Impact Of Social And Medical Factors On Tetanus Neonatorum In Kalyoubia Governorate An Epidemiological Study:

Abd El Moniem Abd El Fatah Younis

- 1311 -SUMMARYTetanus neonatorum constitutes one of the major publichealth problems.The aim of this work was to study the magnitude oftetanus neonatorum problem in Xalyoubia Governorate to findout the factors asaoo1.Ated with IlOrbidity and aortality ofthe disease. Benha fever hospital vas selected as a site forthe study. A detailed observational interview sheetcoaprising infants. aaternal and oase related data vasdesigned to give inforaation about different factors thatinfluence IIOrbidityand mortality of tetanus neonatorum. Thestudy included 95 cases of tetanus neonatorum which ”ereadmitted to Benha fever hospital through one year startingfrom October 1988 to September 1989 as a prospeotive study.Analysis of collected data revealed the folloving:_ The incidence rate of neonatal tetanus ad.issions was 6’·and the case fatality rate of the disease was 53.7’.Tetanus neonatorum deaths comprised S.4’11of neonatal deaths_ Males vere more affected (7S.8’11) than females (24.2’) withsex ratio 311._ The majority of cases (86.3’) were rural infants. vith casefatality rate S4.9’11. They came fro. houses of bad sanitarycondition. where ani.al shed vas present inside houses(811’) and floor of bouse vas eartben (81.1’)._ The incidence rate of neonatal tetanus admissions declinedfro. 111. S’II. to 3.6’110 by the years 1985 and 1989 respectively.- 131 -The highest percentages of admitted cases of tetanusneonatorum were 22.1’. 17.9’ and 15.8’ during November.Decellber and October 1988. It was declined to reach zeropercent during June 1989.- The prognosis was good among cases of vaccinated mothers(63.3’ cured). Also. when the per iod of administration ofsecond dose of tetanus to%oid was more than 6 weeks beforedelivery (64.2’ cured). Also the prognosis of cases ofvaccinated mothers with two doses is better than those ofone dose.The highest percentagemUltiparous mothers where54.”.- The majority of cases were born to farMrs and manualworkers (72.6’) and related to illiterate fathers (43.2’)and lIothers (86.3’).- Only 11.5’ of the IIOthers of tetanus neonatorum casesreceived antenatal care services regUlarly. Also, 65.3’ ofthe IIOthers of the studied cases were without antenatalcare, and there was statistically significant differencebetween the cure rate of cases of IIOthers Whoreceivedantenatal care (63.6’) and those of .others withoutof casesthe casewas 91.5’fatalityborn torate was(37. a).- The hlgb percentage of tetanus neon.torull ca.es was 94.8’infants delivered at home and 84.2’ of cases attended byDayas. Also. unb~1ling instruments were used in cutting the- 132 -umbilical cord of’ 66.3’ and all the instruments wereunsterllized.- The cases with normal appearance of the umbilical stump hada cure rate of 71.4’_ but those With umbilical stump sepsishad a cure rate of 19.6’ only~this difference is statisticallysignificant.- The most common presenting syaptoas and signs were sucklingaffection (93.7’) and lock Jaw (87.4’).The prognosis was worse when the duration of symptoms orsigns was 2 days before admission (63.4’ died).Ninety point two percent of tetanus neonatorum deathsOccurred within 48 hours after ad.is.ion.