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Training traditional birth attendants (TBAs) has been promoted as a way to prevent neonatal tetanus in areas of the developing world where TBAs are widespread. The evidence for the effectiveness of this strategy is reviewed. It is concluded that the evidence that training TBAs prevents neonatal tetanus is much weaker than that for vaccination of women with tetanus toxoid either before or during their pregnancy. Vaccination is the method of choice for prevention of neonatal tetanus wherever it is economically practicable. Where TBAs are trained, their tasks should include promotion of tetanus toxoid vaccination coverage. [ABSTRACT FROM PUBLISHER]