Epidemiological factors associated with neonatal tetanus mortality: observations from a cluster survey in Nigeria
Eregie, C.O.
East African Medical Journal 70(7): 434-437
1993
ISSN/ISBN: 0012-835X PMID: 8293702 Document Number: 411627
Data obtained from a survey conducted in Kano Metropolis in northern Nigeria in July 1990 on a cluster sample of 2623 live births within the year were used to investigate epidemiological factors associated with neonatal tetanus (NNT) mortality. The sample included 1283 males and 1340 females, of which 79 died (54 from NNT). The NNT mortality rate is a high 20.6/1000. 51% of births in the sample were to mothers who received at least one prenatal visit. 37.9% of births involved mothers who received two or more prenatal visits, which is the typical pattern in developing countries. 32% were immunized with a tetanus toxoid vaccine, which is much higher than the typical 14% in developing countries. 40% were hospital or related health facility births. Low socioeconomic status was attributed to 60% of the infants. Over 80% of mothers practiced purdah, and 83% had a health facility within their cluster. Prenatal care, tetanus toxoid vaccine coverage, hospital delivery, poor cord management, and traditional surgery were related to NNT. Poor cord management and traditional surgery increased the risk of mortality, and the other factors reduced the risk. There were relative, but insignificant, risks associated with a male birth, low socioeconomic status, and the purdah system. One recommendation is for improvements in traditional birth attendant training. Affordability and use of health facilities are affected by the purdah system and the low socioeconomic status of most mothers. Prevention should stress good cord management, which Chinese studies show to be effective in reducing NNT mortality. Tetanus toxoid vaccine is recommended for all mothers who are attending any health facility for any reason. Mass immunization campaigns are an additional means of supplementing coverage. Traditional surgery such as circumcision, vulvectomy, ear piercing, and facial marking should be discouraged. Health education is recommended as a means of increasing use of health care facilities, discouraging unhealthful practices, and increasing immunization.