International Journal of Epidemiology, Vol 26, 897-903, Copyright © 1997 by International Epidemiological Association
J Bennett, J Macia, H Traverso, S Banoagha, C Malooly and J Boring
BACKGROUND: Case-control studies previously conducted in Pakistan suggested
that topical antimicrobials might provide protection against neonatal
tetanus (NNT) when applied to the umbilical cord wound during the first
several days of life. The present case-control study, the largest such
study yet reported, was undertaken in Punjab Province, Pakistan and
afforded further opportunities to evaluate such effects. METHODS: A
population-based, matched, case-control study was undertaken to assess
topical antimicrobials and other factors related to NNT risk in rural parts
of Punjab Province. RESULTS: Continuous use of antimicrobial agents
(antibiotics and antiseptics) at delivery and during the first few days
after delivery was highly protective in univariate testing (matched odds
ratio 0.2 [95% confidence interval: 0.11-0.64], P = 0.003), and remained
significantly protective when other delivery and cord care practices were
controlled. In contrast, applying nothing to the wound was risky compared
with antimicrobial exposures. Hand washing and delivery by a trained birth
attendant appeared protective. Application of animal dung or ash to the
umbilical wound was hazardous. Similarly, predelivery cutaneous or
intravaginal exposure of mothers to ghee (clarified butter) and delivery on
a surface prepared with dried cow dung were risky, with significant
interaction noted between them. Mortality and NNT were far more likely
among previous births to mothers of cases. CONCLUSIONS: Topical
antimicrobials offer a new, effective and inexpensive means to prevent NNT,
and could usefully complement maternal immunization with tetanus toxoid in
controlling the disease. Special prevention efforts should be directed
towards mothers of NNT cases.
ARTICLES
Protective effects of topical antimicrobials against neonatal tetanus
Task Force for Child Survival and Development, Atlanta, Georgia, USA.
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