Department of Social and Preventive Medicine, University of Montreal, Montreal, Canada.
Int J Gynaecol Obstet. 2013 Feb;120(2):148-51. doi: 10.1016/j.ijgo.2012.07.030. Epub 2012 Dec 21.
To determine whether the use of disposable clean delivery kits (CDKs) is effective in reducing neonatal tetanus (NNT) infection, regardless of the skills of birth attendants in resource-poor settings.
A secondary analysis was conducted on data from a matched case-control study in Karachi, Pakistan, involving 140 NNT cases and 280 controls between 1998 and 2001. Conditional logistic regression was performed to assess the independent effect on NNT of CDKs and skilled birth attendants (SBAs).
After adjustment for socioeconomic factors, both CDKs (adjusted matched odds ratio [mOR] 2.0; 95% confidence interval [CI], 1.3-3.1) and SBAs (adjusted mOR 1.7; 95% CI, 1.1-2.7) were independently associated with NNT. The association with CDKs remained significant when additionally adjusted for SBAs (mOR 2.0; 95% CI, 1.0-3.9; P=0.05). The population attributable risk for lack of CDK use was 24% in the study setting.
In the context of resource-poor settings in low-income countries with poor coverage of tetanus toxoid immunization, the use of CDKs seems to be an effective strategy for reducing NNT infection, irrespective of the skill levels of birth attendants. Approximately one-quarter of NNT cases could be prevented in low-income populations with the use of CDKs.
无论接生员的技能水平如何，在资源匮乏的环境中，使用一次性清洁接生套件（CDK）是否能有效降低新生儿破伤风（NNT）感染率。
对 1998 年至 2001 年期间在巴基斯坦卡拉奇进行的一项匹配病例对照研究的数据进行了二次分析，该研究涉及 140 例 NNT 病例和 280 例对照。采用条件逻辑回归评估 CDK 和熟练接生员（SBA）对 NNT 的独立影响。
在调整了社会经济因素后，CDK（调整后的匹配优势比[mOR] 2.0；95%置信区间[CI]，1.3-3.1）和 SBA（调整后的 mOR 1.7；95%CI，1.1-2.7）均与 NNT 独立相关。当进一步调整 SBA 时，与 CDK 的关联仍然显著（mOR 2.0；95%CI，1.0-3.9；P=0.05）。在研究环境中，缺乏 CDK 使用的人群归因风险为 24%。
在资源匮乏、破伤风类毒素免疫接种覆盖率低的低收入国家的资源匮乏环境中，使用 CDK 似乎是降低 NNT 感染的有效策略，而与接生员的技能水平无关。在使用 CDK 的情况下，大约四分之一的 NNT 病例可以在低收入人群中得到预防。
