Risk factors of neonatal tetanus in Senegal.

A case-control study for evaluating the risk factors of neonatal tetanus was conducted in a rural area of Senegal under demographic surveillance (Niakhar). Some 45 neonatal tetanus deaths that occurred in the study area between March 1983 and March 1986 were investigated. They were matched with 187 controls. Neonatal tetanus accounted for one-third of all neonatal deaths; mortality from neonatal tetanus was 16/1000 livebirths. The effect of various demographic, socioeconomic, epidemiological and behavioural factors was investigated in a multivariate analysis using linear logistic regression. There was no difference associated with socioeconomic factors between cases and controls. Factors associated with the skill and behaviour of birth attendant and mother were highly significant and were associated with high odds ratio (OR) and included whether the hands of the person cutting the cord were washed with soap (OR = 5.22; p = 0.001); whether the person who dressed the cord was skilled (OR = 4.71; p = 0.012); whether the age of the mother was less than 18 years (OR = 7.03; p = 0.027) and whether the birth attendant arrived before delivery (OR = 4.15, p = 0.023). Conversely, the type of tool used to cut the cord did not have a significant effect (p = 0.239). Data analysis suggests that a main source of Clostridium tetani may be the hands of the birth attendant and that the main mode of contamination may be the dressing of the wound stump. Results suggest that teaching mothers and birth attendants simple hygienic principles and basic techniques may have a significant impact on neonatal tetanus mortality.