title: Incidence and risk factors for neonatal tetanus in admissions to Kilifi County Hospital, Kenya.
abstract: BACKGROUND
  Neonatal Tetanus (NT) is a preventable cause of mortality and neurological sequelae that occurs at higher incidence in resource-poor countries, presumably because of low maternal immunisation rates and unhygienic cord care practices. We aimed to determine changes in the incidence of NT, characterize and investigate the associated risk factors and mortality in a prospective cohort study including all admissions over a 15-year period at a County hospital on the Kenyan coast, a region with relatively high historical NT rates within Kenya.
  
  
  METHODS
  We assessed all neonatal admissions to Kilifi County Hospital in Kenya (1999-2013) and identified cases of NT (standard clinical case definition) admitted during this time. Poisson regression was used to examine change in incidence of NT using accurate denominator data from an area of active demographic surveillance. Logistic regression was used to investigate the risk factors for NT and factors associated with mortality in NT amongst neonatal admissions. A subset of sera from mothers (n = 61) and neonates (n = 47) were tested for anti-tetanus antibodies.
  
  
  RESULTS
  There were 191 NT admissions, of whom 187 (98%) were home deliveries. Incidence of NT declined significantly (Incidence Rate Ratio: 0.85 (95% Confidence interval 0.81-0.89), P<0.001) but the case fatality (62%) did not change over the study period (P = 0.536). Younger infant age at admission (P = 0.001) was the only independent predictor of mortality. Compared to neonatal hospital admittee controls, the proportion of home births was higher among the cases. Sera tested for antitetanus antibodies showed most mothers (50/61, 82%) had undetectable levels of antitetanus antibodies, and most (8/9, 89%) mothers with detectable antibodies had a neonate without protective levels.
  
  
  CONCLUSIONS
  Incidence of NT in Kilifi County has significantly reduced, with reductions following immunisation campaigns. Our results suggest immunisation efforts are effective if sustained and efforts should continue to expand coverage.
authors: KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya.
authors: Fredrick
authors: F
authors: Ibinda
authors: KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya.
authors: Evasius
authors: E
authors: Bauni
authors: KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya.
authors: Symon M
authors: SM
authors: Kariuki
authors: KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom.
authors: Greg
authors: G
authors: Fegan
authors: KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya.
authors: Joy
authors: J
authors: Lewa
authors: KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya.
authors: Monica
authors: M
authors: Mwikamba
authors: KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya.
authors: Mwanamvua
authors: M
authors: Boga
authors: KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya.
authors: Rachael
authors: R
authors: Odhiambo
authors: KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya.
authors: Kiponda
authors: K
authors: Mwagandi
authors: KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom.
authors: Anna C
authors: AC
authors: Seale
authors: KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom.
authors: James A
authors: JA
authors: Berkley
authors: International Centre for Genetic Engineering and Biotechnology, Cape Town, South Africa; Division of Immunology, University of Cape Town, Cape Town, South Africa.
authors: Jeffrey R
authors: JR
authors: Dorfman
authors: KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya; Department of Psychiatry, University of Oxford, Oxford, United Kingdom.
authors: Charles R J C
authors: CR
authors: Newton
mesh_terms: D005260:Female; D006760:Hospitalization; D006766:Hospitals, County; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007630:Kenya / Q000453:epidemiology; D008297:Male; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors; D012424:Rural Population; D016019:Survival Analysis; D013742:Tetanus / Q000209:etiology / Q000401:mortality*