children under- five years of age.

A number of successful strategies have been developed to improve complementary feeding practices in low and middle-income countries, where practical difficulties can limit adherence to complementary feeding guidelines.

A period of vulnerability and opportunity÷

Greatest vulnerability to malnutrition and infection: Nutritional needs for growth and development between 6-24 months of age are greater per kilogram of body weight than at any other time of life. Growth faltering occurs mainly in the first two years of life in all regions of the world. Insufficient nutrient intake and illness resulting from the introduction of pathogens in contaminated foods and feeding bottles are major causes of malnutrition.

Brain and body development: Good nutrition is essential at this time to ensure healthy brain and body development.

Long-term, irreversible consequences.

Poor feeding practices and low quality food can affect future learning ability, economic productivity, immune response, and reproductive outcomes. Children who are undernourished before they reach their second birthday and later gain weight rapidly after the age of two years are at high risk of nutrition-related chronic disease as adults.

Window of opportunity: Nutrition interventions during this period can lead to great benefits. Feeding practices appropriate for the child’s age, nutritionally adequate foods, and continued breastfeeding can ensure optimal growth and development

Poor complementary feeding practices.              

     ·      Poorly timed introduction of complementary  foods (too early or too late)

·        Infrequent feeding (children need to be fed frequently throughout the day because of their small stomach size)

·        Poor feeding methods, hygiene, and child care practices

·        Unsupervised feeding

·        Lack of interaction between caregiver and child

·        Unhygienic food preparation storage and unclean feeding utensils

·        Bottle-feeding

WHO recommendations

Infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health. Thereafter, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods, while continuing to breastfeed for up to two years.