Mortality from tetanus neonatorum in Punjab (Pakistan).
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.
Publication Date: 1982-06-01 PubMed ID: 12282427
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- Journal Article
Summary
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The research article discusses a survey conducted on households in Punjab, Pakistan to investigate the high mortality rates from neonatal tetanus, directly linked to unhealthy childbirth and aftercare practices. The study also suggests strategies for disease control.
Methodology and Demographics of the Study
- The research was carried out among 59,598 households in Punjab, categorized into three major socioeconomic groups: urban slums, rural agricultural areas, and rural cattle and horse raising areas.
- Total of 13,831 live births reported during the survey period, of which 724 infants died within the first month of life.
Predominant Cause of Infant Mortality
- Out of the deceased infants, 432 (60%) deaths were attributed to neonatal tetanus.
- All newborns in the surveyed areas were delivered by untrained local health workers (“dai”) or trained midwives.
- Typical aftercare included placing cow dung on the umbilical cord stump and cleaning the newborn with a dirty cloth.
- Additionally, neonatal deliveries were often aided with unsterilized tools by the midwives.
- Poor hygienic practices were found to directly contribute to the high incidence of neonatal tetanus.
Other Significant Findings
- Families in the rural areas live in close proximity with animals, therefore increasing the exposure to Clostridium tetani, a bacterium responsible for causing tetanus. Notably, neonatal tetanus rates were higher in the rural areas compared to urban slums.
- In most cases, male infants were circumcised by the local barber within the first seven days of life, using unsanitary methods such as stuffing the wound with ash or cow dung, thereby significantly increasing the risk of infection.
- This resulted in a greater number of male infants’ deaths due to tetanus, with a male to female death ratio of 1.61:1.
- Most neonatal deaths occurred between the 4th and the 19th day post delivery, with the high male deaths in the last three weeks of the first month attributed to circumcision.
Mothers’ Vaccination Status
- None of the mothers interviewed during the survey had received a tetanus toxoid vaccination during their pregnancy, increasing the vulnerability to neonatal tetanus.
Need for Disease Control Strategies
- The study underscores the need to implement strategies for controlling neonatal tetanus, particularly by improving sanitary practices during delivery and postnatal care, and promoting maternal immunization.
Cite This Article
APA
Suleman O.
(1982).
Mortality from tetanus neonatorum in Punjab (Pakistan).
Pak Pediatr J, 6(2-3), 152-183.
Publication
Researcher Affiliations
MeSH Terms
- Adolescent
- Age Factors
- Animal Population Groups
- Asia
- Biology
- Circumcision, Male
- Conservation of Natural Resources
- Culture
- Data Collection
- Delivery of Health Care
- Delivery, Obstetric
- Demography
- Developing Countries
- Disease
- Economics
- Environment
- Health
- Health Personnel
- Infant
- Infections
- Midwifery
- Pakistan
- Population
- Population Characteristics
- Poverty
- Pregnancy
- Pregnancy Outcome
- Reproduction
- Research
- Risk Factors
- Sampling Studies
- Social Class
- Socioeconomic Factors
- Surveys and Questionnaires
- Tetanus
Citations
This article has been cited 4 times.- Shah A, Shah A. Total Glans Amputation in a Child following Ritual Circumcision - Report of a Case and Review of Literature. J Indian Assoc Pediatr Surg 2023 May-Jun;28(3):256-259.
- Stanfield JP, Galazka A. Neonatal tetanus in the world today. Bull World Health Organ 1984;62(4):647-69.
- Galazka AM. Control of neonatal tetanus. Indian J Pediatr 1985 Jul-Aug;52(417):329-41.
- Traverso HP, Kamil S, Rahim H, Samadi AR, Boring JR, Bennett JV. A reassessment of risk factors for neonatal tetanus. Bull World Health Organ 1991;69(5):573-9.
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