Neonatal tetanus : incidence and risk factors in district Loralai Balochistan

Date of Award


Document Type


Degree Name

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


Community Health Sciences


Neonatal tetanus is one of the major health problems in developing countries. The incidence of neonatal tetanus can serve as an indicator of the quality and degree of utilization of maternal health services and of the effectiveness of immunization program. Findings on different risk factors in an area can suggest the possible ways to augment the effectiveness of neonatal tetanus elimination program in the area. This study was conducted to estimate the incidence of neonatal tetanus mortality and to identify the risk factors for neonatal tetanus in district Loralai. We conducted a community based cross-sectional survey during July-September, l99J in the rural district of Balochistan, Pakistan. We stratified the sample proportionate to population of union councils. The most populous village in a union council was selected first. We interviewed the women, selected randomly, who had a live birth in the 18 months preceding the survey. We conducted a matched case control study to identify the risk factors. We used the W.H.O criteria to enroll cases, identified during the survey or registered at district head quarter hospital. We enrolled three community-based controls per case, matched on the area of residence and date of birth. We approached 1553 eligible mothers and interviewed 1547 of them with a refusal rate of 0.4%. Of the 1547 live births, there were 36 neonatal deaths due to tet2nus. The incidence of neonatal tetanus mortality in the district was 23 per 1000 live births (95% C.I: 16-30). Home was the most common (96%) place for delivery and a relative was the main (60%) health care provider during the delivery. The immunization coverage with tetanus toxoid was 5%. For the case control study, we enrolled 4l cases and 123 controls. Using conditional logistic regression, the risk of neonatal tetanus was increased with the use of soil as delivery surface (O.R=3, 95% C.I: l.l-9.2), father's illiteracy (O.R=3, 95Vo C.I: I.I-7), Possession of sheep at home (O.R=2, 95% C.I:0.9-5) and multiple pregnancies (O.R=4 95Vo C.I: 1.2-12.2). The population attributable risk percent for soil, as delivery surface was 62%. The high incidence of neonatal tetanus in this area indicates pitfalls of the health system in general and maternal and child health services and Expanded Program for Immunization in particular. Transmission of infection while using soil as delivery surface can occur through direct or indirect contamination of fresh umbilical wound through the hands of birth attendant. There is a clear and urgent need to formulate policies within our resources to address this important health problem in the rural areas of Balochistan. Health planners need to consider the prevailing risk factors in the area while designing the control strategies. Effective strategies to raise the immunization coverage with tetanus toxoid and health education to encourage the use of safer delivery practices in general and clean surface in particular is required to reduce the high incidence of neonatal tetanus in the area.

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