Indonesia almost free from maternal, neonatal tetanus

Around 80 percent of Indonesia’s population do not suffer from maternal and neonatal tetanus, which can lead to death, a Health Ministry official says.

Tjandra Yoga Adhitama, director of disease control and environmental health at the Health Ministry, said that a team consisting of experts from the World Health Organization (WHO), Center for Disease Control (CDC), Unicef, University of Indonesia health research center and the ministry had declared Sumatra free from maternal and neonatal tetanus. The decision adds to the previous finding that Java and Bali are tetanus-free.

Maternal and neonatal tetanus refers to pregnancy and birth-related tetanus. Neonatal tetanus cases occur between three and 28 days after birth, while maternal tetanus happens during pregnancy and within six weeks after delivery.

Tjandra said that to reduce tetanus cases, the ministry had been giving tetanus vaccines to schoolchildren and women of productive age. Between 2006 and 2007, the vaccine distribution reached 52 regencies and 3 million women of productive age, while in 2008, the program reached 27 regencies and 1.5 million women.

“We also have improved services for clean and safe maternity, as well as neonatal health check ups and umbilical cord treatment familiarization programs,” he said.

In 2007, the rate of births assisted by health workers was 77.2 percent. The number has been gradually increasing, with 2008 and 2009 at 80.7 percent and 82 percent, respectively. As a result, the number of neonatal tetanus cases gradually dropped. In 2008, there were 198 neonatal tetanus cases, while 2009 saw only 130 cases. As of June 2010, the ministry recorded only eight cases.

Indonesia is aiming to reduce its 1990 maternal mortality rate by three-quarters by the 2015 deadline.

According to data from the ministry, the 1990 rate stood at around 390, meaning the country should reach a rate of around 100 by the deadline. However, in 2007 the rate still stood at 228 deaths of 100,000 live births.

A key factor in reducing the rate is by increasing the number of births assisted by health workers. According to Health Ministry data, the rate of assistance had increased from 38.5 percent in 1992 to 73.4 percent in 2007.

The National Family Planning Coordinating Board (BKKBN) previously said that the majority of maternal deaths were caused by hemorrhage (30 percent) and eclampsia (25 percent). The rest were caused by infection, postpartum complications, abortion and delivery complications.

Another factor that contributes to a high maternal mortality rate is the limited number of obstetric and gynecology specialists. As of March, the current ratio of obstetric and gynecology specialists was 1:26,000 people. The ratio is still far from the ideal 1:200. Indonesia lags far behind other Southeast Asian countries in terms of the number of specialists, such as the Philippines, which has reached a ratio of 1:2,000.

Indonesian Obstetrician and Gynecologists Association chairman Soegiarto Soebijanto said that discrepancy would be hard to combat in the short term because only 14 state universities in Indonesia currently offered such programs, which produced around 200 such specialists per year.