By Sue Hanley.

Angong was expecting her third baby. After a good pregnancy she was eagerly awaiting the birth. The birth pains began while she was collecting water. She returned home and prepared for the birth. There were two or three women in her village who helped at the birth of babies, so a message was sent to one of them to come and assist.

That night Angong gave birth to a lovely baby boy. The cord had been cut with a knife which she used every day for different chores and then cow dung was put on the cord.

The baby was beautiful and was very contented. However, on the third day Angong noticed that he would not suck and his mouth was stiff and tight. As the day went on, he became more sick, his whole body becoming stiff and shaking. They tried to give him milk on a spoon but every time they touched him, he began to shake and become stiff. The baby got rapidly worse and later that week he died. He died of a disease called tetanus.


  1. Does this disease occur in your community?
  2. Why do you think babies die of this disease?
  3. What can you do about it?

This disease gets into the baby through the cord, either when it is cut by something that is not clean or when something (eg manure) is put onto the cord which contains the tetanus germ.

There are two ways that you can stop this happening:


The pregnant mother can be vaccinated with two or three doses of tetanus toxoid, at intervals of one month or more, completing at least a month before the expected birth date. If the mother has been immunised against tetanus before this pregnancy, only one dose is necessary.


The cord must be cut with something sterile and kept clean. A kit can be given – or sold for a small fee – to each mother. This kit would contain the following items in a small box or plastic bag…

Soap for the person assisting with the birth to wash her hands with.

Clean cotton tape to tie the cord.

A new unused razor blade to cut the cord. Local alternatives (eg a split sorghum stalk) may be used if these are first sterilised and then kept clean.

A tiny bottle of gentian violet to put on the cord with cotton wool to help it dry.

After birth, wait until the cord becomes thin and white. Tie the cord near to the baby and then tie it again 1 – 2 cms away. Use the new razor blade to cut between the ties.

Sue Hanley has worked as a midwife in both Sudan and Kenya where this kit has been used successfully.