Pakistan Targets Full Tetanus Elimination by 2028

Maternal and Neonatal Tetanus (MNT) remains a significant public health concern in Pakistan. Despite global efforts to eradicate this preventable disease, Pakistan continues to face challenges in achieving complete elimination. Recent developments, however, indicate progress in certain regions, offering hope for nationwide eradication.

Current Status of MNT in Pakistan

As of 2024, Pakistan is among the countries that have not fully achieved the global elimination target for neonatal tetanus, defined as less than one case per 1,000 live births in every district. The World Health Organization (WHO) relaunched the Maternal and Neonatal Tetanus Elimination (MNTE) effort in 1999, targeting 59 countries with high tetanus prevalence. After three decades, 49 out of these 59 high-risk countries have successfully met the eradication target. Pakistan, however, remains the only South Asian country yet to achieve this milestone.

Recent Achievements

Despite the overarching challenges, certain regions in Pakistan have made notable progress:

• Islamabad Capital Territory (ICT) and Pakistan-Administered Kashmir (PAK): These areas have achieved the elimination of MNT, bringing Pakistan closer to interrupting the transmission of this life-threatening disease for mothers and newborns nationwide. This validation was confirmed by the WHO following a weeklong final review led by WHO and UNICEF at the request of the Federal Government. Approximately 80% of Pakistan’s population (190 million people) now live in areas where the spread of neonatal tetanus remains under controlled limits. Sindh achieved elimination in December 2024, while Punjab reached this milestone in 2016.

Strategies Leading to Success

The progress in these regions can be attributed to several key strategies:

1. Enhanced Immunization Programs: Focused efforts on vaccinating pregnant women and women of childbearing age have been pivotal. In 2024 alone, WHO and UNICEF supported the vaccination of 5.4 million women across Pakistan.

2. Improved Surveillance: Strengthening monitoring systems has ensured timely detection and response to MNT cases.

3. Community Engagement: Educating communities about the importance of immunization and safe delivery practices has increased acceptance and participation.

4. Safer Delivery Practices: Promoting skilled birth attendance and proper cord care has reduced the risk of neonatal tetanus.

Ongoing Challenges

Despite regional successes, several challenges hinder nationwide elimination:

• Underreporting: In 2024, a total of 322 cases and six deaths were reported across the country. However, WHO experts estimate that only 30% of cases are notified to the authorities, indicating a significant gap in surveillance.

• Healthcare Accessibility: In remote areas, especially in provinces like Balochistan, Khyber Pakhtunkhwa, and Gilgit-Baltistan, access to healthcare facilities remains limited, affecting immunization coverage and safe delivery practices.

• Sociocultural Barriers: Misinformation and traditional beliefs can lead to vaccine hesitancy and reliance on unskilled birth attendants.

Future Directions

To achieve nationwide elimination of MNT by the target year of 2028, Pakistan must:

1. Strengthen Routine Immunization: Ensuring consistent and widespread vaccination coverage for women of childbearing age is crucial.

2. Enhance Surveillance Systems: Improving data collection and reporting mechanisms will provide a clearer picture of MNT incidence and guide interventions.

3. Promote Skilled Birth Attendance: Training and deploying more skilled birth attendants in underserved areas can reduce neonatal tetanus cases.

4. Increase Community Engagement: Tailored health education campaigns can address misconceptions and encourage preventive practices.

5. Collaborate with International Partners: Continued support from organizations like WHO and UNICEF is essential for technical assistance, funding, and resource mobilization.

While Pakistan faces significant challenges in eliminating maternal and neonatal tetanus, the successes in regions like ICT and PAK demonstrate that progress is achievable. By building on these successes and addressing the existing challenges, Pakistan can move closer to ensuring that no mother or newborn suffers from this preventable disease.