SERIAL FEATURES Selective Primary Health Care: Strategies for Control of Disease in the

Tetanus, although an eminently preventable disease, remains common and uncontrolled in many developingcountries. The persistenceof tetanus is attributable to health service policies that ignore the disease because of a dearth of reliable epidemiologic and eco-nomic information. In many developingcountries there have, as yet, been few public or professional demands for preventiveaction. For the prevention of neonatal tetanus, the immediate priority is immunization timed to produce and maintain protective levels of maternal antitoxin during pregnancy. This strategy should be accompanied by the exten-sion and improvementof scientificstandards of midwifery. Toprotect the restof the popu-lation from wound tetanus, the strategy of first choice consists of continuous multiple-antigen immunization in infancy and childhood. Such a program should be reinforced by the routine administration of a toxoid booster followingall accidental wounds as well as before all ritual procedures known to carry risk. These strategies,which are of proven efficacy and adaptable to local conditions of the large populations still in need of protec-tion, together provide powerful justification for the expansion of primary maternal and child health services. Careful measurement of the incidence of neonatal tetanus would providea good indicator of the degreeof effectiveness such services haveattained in many rural communities. In many parts of the world, the incidence of tetanus is decreasing as a result both of rising standards of living and of effective primary care services that in-clude routine childhood immunization and scientific midwifery. The most feasible and long-term cost-effective techniques for controlling tetanus are best applied in the context of personal, preventive care to three groups: children, women during pregnancy and childbirth, and all those who have been acciden-tally wounded or are about to undergo a wounding ritual