International Journal of Epidemiology, Vol 28, 263-266, Copyright © 1999 by International Epidemiological Association
J Bennett, C Breen, H Traverso, SB Agha, J Macia and J Boring
BACKGROUND: Previous case-control studies have paradoxically suggested that
circumcisions protect against neonatal tetanus (NNT), but these
observations have not been adjusted for differences in the length of
survival of cases and controls. METHODS: Boy cases (n = 133) and their
sex-matched controls (n = 399) were extracted from a population-based study
of NNT undertaken in Punjab Province, Pakistan. In the resulting file,
circumcisions were censored such that analysis was restricted to only those
that occurred before onset in cases or before age of onset in the matched
case for controls. The effect of topical antibiotics in circumcision wounds
was then evaluated. RESULTS: After adjusting for confounders, circumcision
before onset posed a significant risk for NNT (matched odds ratio [OR] =
3.1, 95% CI: 1.2-8.0). The risk of NNT in those circumcised before onset
and treated with topical antibiotics did not differ significantly from the
referent group who had not been circumcised before onset (matched OR = 1.1,
95% CI: 0.2-6.8), whereas the lack of topical use was associated with
significant risk (matched OR = 4.2, 95% CI: 1.4-12.6). This suggests that
topical antibiotics are likely to be highly effective in preventing NNT
from circumcision wounds. We estimated an overall risk of about 16 fatal
NNT cases per 1000 live boy births with circumcision wounds that were not
protected by topical antibiotics, and that circumcision and umbilical
wounds each accounted for about half of this overall risk in these boys.
CONCLUSIONS: Topical antibiotics should be routinely applied to all wounds
created by traditional circumcisions, to prevent NNT and sepsis from these
frequently unsterile procedures.
ARTICLES
Circumcision and neonatal tetanus: disclosure of risk and its reduction by topical antibiotics
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
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