title: Predictors and outcome of tetanus in newborns in slum areas of Karachi City: a case control study.
abstract: BACKGROUND
  Tetanus in newborns, is an under-reported public health problem and a major cause of mortality in developing countries. This study aimed to determine the predictors and outcome of tetanus in newborn infants in the slums of Bin-Qasim town, Karachi, Pakistan.
  
  
  METHODS
  We conducted a case-control study at primary health care centers of slums of Bin-Qasim town, area located adjacent to Bin Qasim seaport in Karachi, from January 2003 to December 2013. Cases were infants aged ≤30 days with tetanus, as defined by the World Health Organization. Controls were newborn infants aged ≤30 days without Tetanus, who were referred for a checkup or minor illnesses. The case to control ratio was 1:2.
  
  
  RESULTS
  We analyzed 26 cases and 52 controls. The case fatality was 70.8%. We identified four independent predictors of Tetanus in newborns: maternal education (only religious education with no formal education OR 51.95; 95% CI 3.69-731), maternal non-vaccination (OR 24.55; 95% CI 1.01-131.77), lack of a skilled birth attendant (OR 44.00; 95% CI 2.30-840.99), and delivery at home (OR 11.54; 95% CI 1.01-131.77).
  
  
  CONCLUSIONS
  We identified several potentially modifiable socio-demographic risk factors for Tetanus in newborns, including maternal education and immunization status, birth site, and lack of a skilled birth attendant. Prioritization of these risk factors could be useful for planning preventive and cost-effective measures.
authors.affiliation: Department of Paediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan. arjumand.sohaila@aku.edu.
authors.forename: Arjumand
authors.initials: A
authors.lastname: Sohaila
authors.affiliation: Department of Paediatrics and Child Health-Research, Aga Khan University Hospital, Karachi, Pakistan. yasir.shafiq@aku.edu.
authors.forename: Yasir
authors.initials: Y
authors.lastname: Shafiq
authors.affiliation: Department of Paediatrics and Child Health-Research, Aga Khan University Hospital, Karachi, Pakistan. shazia.azim@aku.edu.
authors.forename: Shazia
authors.initials: S
authors.lastname: Azim
authors.affiliation: Department of Paediatrics and Child Health-Research, Aga Khan University Hospital, Karachi, Pakistan. Benazir.balouch@aku.edu.
authors.forename: Benazir
authors.initials: B
authors.lastname: Baloch
authors.affiliation: Department of Paediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan. ali.akhtar@aku.edu.
authors.forename: Ali Syed Muhammad
authors.initials: AS
authors.lastname: Akhtar
authors.affiliation: Department of Paediatrics and Child Health-Research, Aga Khan University Hospital, Karachi, Pakistan. shiyam.sunder@aku.edu.
authors.forename: Shiyam Sunder
authors.initials: SS
authors.lastname: Tikmani
authors.affiliation: Department of Paediatrics, Salisbury District Hospital, Salisbury, Wiltshire, UK. nickjwbrown@gmail.com.|Department of Paediatrics, Aga Khan University Hospital, Karachi, Pakistan. nickjwbrown@gmail.com.
authors.forename: Nick
authors.initials: N
authors.lastname: Brown
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007114:Immunization; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality; D008297:Male; D009035:Mothers; D010154:Pakistan; D011204:Poverty Areas; D011320:Primary Health Care; D012307:Risk Factors; D013742:Tetanus / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality*; D013745:Tetanus Toxoid; D014505:Urban Population; D055815:Young Adult
chemical_list: D013745:Tetanus Toxoid