Risk factors of neonatal tetanus in Wenzhou, China: a case-control study

Abstract

Introduction: Neonatal tetanus is a major cause of neonatal mortality in many developing countries and remains a major public health problem. This study aimed to determine risk factors associated with neonatal tetanus in Wenzhou, China.

Methodology: Medical records of neonatal tetanus cases in 17 hospitals over an 8-year period (2005-2012) were reviewed for potential risk factors. Neonates with other diseases, but not tetanus, that were admitted to the same facility during the same period were selected as controls. The potential risk factors of the neonatal tetanus group were compared with the control group using univariate analysis. The significant variables were further subjected to an unconditional logistic regression model. Statistic analysis was carried out with SPSS 14.0 software.

Results: Univariate analysis showed that training of birth attendants, places of delivery, method of delivery, parity and type of inhabitants were significantly different between the two groups (P<0.001). The cord was cut without taking disinfection measures in the majority of tetanus cases. The risk of tetanus was also high in the floating population of Wenzhou. Logistic regression analysis revealed that the untrained birth attendants was significantly higher in the tetanus group than the control group (OR=61.39, 95% CI 1.60, 354.33).

Conclusions: The present study identified that the risks of neonatal tetanus in the studied neonatal patients from Wenzhou were associated with untrained birth attendant, unsterile method of delivery and poor cord hygiene. Preventive measures directed to the pregnant floating population may reduce the occurrence of neonatal tetanus in the studied area.