Neonatal tetanus incidence in Dadu District, Pakistan, 1993-2003

The study objective was to assess the incidence of neonatal tetanus (NT) in Dadu District, Pakistan.

We analyzed the NT surveillance data for the period 1993-2003 in order to determine the NT incidence. We identified unreported NT cases retrospectively in 2005, by active surveillance and hospital record reviews. The 2-source capture-recapture method was used to estimate the incidence of NT cases.

Active methods identified 134 cases in addition to 274 cases in the routine surveillance system. The average annual incidence in routine surveillance was 0.55 per 1000 live-births (LB). Based on an estimated 463 NT cases during this period (95% confidence interval (CI) 425-509), the average annual incidence (capture-recapture) was 0.62 per 1000 LB. Through routine immunization and supplementary immunization activities, NT incidence declined from 0.87 per 1000 LB in 1994 to 0.18 per 1000 LB in 2003. Males had higher incidence rates than females. Both of the average annual incidence rates (by routine surveillance and capture-recapture method) are below the World Health Organization global elimination goal.

Enhanced case-based investigation, targeted tetanus toxoid immunization of women of childbearing age, community-based NT reporting, immediate reporting and active surveillance are critical to sustain the ongoing decline in NT incidence.