BACKGROUND: Previous studies in Pakistan have shown that ghee (clarified butter) is commonly applied to umbilical wounds of neonates, and have documented that such applications are a risk factor for neonatal tetanus (NNT). In-use contamination of ghee with Clostridium tetani has been demonstrated, but mechanisms underlying the risk of ghee have been incompletely evaluated epidemiologically. METHODS: Detailed information on ghee usage, including fuels used to heat it, was obtained from cases of NNT (n = 229) and their matched controls (n = 687) from a population-based study of NNT in Punjab Province, Pakistan. Design variables were created to evaluate the impact of different fuel sources on risk of ghee applications. RESULTS: Nearly one-third of all infants had ghee applied, and it was nearly always heated before application to umbilical wounds of newborns. After controlling for all factors found to be significantly associated with NNT in conditional logistic regression, only ghee that had always been heated with dried cow dung fuel was significantly associated with NNT. Topical antimicrobials and ghee were never applied together. CONCLUSIONS: Ghee applications to umbilical wounds, when heated with 'clean' fuels, appear to pose no increased risk of NNT, although handling practices undoubtedly result in hazardous microbial contamination. In contrast, ghee heated with dung fuel was significantly associated with NNT. The effective promotion of topical antimicrobials might help reduce ghee use, since the intended purpose of each is to enhance healing.
BACKGROUND: Previous studies in Pakistan have shown that ghee (clarified butter) is commonly applied to umbilical wounds of neonates, and have documented that such applications are a risk factor for neonatal tetanus (NNT). In-use contamination of ghee with Clostridium tetani has been demonstrated, but mechanisms underlying the risk of ghee have been incompletely evaluated epidemiologically. METHODS: Detailed information on ghee usage, including fuels used to heat it, was obtained from cases of NNT (n = 229) and their matched controls (n = 687) from a population-based study of NNT in Punjab Province, Pakistan. Design variables were created to evaluate the impact of different fuel sources on risk of ghee applications. RESULTS: Nearly one-third of all infants had ghee applied, and it was nearly always heated before application to umbilical wounds of newborns. After controlling for all factors found to be significantly associated with NNT in conditional logistic regression, only ghee that had always been heated with dried cow dung fuel was significantly associated with NNT. Topical antimicrobials and ghee were never applied together. CONCLUSIONS:Ghee applications to umbilical wounds, when heated with 'clean' fuels, appear to pose no increased risk of NNT, although handling practices undoubtedly result in hazardous microbial contamination. In contrast, ghee heated with dung fuel was significantly associated with NNT. The effective promotion of topical antimicrobials might help reduce ghee use, since the intended purpose of each is to enhance healing.
Entities:
Keywords:
Age Factors; Antibiotics; Asia; Bacterial And Fungal Diseases; Biology; Demographic Factors; Developing Countries; Diseases; Drugs; Infant; Infections; Neonatal Diseases And Abnormalities; Pakistan; Population; Population Characteristics; Research Report; Risk Factors; Southern Asia; Tetanus; Treatment; Youth
Authors: Luke C Mullany; Gary L Darmstadt; Joanne Katz; Subarna K Khatry; Steven C LeClerq; Ramesh K Adhikari; James M Tielsch Journal: Am J Epidemiol Date: 2006-10-25 Impact factor: 4.897
Authors: Luke C Mullany; Gary L Darmstadt; Subarna K Khatry; Joanne Katz; Steven C LeClerq; Shardaram Shrestha; Ramesh Adhikari; James M Tielsch Journal: Lancet Date: 2006-03-18 Impact factor: 79.321
Authors: Hannah Blencowe; Simon Cousens; Luke C Mullany; Anne C C Lee; Kate Kerber; Steve Wall; Gary L Darmstadt; Joy E Lawn Journal: BMC Public Health Date: 2011-04-13 Impact factor: 3.295