Prevention of neonatal conjunctivitis in Zaire

With the emergence of chlamydia as a major cause of neonatal conjunctivitis, silver nitrate is no longer the prophylactic agent of choice in many parts of the world. We studied 450 consecutive newborns in north-eastern Zaire in an effort to determine which of two agents provided the most effective prophylaxis. None of 236 newborns treated at birth with 1% silver nitrate and none of 123 treated with 1% tetracycline was found to develop conjunctivitis. Three of 91 "forgotten" babies developed gonococcal conjunctivitis. Nurses, thinking tetracycline was "messy", tended to "forget" to treat babies for whom tetracycline was prescribed. The use of silver nitrate still provides adequate prophylaxis in Zaire. Potential changes in the prophylactic regimen would need to take the perceptions of health care workers into account.