JMIR Publications

ABSTRACT

Background:

Neonatal Tetanus (NNT) is a vaccine preventable disease that occurs at higher incidence in resource-poor countries, presumably because of low maternal immunization rates and unhygienic cord care practices. Neonatal Tetanus (NNT) remains an important cause of infant mortality in rural areas of Punjab Province

Objective:

To evaluate and determine the risk factors for mortality in NNT cases and to make the recommendations for future strategies.

Methods:

A descriptive study was conducted from 6th July to 14th July 2021 at DG Health Office Lahore. Surveillance data set for the year of 2020 and clinical notes were reviewed and analyzed . Demographic information, clinical presentation progression and outcome was evaluated from all investigated cases and comparison analysis was done between those who survived and those who died.

Results:

Out of total of 176 reported cases, 145 (82.3%) cases were notified from rural areas of Punjab. Mean age was 9 days, 37% cases were females and 63% were males. The overall mortality was 77 (43.75%) while 31 (17.6%) maternal deliveries were conducted by untrained birth attendants. 119 (67.6%) women received zero TT shot in their life. Clinical notes revealed the group who survived had a significantly greater mean body weight on admission, later onset of disease, was hospitalized early and received Tetanus Immunoglobulin (TIG). The children who could not survive had significantly common clinical feature like generalized rigidity, fever and respiratory arrest.

Conclusions:

Number of increased mortality in rural and tribal areas is suggestive of poor TT immunization coverage. Low literacy, poor socio-economic status of families, lack of awareness regarding antenatal care and poor hygienic deliveries conducted by untrained persons remained main risk factors. Improvement in TT coverage, deployment of trained community midwives and awareness sessions regarding TT vaccination in hard to reach areas was recommended.