Risk factors for neonatal tetanus in KwaZulu-Natal

To study cases of neonatal tetanus (NNT) in an intensive care unit (ICU) to support formulation of appropriate intervention strategies. SITE: Paediatric ICU, King Edward VIII Hospital, Durban.

(i) Trend in number of admissions with NNT between 1983 and 1993; (ii) prospective study of NNT cases admitted during 1993.

The mean annual admission rate decreased from 41 cases before 1985 to 24 cases between 1985 and 1988 and 18 cases between 1989 and 1992. There were 27 cases in 1993. Most patients in 1993 were from informal settlements, squatter camps and rural areas (44%, 22% and 22% respectively). All 27 patients were delivered at home. Fourteen mothers (52%) had attended an antenatal clinic; 12 of them had attended at least twice. Fifteen mothers had used a clean sterile instrument to cut the cord. Only 1 mother had used cow dung to staunch blood flow from the severed cord. Ninety-three per cent of cases were severe; the overall mortality rate was 22%. The mean duration of ventilation was 23 days (range 17-60 days) and of ICU stay 35 days (range 13-87 days).

These results suggest that the promotion of the maternal immunisation campaign is perhaps the most important factor for the elimination of NNT. Measures should be taken to ensure universal coverage with tetanus toxoid of all pregnant women, and coverage of all women of reproductive age in underserved areas.