Cotter B, Bremer V, Stroh G et al. (2003): Assessment of neonatal tetanus elimination in an African setting by lot quality assurance cluster sampling (LQA-CS)
Epidemiol. Infect. 130: 221-226.

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.