Experience in the control of tetanus neonatorum (TN) in a rural area is presented. TN was reduced by training of dais, increasing the coverage of tetanus toxoid to pregnant women and distribution of presterilized delivery kits to pregnant ladies for use by birth attendants. The problems of untrained birth attendants, effectiveness of tetanus toxoid coverage and place of delivery are discussed.
PIP: Researchers analyzed 1972, 1977, 1982, 1987 data on neonatal tetanus death and birth attendants from the Comprehensive Rural Health Services Project in rural Ballabgarh, India which comprised 28 villages. Health workers visited each house in an area monthly. Even though they began vaccinating pregnant women with the tetanus toxoid (TT) in 1970, the TT coverage percentage did not fall substantially until between 1977-1982 (31.6%-70%), by 1983, TT coverage stood at 93%. It was not until TT coverage reached 85% did neonatal tetanus deaths fall significantly. In 1982, they gave every women near the end of pregnancy a sterilized delivery kit complete with gauze, half a razor blade, and thread. The health workers instructed the women to request anyone who delivers the child to use the contents of the kit. Regardless of the year, around 90% of deliveries occurred at home. Except for 1982, untrained individuals attended about 70% of deliveries. 1982 was the year with the highest percentage of trained dais involved in home delivery (27.6%). The percentage of deliveries my primary health care staff did rise from 4.2-12.1% between 1972-1987, however. In this time period, neonatal mortality fell gradually from 42.3-17.9. Moreover neonatal deaths from tetanus fell consistently but dramatically from 14.6-0. The drop in tetanus related deaths between 1972-1977, was not significant, however, because tetanus and septicemia were not differentiated and health staff seldom saw tetanus cases in hospitals. In conclusion, the Comprehensive Rural Health Services Project of India should expand prenatal care including TT to all pregnant women, distribute sterilized delivery kits to these women between 36-40 weeks gestation, and include instructions on how to use the contents of the kit.