**Question:** To achieve neonatal tetanus elimination, the incidence of neonatal tetanus per 1000 live births should be reduced to less than -

A. 10
B. 20
C. 30
D. 50

**Correct Answer:** A. 10

**Core Concept:** Neonatal tetanus is a serious neurological disorder caused by the entry of clostridial toxins into the human body, particularly through contaminated wounds during childbirth. The World Health Organization (WHO) and Unicef have set a target to eliminate neonatal tetanus by reducing the incidence to less than 1 case per 1000 live births.

**Why the Correct Answer is Right:** Neonatal tetanus elimination is essential to reduce the burden of this disease in newborns. The target of less than 10 cases per 1000 live births ensures that the incidence is significantly low, reducing the risk of neonates acquiring tetanus infection. This target is set as per WHO recommendations and helps in monitoring progress towards achieving the elimination goal.

**Why Each Wrong Option is Incorrect:**

A. 20: This option is too high, and even though it is better than the correct answer, it still allows for a significant number of tetanus cases in newborns.
B. 30: This is also higher than the recommended target, making it insufficient for achieving neonatal tetanus elimination.
C. 50: Similar to options A and B, this option is not low enough to ensure a significant reduction in neonatal tetanus cases.
D. The correct answer, 10, is the recommended target by WHO to achieve neonatal tetanus elimination. Lowering this number helps in reducing the risk of neonatal tetanus cases and contributes to global health goals.

**Clinical Pearl:**

Neonatal tetanus elimination can be achieved through a comprehensive approach involving vaccination programs, improving maternal health, and promoting clean delivery practices. This includes vaccination of pregnant women against tetanus, promoting institutional delivery, and ensuring proper wound cleaning and dressing during childbirth. By focusing on these strategies, we can significantly reduce the number of neonates contracting tetanus, which is essential for global health goals and the well-being of infants and mothers alike.