In South Sudan, 91 percent of all pregnant women deliver in their homes without access to a skilled birth attendant. Araw Ayom, who was his mother’s first child, was delivered at home like other local babies. Araw’s 21-year-old mother gave birth to a healthy boy of six pounds. For three days, she gazed in awe as he slept, cried, and suckled for milk. On the fourth day, however, everything changed: Araw stopped feeding, and the muscles in his neck, abdomen, and eventually his entire body, grew stiff.
Anxious, Araw’s mother sought care from the midwife in the village, who advised that he was in a critical condition. After hearing of his need for medical attention, Araw's mother walked as fast as she could for hours—from the Roc Roc Dong village in Jur River county to a hospital in the Wau town—clutching the wailing baby in her arms. Upon arrival, she discovered that Araw had contracted neonatal tetanus.
“She delivered him on the floor of her house littered with animal fecal matter,” says Dr. Marianna, the pediatrician at the St. Daniel Comboni Catholic Hospital’s neonatal ward. “She said that the baby’s grandmother rubbed cow dung over his umbilical cord, a traditional practice, for it to dry up quickly. These are clear causes for neonatal tetanus, which kills nearly all affected children, despite treatment."
In the same month, three similar cases of neonatal tetanus were reported in hospitals in Wau town, and all three newborns died within days. “These are the few cases that get reported when families are able to travel long distances to the hospital. Many more, I believe, die each day in their homes without knowing the cause for death,” says Dr. Marianna.
As children and mothers often die without visiting a health facility, only five percent of maternal and neonatal tetanus (MNT) cases are reported.
“MNT is a silent killer because within days of a child’s birth in unsanitary conditions, with the use of contaminated instruments and dressing such as razor blades, cow dung, or ash, even the healthiest newborns die,” says Paul Oyik Okot, a health officer at the UNICEF Wau field office.
In South Sudan, UNICEF, The Church of Jesus Christ of Latter-day Saints, and other humanitarian collaborators are working to cut these instances to one in every 1,000 live births. “All efforts are underway to prevent the disease by ensuring that all women of childbearing age in high risk are immunized with at least three doses of the tetanus vaccine. This will protect both the newborn and the mother,” says Paul.
“Initially, women blatantly refused to be vaccinated. Myths are easily spread that the vaccine is for family planning, and they feared coming to the posts,” says Monika Guido, a social mobilizer in the Hai Jalaba in Wau County.“However, after three rounds of rigorous campaigning and counseling, they are now able to see the benefits of the vaccine. Girls going to school readily took the vaccine, and this further instilled confidence in other women."
During a campaign, the vaccine was administered at both health facilities and temporary posts erected in populous locations such as markets and churches for the benefit of women. Monika spends at least 45 minutes counseling each woman and her family about taking all three doses of the vaccine for full protection. Beginning at dawn, she works with community and religious leaders so they can help gather women for discussions to raise awareness. “Today, all women in over 200 households here have received at least one dose of the vaccine,” she says.