Preventie van neonatale tetanus in ontwikkelingslanden bemoeilijkt door lokale organisatie en beperkte kennis bij gezondheidswerkers en traditionele vroedvrouwen; Noord-Sulawesi (Indonesië)

Evaluation of the policy to prevent neonatal tetanus in North-Sulawesi (Indonesia).

Design

Descriptive and questionnaire study.

Setting

Twelve villages in the district of Minahassa, Sulawesi, Indonesia.

Method

The policy aimed at preventing neonatal tetanus was studied during the period April-June 1992. The relevant knowledge was tested of the community health workers (CHWs, n = 142) and traditional birth attendants (TBAs, n = 37) active in the 12 villages. To this purpose, 54 and 27 workers, respectively, were interviewed using a standard questionnaire.

Results

Not all women were vaccinated sufficiently to prevent their unborn children from tetanus; mostly, adequate vaccination records were lacking. 33 of the TBAs were unaware that neonatal tetanus can be prevented by hygienic delivery; in this respect there was no difference between trained and untrained TBAs. Of the CHWs, 39 were familiar with the correct vaccination policy and 26 did not know that pregnant women have to be vaccinated. 70 of the CHWs and TBAs wrongly believed that neonatal tetanus no longer occurred in their village.

Conclusion

CHWs and TBAs showed little interest in neonatal tetanus, so that they were lacking in motivation regarding hygienic delivery procedures and preventive tetanus toxoid vaccination. Implementation of a good preventive programme in developing countries mostly requires organizatory rather than biomedical improvement.