title: Risk factors for neonatal tetanus--Busoga region, Uganda, 2002-2003.
abstract: BACKGROUND
  Uganda has not achieved the 2005 neonatal tetanus (NNT) global elimination target set by the World Health Organization (WHO). The Busoga region has the highest recorded level of NNT incidence in Uganda. To understand the reasons for this high incidence, a study was conducted to identify NNT risk factors.
  
  
  METHODS
  During March-May 2004, a matched case-control study was conducted in the Busoga region for a 2-year study period (2002-2003). Matching variables were sex, residence, and date of birth. A total of 24 cases of NNT (according to the WHO case definition) were identified from hospital records, and 96 community controls (children who survived the neonatal period) were selected.
  
  
  RESULTS
  Bivariate analysis indicated that neonates with NNT were more likely to have been delivered outside a health facility, on an unclean surface, without use of gloves, or by unskilled attendants. Mothers of these neonates were less likely to report vaccination during previous pregnancies, administration of 2 doses of tetanus toxoid (TT) during the study pregnancy, or use of certain intravaginal substances (most commonly, herbs) at onset of labor. Multivariate analysis indicated that unclean delivery surfaces (odds ratio [OR] = 38.8; 95% confidence interval [CI] = 2.9-518.1) and primigravidae mothers (OR = 79.5; CI = 1.8-3,472.2) were associated with NNT. Administration of 2 doses of TT during pregnancy, vaccination during previous pregnancies, and intravaginal application of certain substances were protective against NNT.
  
  
  CONCLUSIONS
  These findings underscore the importance of having clean delivery surfaces and of mothers receiving 2 doses of TT during pregnancy. Implementation of these measures might help eliminate NNT from the Busoga region of Uganda.
authors.affiliation: Makerere University Institute of Public Health, Kampala, Uganda. sgitta@iph.ac.ug
authors.forename: Sheba N
authors.initials: SN
authors.lastname: Gitta
authors.forename: F
authors.initials: F
authors.lastname: Wabwire-Mangen
authors.forename: D
authors.initials: D
authors.lastname: Kitimbo
authors.forename: G
authors.initials: G
authors.lastname: Pariyo
mesh_terms: D016022:Case-Control Studies; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D017053:Infection Control; D008297:Male; D012307:Risk Factors; D013742:Tetanus / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D013745:Tetanus Toxoid; D014454:Uganda / Q000453:epidemiology
chemical_list: D013745:Tetanus Toxoid