Tukul 3 is uncharacteristically quiet and cool. There is only one tiny patient here, lying on a wooden bed under a mosquito net. She is all of 5 days old. The baby’s mother divides her attention between her sick newborn and her older child who plays quietly in the corner of the tukul.
The baby is unable to breast feed. Her tiny fists are balled up against her chest and her arms and legs are stiff. Sounds, lights and movement can all cause painful muscle spasms. Even a lick of wind can do it. She must be nursed quietly in the cool dark tukul away from the other patients. Her mother is having a hard time understanding why she cannot touch and hold her baby.
The baby has tetanus, or “lockjaw”. Tetanus is a terrible painful disease; victims remain fully conscious and can feel the muscle contractions. In newborns, tetanus is caused by contamination of the umbilical stump by the bacteria Clostridium tetani. Contaminated instruments used to tie and cut the cord are usually responsible.
The baby is being tube fed; she is getting an antibiotic, antitoxin and diazepam for the muscle spasms, but that is the limit of our capabilities. If the infection attacks her respiratory muscles, we can only support her breathing for a short time.
In this setting, mortality from neonatal tetanus (tetanus in the first 28 days of life) is probably close to 90%. In developed countries, neonatal tetanus is rare to non-existent but in places like southern Sudan it is a common cause of death in newborns. WHO estimates that up to half of all neonatal deaths in Africa and Asia are caused by tetanus.
The tragedy for this baby is that neonatal tetanus is utterly preventable. Immunization of pregnant mothers with tetanus toxoid and clean deliveries can decrease the incidence of neonatal tetanus to almost zero.
It was the end of the 19th century when scientists first learned how to prevent neonatal tetanus. But here we are, more than 100 years later, and babies in southern Sudan are still dying from it.