Risk factors for neonatal tetanus in Karachi : a matched case control study

Date of Award


Document Type


Degree Name

Master of Science in Epidemiology & Biostatistics (MSc Epidemiology & Biostats)


Community Health Sciences


Neonatal tetanus is a major public health problem in our country. This preventable disease is one of the most underreported diseases. In 1999, Pakistan reported an estimated 21,600 deaths from neonatal tetanus. Pakistan is among the three countries, which account for more than half of world's neonatal tetanus deaths. In order to eliminate neonatal tetanus by the year 2005, a target year set by UNICEF, WHO and UNFPA, we need to evaluate factors that are responsible for the disease. We conducted a matched case control study to identify the risk factors for neonatal tetanus in all the five districts of Karachi. We recruited 140 cases and 280 matched controls. Cases were identified through the EPI linelisting and the hospitals of Karachi. Hospital reported cases and their two corresponding controls matched on gender, area of residence, and the date of birth of cases were enrolled. Female interviewers who were trained to administer a pre-tested questionnaire carried out data collection. Conditional logistic regression was performed to assess the independent effect of factors associated with neonatal tetanus. Our final multivariate model identified three risk factors for neonatal tetanus after adjusting for other variables in the model. Subsequent cord applications of substances (ghee, mustard oil, and surma) on umbilical cord was associated with neonatal tetanus (adjusted mOR = 1.9:95% Cl: 1.3, 2.8). Population attributable risk percent for subsequent cord application was 68Vo. Home delivery was identified as risk factor for neonatal tetanus after controlling for other risk factors (adjusted mOR = I .7; 95% CI: I .2, 2.7). Population attributable risk percent for home delivery was 32Vo. An illiterate mother was also associated with the neonatal tetanus (adjusted mOR = 1.6; 95% CI: I .0, 1.5). Neonatal tetanus should be given the foremost priority in the already existing maternal and child health care programs. Unhygienic application of substances on the umbilical cord in subsequent days should be discouraged. Health planners need to consider the impact of this practice while formulating the control strategies through immunization Health awareness in the community regarding this practice should be promoted. Pregnant women should be counseled for giving preference to health care setting during delivery. Home delivery should be discouraged since mother should give birth at a place where newborn care is carried out in an aseptic environment such as hospitals and maternity clinics where the child is less likely to be exposed to unhygienic substances.

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