CONTROL OF NEONATAL TETANUS IN SOUTHERN THAILAND

Prior to 1989, Krabi and Satun, two neighbouring provinces with simila r socioeconomic background and health service coverage, had the highes t reported incidence rates of neonatal tetanus in Thailand (3 per 1000 livebirths). A control programme was conducted between 1989 and 1991. The objective of this study was to examine changes in prevalence of r isk factors among the population and changes in incidence rates of thi s disease due to this programme. Two 30-cluster surveys to measure pre valence rates of risk factors were conducted in Krabi, before and afte r the campaign. Information on incidence was obtained from routine sur veillance. The intervention in Krabi consisted of mass immunization an d intensive education for traditional birth attendants (TBA) whereas o nly the latter was carried out in Satun. The incidence of neonatal tet anus in both provinces declined dramatically to less than 0.4 per 1000 livebirths in 1990 and 1991. From 1989 to 1991, in Krabi Province, th e coverage of at least two doses of tetanus toxoid injections at any t ime prior to delivery, delivery by trained health personnel, acceptabl e sterile technique for umbilical cord cutting and correct method of d ressing the umbilical stump rose from 70 to 88%, 55-80% cent, 80-94% a nd 40-74%, respectively. Reduction in the incidence rate of neonatel t etanus was achieved by strengthening of routine health services with o r without additional mess immunization. Considering that the coverage of immunization has not yet been completed and the prevalence rates of different risk factors are still high, further attempts to improve th e problem of neonatal tetanus are necessary.