title: Neonatal tetanus mortality in Veracruz, Mexico, 1989.
abstract: This article describes a survey conducted in the State of Veracruz, Mexico, to estimate neonatal tetanus (NNT) mortality. The survey, which entailed visits to 72,720 households, collected data on 8,401 live births and 209 infant deaths occurring between April 1988 and May 1989. Twenty-six of the 209 fatalities conformed to a WHO standard case definition of death from neonatal tetanus. The estimated neonatal tetanus mortality was thus 3.1 deaths per 1,000 live births (95% confidence limits = 1.7, 4.5). Comparison of this rate to reported figures suggests that for every NNT death recorded in Veracruz during the study period, as many as 50 others went unreported. A case-control study nested within the survey was conducted to assess preventable NNT risk factors. Limited information on 13 NNT deaths and 217 controls showed an increased risk for neonates who were delivered at home and whose parents' ethnic background was Mexican Indian. Five of the 13 fatalities had their umbilical cords cut with a domestic or traditional cutting tool such as a reed cane, as compared to none of the 217 controls. The observed vaccine efficacy of 2+ doses of tetanus toxoid was 70% (95% confidence limits = 52, 100). Both the mothers of neonates who died of NNT and their controls missed an average of five opportunities to receive tetanus toxoid. These findings underscore the need to launch a perinatal health program serving Mexico's high-risk populations.
authors.affiliation: Veracruz State Health Secretariat, Health District 1, Pánuco.
authors.forename: V M
authors.initials: VM
authors.lastname: Cárdenas Ayala
authors.forename: R M
authors.initials: RM
authors.lastname: Núñez Urquiza
authors.forename: D R
authors.initials: DR
authors.lastname: Brogan
authors.forename: J M
authors.initials: JM
authors.lastname: Ibarra Rosales
authors.forename: N
authors.initials: N
authors.lastname: Gatica Valdés
authors.forename: T E
authors.initials: TE
authors.lastname: Smith
authors.forename: S
authors.initials: S
authors.lastname: Galván Arriaga
authors.forename: M E
authors.initials: ME
authors.lastname: Flores Collins
authors.forename: A
authors.initials: A
authors.lastname: Escobar Mesa
mesh_terms: D016022:Case-Control Studies; D002423:Cause of Death; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008297:Male; D008800:Mexico / Q000453:epidemiology; D011159:Population Surveillance; D011247:Pregnancy; D012307:Risk Factors; D013742:Tetanus / Q000401:mortality* / Q000517:prevention & control; D013745:Tetanus Toxoid / Q000008:administration & dosage
chemical_list: D013745:Tetanus Toxoid