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In December 2005, national and state-level representatives of the Ministry of Health and Family Welfare of the Government of India, together with national and international WHO and UNICEF representatives, reviewed district-level data on 6 states in India. The aim of the data review was to assess whether neonatal tetanus (NT) had been eliminated in Haryana, Karnataka, Kerala, Maharashtra, Tamil Nadu and West Bengal. The meeting concluded that surveys would be needed in all states to confirm NT elimination, except in Kerala. Such surveys typically use a technique that combines the principles of lot-quality assessment and cluster surveys. Kerala state was considered as having eliminated NT based on the data review.
Elimination of NT is defined as an annual rate of less than 1 case per 1000 live births at district level. In 1989, the World Health Assembly called for NT elimination by 1995, a target date which has been extended several times. As of end 2005, 49 countries remained that had not yet eliminated NT, including India.
Kerala state in southern India has a total population of 31.8 million people. It consists of 14 administrative districts and ranks first of 15 Indian states in the National Human Development Index (2001). The literacy rate is 91% (88% in females) compared with 65% (54% in females) for the whole of India. In 2003, the birth rate was 16.7 per 1000 population (24.8 for India), the infant mortality rate was 11 per 1000 live births (60 for India), and life expectancy was 71.7 years for men and 75 years for women (64.1 years and 65.8 years for India, respectively).
The group reviewed a series of district-level data for each of the 6 states. Table 1 summarizes the data presented for Kerala.
In the past, an algorithm has been used to guide assessments on NT elimination (Fig. 1).
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Kerala state reported zero NT cases in 2003-2004; the last case was reported from a migrant family in Ernakulam District in 2002. The state has a …