Medknow Publications and Staff Society of Seth GS Medical College and KEM Hospital, Mumbai, India
Abstract
Background: Previous studies have identified various risk factors for
neonatal tetanus (NNT) in rural areas of Pakistan. The present matched
case control study was conducted to further evaluate these risk factors
in an urban setting. Aim: The study was carried out to identify risk
factors for NNT in Karachi. Materials and Methods: Patients of NNT (n
= 125) diagnosed from January 1998 to February 2001 were recruited
through a surveillance system of Expanded Programme on Immunization
(EPI). Two neighbourhood controls (n = 250) were matched for each case
for gender and date of birth of the case. Statistical Analysis:
Conditional logistic regression was performed to assess the independent
effect of factors associated with NNT. Results: The final
multivariable model identified subsequent application of substances on
the umbilical cord (adjusted matched odds ratio [adj. mOR] = 5.1
[2.7-9.7]), home delivery (adj. mOR = 1.8; 95% CI: 1.1- 3.1) and
illiterate mother (adj. mOR = 1.6; 95% CI: 1.0- 2.0) as risk factors
for NNT after adjusting for other variables in the model. Population
attributable risk per cent (PAR %) for subsequent cord application was
69% and PAR % for home delivery was 31%. Conclusion: Health planners,
while formulating control strategies through immunization programmes
should also take into account the impact of post-delivery practices,
such as 'subsequent cord application' along with pre-delivery
practices. Health awareness regarding appropriate post-delivery
practices should be promoted and counselling of pregnant women for
giving preference to health care setting for delivery is also crucial