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  • Title: Mortality from tetanus neonatorum in Punjab (Pakistan).
    Author: Suleman O.
    Journal: Pak Pediatr J; 1982; 6(2-3):152-83. PubMed ID: 12282427.
    Abstract:
    Researchers conducted a survey study of 59,598 households in 3 major socioeconomic groups (urban slums, rural agricultural areas, and rural cattle and horse raising areas) in the Punjab province of Pakistan to estimate mortality from neonatal tetanus and to develop a strategy for its control. The investigators learned of 13,831 live births. 724 of these died in the 1st month of life with 432 (60%) dying from neonatal tetanus. Village untrained "dai" or trained midwives delivered all infants in all 3 areas. Often these deliverers placed cow dung on the stump of the severed umbilical cord and used a dirty cloth for cleaning the infant. In addition, the trained midwives would use unclean unsterilized tools to assist in delivery. In rural areas, animals sleep inside with the family and they are always with the family. Since Clostridium tetani is found in intestines of animals, especially horses, the neonatal tetanus rates as a percentage of all neonatal deaths for the rural agricultural and rural cattle and horse raising areas were higher (60% and 73%) than for the urban slums (45%). The village barber circumcises male infants on or before the 7th day of life. Since he stuffs the wound with ash or cow dung or rubs it with a dirty cloth, the chances of infecting the wound with C1. tetani increases. Therefore the total ratio of male deaths to female deaths was 1.61:1. Most males died during the last 3 weeks of the 1st month which can be attributed to circumcision. Overall most deaths occurred between 4-19 days. None of the mothers interviewed had been vaccinated with a tetanus toxoid during pregnancy which greatly contributed to the neonatal tetanus mortality rate.
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