By Alan Mozes

BLA (Reuters Health) - Under the cool shade of a baobab tree, all 30 families of this remote West African village of mud huts and thatched roofs danced, chanted and beat gourd drums to celebrate their role in the introduction of a potentially revolutionary advance in the global effort to eliminate tetanus.

Immunization is the chief weapon against this deadly disease, but the lack of resources and medical expertise in the developing world mean few people receive the shots necessary to confer protection. More than 200,000 newborns and 30,000 mothers in 57 countries die of tetanus each year.

The adult women of Bla--along with more than 100,000 women of child-bearing age across the poverty-stricken nation of Mali--are the first in the world to be inoculated against tetanus with a new device called Uniject.

The disposable single-use syringe is designed to be a smaller, simpler and more durable delivery system for the tetanus toxoid vaccine than traditional needles. It is the first syringe to come pre-loaded with a waste-free single dose of the vaccine; the first to reduce the need for expensive refrigeration during transport; and, most critically, the first to eliminate the need for trained medical personnel for administration.

The result of a decade-long public health initiative, the Uniject syringe was developed by the Seattle-based Program for Appropriate Technology in Health (PATH) in collaboration with the World Health Organization ( news - web sites) (WHO) and the United States Agency for International Development (USAID).

Mali is the first country to use the syringe in its ongoing tetanus campaign. The official launch began Thursday. According to UNICEF ( news - web sites), which is spearheading the introduction and monitoring of the new technology, Uniject will also be introduced into Afghanistan ( news - web sites), Burkina Faso, Ghana, Southern Sudan, Somalia and Uganda in the coming months.

The pharmaceutical manufacturers Becton Dickinson and Bio-Farma have committed to donating 9 million Uniject devices along with the pre-packaged tetanus vaccine over the next three years.

Together these public and private organizations are optimistic that the syringe can help achieve the goal of eliminating tetanus by the year 2005. Uniject, they suggest, will make the vaccine more broadly available in the developing world, where doctors, nurses and medical facilities are few and far between. The populations of these countries are often spread across hard-to-reach mountain ranges, deserts and tropical forests, and rarely obtain routine medical care.

"With Uniject anybody can inject the vaccine," Dr. Francois Gasse, senior project officer for immunization for UNICEF, told Reuters Health. "An illiterate midwife who's never been trained in medicine or birthing can do an absolutely perfect job." The syringe features a wordless, color-coded safe-to-use indicator.

Bla resident Bintou Doumbia--one of the traditional birthing assistants of whom Gasse speaks--said she felt capable of using the device to deliver vaccinations after only a few minutes of training.

"I am happy to be able to do this," the 35-year-old mother of six told Reuters Health. "It's so easy to use, and I didn't see any crying or screaming."

The device's small needle means it's less intimidating than a traditional needle, Gasse points out.

"The needle is so small--about one inch--so that it looks absolutely non-medical, and it feels like nothing more than a mosquito bite," he said. "So you reduce fear among people who may have never seen a needle before."

Mali, among the poorest countries in the world, is one of the 27 nations worst-hit by tetanus. It is a land-locked primarily Muslim nation of just over 11 million people, thinly spread over nearly 500,000 square miles. Sixty five percent of the country is desert or semi-desert. The government has few medical resources to offer in the face of multiple health threats, including the highest maternal mortality rate in Africa.

According to UNICEF, less than one third of Malians most at risk for tetanus--women between the ages of 14 and 49--have received the 3 vaccine doses and 2 booster shots required for life-long immunity. The disease is spread through bacterial spores--found in soil everywhere--which enter through open wounds, most often as a result of unclean birthing practices.

Dr. Soduyougo Teme, the chief of medicine in the town of Kadiolo in southern Mali, says his country's inoculation rate--against a disease that promises an agonizing death due to nerve and muscle damage--is unacceptable. Infections are fatal in over 70% of cases.

"A child or women who gets the disease can't eat, their jaw is frozen, they have convulsions which break the neck and back, and the muscles around the lungs seize until they can not breathe," he explained. "It's horrible. Treatment is a question of luck, so the best thing to fight it is prevention. In that respect, Uniject brings a great hope."

The response of 25-year-old Noutene Sangare--Bla's first recipient of the Uniject-delivered vaccine--bodes well for the campaign.

"It went well," she said, after receiving her shot. "I had no fear."