Cárdenas Ayala V M, Núñez Urquiza R M, Brogan D R, Ibarra Rosales J M, Gatica Valdés N, Smith T E, Galván Arriaga S, Flores Collins M E, Escobar Mesa A
Veracruz State Health Secretariat, Health District 1, Pánuco.
Bull Pan Am Health Organ. 1995 Jun;29(2):116-28.
This article describes a survey conducted in the State of Veracruz, Mexico, to estimate neonatal tetanus (NNT) mortality. The survey, which entailed visits to 72,720 households, collected data on 8,401 live births and 209 infant deaths occurring between April 1988 and May 1989. Twenty-six of the 209 fatalities conformed to a WHO standard case definition of death from neonatal tetanus. The estimated neonatal tetanus mortality was thus 3.1 deaths per 1,000 live births (95% confidence limits = 1.7, 4.5). Comparison of this rate to reported figures suggests that for every NNT death recorded in Veracruz during the study period, as many as 50 others went unreported. A case-control study nested within the survey was conducted to assess preventable NNT risk factors. Limited information on 13 NNT deaths and 217 controls showed an increased risk for neonates who were delivered at home and whose parents' ethnic background was Mexican Indian. Five of the 13 fatalities had their umbilical cords cut with a domestic or traditional cutting tool such as a reed cane, as compared to none of the 217 controls. The observed vaccine efficacy of 2+ doses of tetanus toxoid was 70% (95% confidence limits = 52, 100). Both the mothers of neonates who died of NNT and their controls missed an average of five opportunities to receive tetanus toxoid. These findings underscore the need to launch a perinatal health program serving Mexico's high-risk populations.
本文描述了在墨西哥韦拉克鲁斯州进行的一项旨在估计新生儿破伤风（NNT）死亡率的调查。该调查走访了72,720户家庭，收集了1988年4月至1989年5月期间8,401例活产和209例婴儿死亡的数据。209例死亡中有26例符合世界卫生组织关于新生儿破伤风死亡的标准病例定义。因此，估计的新生儿破伤风死亡率为每1,000例活产中有3.1例死亡（95%置信区间 = 1.7, 4.5）。将该比率与报告数据进行比较表明，在研究期间，韦拉克鲁斯州每记录1例新生儿破伤风死亡病例，就有多达50例未被报告。在该调查中嵌套进行了一项病例对照研究，以评估可预防的新生儿破伤风风险因素。关于13例新生儿破伤风死亡病例和217例对照的有限信息显示，在家中分娩且父母族裔背景为墨西哥印第安人的新生儿风险增加。13例死亡病例中有5例的脐带是用诸如芦苇杆之类的家用或传统切割工具切断的，而217例对照中无一例如此。观察到的2剂及以上破伤风类毒素的疫苗效力为70%（95%置信区间 = 52, 100）。死于新生儿破伤风的新生儿母亲及其对照平均都错过5次接种破伤风类毒素的机会。这些发现强调了开展一项为墨西哥高危人群服务的围产期健康计划的必要性。
