Risk factors associated with neonatal tetanus in Ibadan, Nigeria--a revisit.

To identify major risk factors associated with recent occurrence of neonatal tetanus (NNT) in Ibadan Nigeria, 140 cases matched 1:1 with controls were recruited into the study from the major referral hospitals. Maternal age (<20 years), low paternal education, low socio-economic status, primiparity and delivery outside health facilities were associated with significantly increased risk for NNT. Lack of trained attendant at delivery, the type of instrument used to cut the cord and the presence of livestock within the family compound also significantly increased the risk for NNT. Antenatal clinic (ANC) was attended by 86.4% of mothers of cases but only 25.6% of these mothers received full immunization. Three out of four mothers of cases who attended ANC did so with a frequency of 5 to 20 times indicating missed opportunities for immunization. Data also suggest that the main reason for failure to receive full immunization was ignorance on the mothers' part, which reflects inadequate health education by the health system. The study case fatality rate was 79.4 percent. Risk factors observed in this population are generally known, indicating that the problem has not yet received adequate attention. Effort needs to be made towards providing the masses with formal education as well as health education, targeting the population at grass root level. Improving access to antenatal care services as well as improving the quality of these services; outreach efforts on immunization would contribute in no small measure to reducing the incidence of neonatal tetanus in this community.