Factors associated with neonatal tetanus mortality in northern Nigeria.

Over a 12-month period, a cluster survey on Neonatal tetanus (NNT) mortality was conducted in Northern Nigeria. The relative contributions of knowledge, attitude and practice (KAP) to certain epidemiological factors associated with NNT deaths were evaluated. NNT mortality was 20.6/1000 live-births (i.e. over 65% of neonatal mortality). Poor cord management showed the strongest association with NNT mortality with comparable contributions from KAP. Less than 40% of 2,623 live-births recorded during the survey followed two or more ante natal visits. This was significantly associated with NNT mortality with virtually equal contributions from KAP. Over 60% of the births had traditional surgeries performed with highly significant association with NNT mortality. Knowledge deficit was the most important contributor to performance of traditional procedures. Tetanus toxic coverage (32.0%) was also associated with NNT mortality with knowledge and attitudinal deficits accounting for over 75% of poor coverage. Most deliveries were outside hospitals and related facilities with highly significant association with NNT deaths. Attitude and practice contributed over 80% to this observation. In view of the associated epidemiological factors, and the relative roles of KAP, community--specific prevention strategies are suggested. Training and involvement of traditional birth attendants is emphasized. Domicilliary service are also suggested in view of the widely practised purdah system.