Of the 130 million babies born annually globally, 4 million (3.1%) die within the first 4 weeks of life.¹ In Nigeria, of the 5 million babies born annually, 240 000 (4.8%) die within the first 4 weeks of life.² Globally, tetanus accounts for 7% of these neonatal deaths, but accounts for up to 20% in Nigeria, one of 27 countries that account for 90% of the global burden of the disease.^1,3–8 At the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria, a tertiary hospital located in the capital of Rivers State, one of the oil-producing states of Nigeria, 30–50 patients with neonatal tetanus (NNT) are admitted annually; most of them are full-term normal-sized babies.^9–11

This review highlights some of the reasons for the persistently high incidence of NNT in Nigeria and examines options for reduction within the context of Millennium Development Goal 4—that is, reduction in child mortality by two thirds from 1990 to 2015.

THE DISEASE

The clinical picture of NNT is too well known to be discussed here. Briefly, the affected baby usually establishes sucking after birth, but stops sucking 2 days later, and about the same time develops a fixed expression on the face resembling a smile, sometimes referred to as the smile of the wicked (risus sardonicus). This is later followed by stiffness or spasms. Usually death occurs by the end of the …