Bennett J, Schooley M, Traverso H, Agha S B, Boring J
Task Force for Child Survival, Emory University, Atlanta, GA, USA.
Int J Epidemiol. 1996 Aug;25(4):879-84. doi: 10.1093/ije/25.4.879.
Bundling, which consists of wrapping an infant for prolonged periods in a sheepskin cover after dried cow dung is applied, is a common and apparently unique practice limited to the rural, mountainous regions of Northern Pakistan. The practice is initiated at various ages during the neonatal period. Its potential contribution to neonatal tetanus (NNT) had not been evaluated.
A population-based, matched, case-control study was undertaken to assess bundling and other factors potentially related to NNT in rural parts of the Northern Areas, Pakistan.
Bundling instituted within the first 3 days of life was a substantial risk factor for NNT (odds ratio [OR] = 2.5, 95% confidence interval [CI]: 1.3-4.9). Other factors found risky for NNT were delivery on a straw surface and pre-delivery intravaginal application of ghee to the mothers. Handwashing by the delivery attendant and use of a new razor to cut the umbilical cord were protective.
Bundling is a significant risk factor for NNT in the mountainous regions of Northern Pakistan. While this practice is seemingly limited to these remote areas, the findings have broad implications since they indicate that NNT can derive from exposures of the umbilical wound at any time during the first several days of life. Thus, clean cord care at delivery is not itself sufficient to prevent NNT and control programmes need to address post-delivery sources of NNT.
包裹法是指在涂抹干牛粪后，用羊皮覆盖物长时间包裹婴儿，这是巴基斯坦北部农村山区常见且独特的做法。这种做法在新生儿期的不同年龄段开始实施。此前尚未评估其对新生儿破伤风（NNT）的潜在影响。
在巴基斯坦北部地区的农村开展了一项基于人群的配对病例对照研究，以评估包裹法及其他可能与新生儿破伤风相关的因素。
出生后3天内采用包裹法是新生儿破伤风的一个重要危险因素（比值比[OR]=2.5，95%置信区间[CI]：1.3-4.9）。其他被发现有新生儿破伤风风险的因素包括在稻草表面分娩以及在分娩前给母亲阴道内涂抹酥油。接生人员洗手以及使用新剃须刀剪脐带具有保护作用。
在巴基斯坦北部山区，包裹法是新生儿破伤风的一个重要危险因素。虽然这种做法似乎仅限于这些偏远地区，但研究结果具有广泛的意义，因为它们表明新生儿破伤风可能源于出生后最初几天内脐带伤口在任何时候的暴露。因此，分娩时脐带的清洁护理本身不足以预防新生儿破伤风，控制项目需要关注分娩后的新生儿破伤风来源。
