With an estimated 257,000 neonatal tetanus deaths annually and 30,000 women dying each year from tetanus infection after they have given birth (9), the goal to eliminate maternal and neonatal tetanus (MNT) - that is, to reduce incidence to less than 1 case per 1,000 live births at the national level and in all districts of a country - will not be achieved in 2005, not least because of uncertainties over future funding.
However, the number of countries still to eliminate MNT has been substantially reduced, from 90 in 1990 to 58 in 2003. Of these, 34 countries have initiated or expanded tetanus immunization activities in the past four years, leading to the effective protection of an estimated 46 million women and their newborn babies at risk in areas that are hard to reach(10). Furthermore, MNT elimination in at least six additional countries - Eritrea, Malawi, Namibia, Rwanda, South Africa and Zimbabwe - has been provisionally validated. Ten other countries have completed elimination activities and their elimination status will be assessed and validated by 2006 (11).
Accelerated disease-control strategies for measles, polio and MNT have demonstrated that it is possible to reach the marginalized and excluded through analysing district performance data, microplanning and budgeting, and community-based communication strategies. Mortality reduction will also depend on strengthening routine immunization services in order to sustain the gains made.