Cross cultural communication of tetanus vaccinations in Bolivia.

Although neonatal tetanus (NNT) is common in developing countries, many people are unaware of its causes and prevention. A study analyzed cultural beliefs and practices to understand how people in three cultural areas in Bolivia (Aymara, Quechua and Tupi-Guarani) think about NNT and tetanus toxoid (TT) immunizations. In all three cultural areas NNT is perceived within a magical and biological framework that involves alternative healing systems and healers. Tetanus immunization programs could be more successful if tetanus were a clearly marked target for the Aymara, Quechua and Tupi-Guarani people, and vaccinators were sensitive to their cultural perceptions. Health workers need to communicate cross-culturally the relationship of TT vaccinations to how members of these ethnic groups perceive NNT.

Neonatal tetanus among rural-born Nigerian infants.

PROBLEM: Identify factors that influence the high rate of tetanus among infants born in rural areas. SUBJECTS: Home-born infants (n = 39) admitted to a medical center with fever. Males (n = 24) and females (n = 15); age range 3-15 days. METHOD: Retrospective, descriptive design. The author used a 10-item interview schedule and a 9-item clinical checklist, including observation of infants' umbilical cords and physical state. FINDINGS: Of the 39 infants, 27 contracted neonatal tetanus; 11 died. All infants with tetanus were delivered at home by traditional, nonprofessional attendants. Factors contributing to high tetanus incidence included: lack of sepsis control, cord care, mothers' lack of immunization, delivery in settings. CONCLUSIONS & IMPLICATIONS FOR NURSING: Traditional nonprofessional attendants need training by professional nurses and midwives, and integration into the national health services. Immunization programs and health education are necessary, and can be delivered by nurses and midwives.

Prenatal tetanus immunization and other practices associated with neonatal tetanus.

The relationship between neonatal tetanus (NT) on one hand, and maternal tetanus immunization and other prenatal and natal practices on the other hand, was examined in a case-control study done at San Lazaro Hospital (SLH) in Manila from late 1990 to mid 1991. Included as cases were 54 patients diagnosed as NT on the basis of WHO criteria, and 50 controls who were patients 0-4 months of age, hospitalized at SLH during the study period and with no past history of tetanus. The result showed that the following were statistically associated with the risk of NT: home delivery (OR = 30.5); delivered by a traditional birth attendant (OR = 5.2); use of instrument other than scissors to cut the cord (OR = 19.3); traditional birth attendant who dressed the cord (OR = 12.7); and having less than two doses of tetanus toxoid (OR = 15.3). The need to intensify prenatal tetanus immunization, health education of the mothers as well as the training of birth attendants is evident from this study if NT has to be prevented.

A survey of neonatal tetanus and perinatal mortality in southern Muslim communities in Thailand.

The objective was to obtain the incidence rate of neonatal tetanus, perinatal mortality rate, and the coverage of health care utilization in the rural Muslim in the lower part of southern Thailand. In a retrospective field study, the rural populations of Narathiwat, Yala and Pattani provinces were studied by cluster sampling technique. The still birth rate and early neonatal mortality rate were 15.3 per 1,000 births and 11.2 per 1,000 live births, respectively. The maternal mortality rate was 1.7 per 1,000 live births. 55% of all pregnancies received 2 injections of tetanus toxoid, 80% of deliveries were performed by traditional birth attendants. The incidence rate of neonatal tetanus was 0.9 per 1,000 live births. The coverage of health service for prevention of perinatal mortality was low and these perinatal and maternal mortality rates were unacceptably high. In contrast, the incidence of neonatal tetanus was not particularly high for unknown reasons.

Traditional birth attendants in an endemic area of tetanus neonatorum in Thailand: pitfalls in the control program.

A survey of the characteristics of traditional birth attendants in Krabi Province, Thailand, where the incidence rate of tetanus neonatorum was the highest in the country, was conducted in order to obtain background information necessary for planning a training curriculum and to evaluate previous training courses. Five second year medical students were used as research assistants. After the questionnaire was constructed and tested, the students went to visit a sample of 116 traditional birth attendants (TBAs) to interview them about their personal backgrounds, techniques and practices in delivery and beliefs and attitudes towards midwifery. The study revealed that these TBAs were a mixture of Buddhist and Islamic females whose literacy rate was 53 percent. Ninety-one per cent knew about the availability of an injection for antenatal care at the health center, but only about half knew that it was for tetanus prevention. More than half provided antenatal care at their own home but 85 per cent conducted delivery at the client's home. About eighty per cent of the TBAs claimed that sterilization of instruments was performed. However, dressing of the umbilical cord was done inappropriately using various kinds of powders by about 40 per cent. The majority of TBAs had experience with complicated labors but only 30 per cent were referred, perhaps, due to excessive self-confidence and supernatural beliefs. The trained TBAs possessed a higher level of knowledge of immunization and sterile techniques for cord cutting and dressing of the stumps of the umbilical cord than the untrained group. However, knowledge of sterilization of instruments was not significantly different, indicating a need to improve teaching in this area.(ABSTRACT TRUNCATED AT 250 WORDS)