TOPICAL ANTIMICROBIALS APPLIED TO THE UMBILICAL-CORD STUMP - A NEW INTERVENTION AGAINST NEONATAL TETANUS

Background Previous else-control studies of neonatal tetanus (NNT), a leading cause of infant mortality in developing countries, have sugges ted that antimicrobials applied after delivery to the umbilical cord s tump may protect against this disease. However, assessment of their pr otective effect has been limited by the low prevalence of antimicrobia l use in developing countries. Methods We conducted a population-based , matched, case-control study to assess the use of antimicrobials and other factors potentially related to NNT in rural parts of Bangladesh. We studied 359 cases (infants who were normal at birth but who died b etween the 3rd and 30th day of life after an illness characterized by signs of NNT), each matched to three living controls for gender, resid ence, and date of birth. Results In univariate analyses, the applicati on of either antibiotics or disinfectants at delivery, and the continu ous or any application of disinfectants were protective against NNT. T he application of antibiotics at delivery (odds ratio [OR] = 0.21, P = 0.019), hand washing by the delivery attendant (OR = 0.64, P = 0.005) , and prior maternal immunization with tetanus toroid (OR = 0.50, P = 0.001) remained protective in conditional logistic-regression analyses . Application of animal dung to the umbilical stump (OR = 2.31, P = 0. 047) was hazardous. Conclusions Effective and inexpensive topical anti microbials provide a new prevention opportunity that could be used by traditional birth attendants and mothers to provide additional benefit s to NNT control programmes based on maternal immunization with tetanu s toroid. Promotion of hygienic delivery and cord-care practices and i ncreasing tetanus toroid coverage remain cornerstones for the preventi on of NNT deaths.