title: Epidemiology of neonatal tetanus in rural Pakistan.
abstract: OBJECTIVE
  To estimate the incidence of neonatal tetanus (NT) and to study the factors associated with NT mortality in Dadu district, Pakistan.
  
  
  METHODS
  This study is a retrospective analysis of surveillance data from 1993-2003. NT cases were identified from the district surveillance database and hospital records reviews. Cases were ascertained using the NT standard case definition. Clinical records of all neonates (n = 416) admitted with the diagnosis of NT from 1993 through 2003 were reviewed for clinical presentation, progression and outcome. Rates, means and frequencies were calculated. Odds ratio was calculated to determine the association between potential risk factors and NT mortality. Logistic regression models were used to compute odds ratios and their associated 95% Confidence Intervals.
  
  
  RESULTS
  Out of a total of 416 NT cases, 408 met the case definition. The overall case fatality rate (CFR) for NT was 30.1% (95% Confidence Interval (CI):25.6-34.6); CFR fell from 42% in 1993 to 29% in 2003 (p = 0.377). NT incidence decreased from 0.90/1000 live births (LB) in 1994 to 0.18/1000 LB in 2003. Multivariable analysis showed that age at admission of 8 days or less with {Odds Ratio (OR) 9.41, CI: 2.67-33.14} or without (OR 2.62, CI: 1.52-4.50) low neonatal weight was the strongest predictor of mortality.
  
  
  CONCLUSIONS
  The rate of decline of neonatal tetanus incidence and case fatality was consistent with the impact of routine and supplementary immunization activities. In addition to strengthening maternal tetanus toxoid immunization coverage and hygienic delivery practices, health education focusing on increasing awareness of NT could help reduce NT mortality.
authors: Faculty of Health Sciences, University of Lethbridge, Lethbridge, Canada.
authors: Jonathan Adebola
authors: JA
authors: Lambo
authors: Mahmood Iqbal
authors: MI
authors: Memon
authors: Zahid Hussain
authors: ZH
authors: Khahro
authors: Muhammad Ismail
authors: MI
authors: Lashari
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D005260:Female; D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration; D015994:Incidence; D007226:Infant Mortality; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008423:Maternal Age; D008875:Middle Aged; D016017:Odds Ratio; D010154:Pakistan / Q000453:epidemiology; D011159:Population Surveillance; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology; D011295:Prenatal Care; D012189:Retrospective Studies; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D013742:Tetanus / Q000401:mortality* / Q000517:prevention & control