Epidemiology and Infection

Assessment of neonatal tetanus elimination in an African setting by lot quality assurance cluster sampling (LQA–CS)

a1 European Programme for Intervention Epidemiology Training (EPIET), Istituto Superiore di Sanita, 299 Viale Regina Elena, 00161, Rome, Italy
a2 Robert Koch-Institute, Seestrasse 10, 13353 Berlin, Germany
a3 Department of Vaccines and Biologicals, Vaccine Assessment and Monitoring Team, World Health Organisation, Geneva, Switzerland
a4 World Health Organisation, Intercountry Zimbabwe, PO Box 5160, Harare, Zimbabwe
a5 Ministry of Health, PO Box CY 1122 Causeway, Harare, Zimbabwe
a6 World Health Organization, Department of Vaccines and Biologicals, Vaccine Assessment and Monitoring Team, Geneva, Switzerland


Neonatal tetanus (NT) elimination, <1 case per 1000 live births (LB), was assessed at district level in Zimbabwe using a combined lot quality assurance–cluster sampling survey (LQA–CS). Three of the highest risk districts were selected. NT was considered eliminated if fewer than a specified number of NT deaths (proxy for NT cases) were found in the sample determined using operating characteristic curves and tables. TT2+ vaccine coverage was measured in mothers who gave birth 1–13 months before the survey and women aged 15–49 years. NT was considered as eliminated, TT2+ coverage was 78% (95% CI 71–82%) in women aged 15–49 and 83% (95% CI 76–89%) in mothers. The survey cost US$ 30000 excluding costs of consultants. NT incidence was below the elimination threshold (<1/1000 LB) in the surveyed districts and probably in all districts. LQA–CS is a practical, relatively cost effective field method which can be applied in an African setting to assess NT elimination status.

(Accepted December 9 2002)

c1 Author for correspondence: Public Health Surveillance Scientist, Department of Public Health, Southern Health Board, Sarsfield House, Wilton, Cork, Ireland.