title: Risk factors of neonatal tetanus in Wenzhou, China: a case-control study.
abstract: BACKGROUND
  Neonatal tetanus is a major cause of neonatal mortality in many developing countries and remains a major public health problem. This study aimed to determine risk factors associated with neonatal tetanus in Wenzhou, China.
  
  
  METHODS
  Medical records of neonatal tetanus cases from 17 hospitals over a 13-year period (2000-2012) were reviewed for potential risk factors. Controls were selected from neonates with diseases other than tetanus who were admitted to the same facility during the same period. The potential risk factors of the neonatal tetanus group were compared with the control group using univariate analysis and an unconditional logistic regression model.
  
  
  RESULTS
  A total of 246 neonates with tetanus and 257 controls were included in this study. Univariate analysis showed that having untrained birth attendants, home delivery, an unsterile method of delivery and being a migrant to Wenzhou were significantly different between the two groups (P < 0.001). Logistic regression analysis revealed that the odds of having an untrained birth attendant, home delivery and an unsterile method of delivery were significantly higher in the tetanus group than the control group (odds ratio: 1371.0; 95% confidence interval: 206.0, 9123.5).
  
  
  CONCLUSIONS
  This study identified that the main risks of neonatal tetanus in cases from Wenzhou were having an untrained birth attendant, home delivery and an unsterile method of delivery. Preventive measures directed to these risk factors may reduce the occurrence of neonatal tetanus in the studied area.
authors.affiliation: Department of Emergency Response, Wenzhou Center for Disease Control and Prevention, Wenzhou 325000, People's Republic of China .
authors.forename: Zhou
authors.initials: Z
authors.lastname: Zu-Mu
authors.affiliation: Department of Preventive Medicine, Wenzhou Medical University, Wenzhou 325000, People's Republic of China .
authors.forename: Shi
authors.initials: S
authors.lastname: Hong-Ying
authors.affiliation: Department of Emergency Response, Wenzhou Center for Disease Control and Prevention, Wenzhou 325000, People's Republic of China .
authors.forename: Xu
authors.initials: X
authors.lastname: Yi
authors.affiliation: Department of Emergency Response, Wenzhou Center for Disease Control and Prevention, Wenzhou 325000, People's Republic of China .
authors.forename: Hu
authors.initials: H
authors.lastname: Cai-Song
authors.affiliation: Department of Emergency Response, Wenzhou Center for Disease Control and Prevention, Wenzhou 325000, People's Republic of China .
authors.forename: Zhang
authors.initials: Z
authors.lastname: Xiao-Ming
authors.affiliation: Department of Emergency Response, Wenzhou Center for Disease Control and Prevention, Wenzhou 325000, People's Republic of China .
authors.forename: Zhao
authors.initials: Z
authors.lastname: Li-Na
authors.affiliation: Department of Medical Records, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, People's Republic of China .
authors.forename: Xie
authors.initials: X
authors.lastname: Zuo-Kai
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002681:China / Q000453:epidemiology; D005260:Female; D006700:Home Childbirth; D006801:Humans; D006920:Hygiene; D007231:Infant, Newborn; D016015:Logistic Models; D016017:Odds Ratio; D012307:Risk Factors; D013742:Tetanus / Q000453:epidemiology* / Q000401:mortality; D014171:Transients and Migrants