PROTECTIVE EFFECTS OF TOPICAL ANTIMICROBIALS AGAINST NEONATAL TETANUS

Background. Case-control studies previously conducted in Pakistan sugg ested that topical antimicrobials might provide protection against neo natal tetanus (NNT) when applied to the umbilical cord wound during th e first several days of life. The present case-control study, the larg est such study yet reported, was undertaken in Punjab Province, Pakist an and afforded further opportunities to evaluate such effects, Method s. A population-based, matched, case-control study was undertaken to a ssess topical antimicrobials and other factors related to NNT risk in rural parts of Punjab Province. Results. Continuous use of antimicrobi al agents (antibiotics and antiseptics) at delivery and during the fir st few days after delivery was highly protective in univariate testing (matched odds ratio 0.2 [95% confidence interval: 0.11-0.64], P=0.003 ), and remained significantly protective when other delivery and cord care practices were controlled. In contrast, applying nothing to the w ound was risky compared with antimicrobial exposures, Hand washing and delivery by a trained birth attendant appeared protective. Applicatio n of animal dung or ash to the umbilical wound was hazardous. Similarl y, predelivery cutaneous or intravaginal exposure of mothers to ghee ( clarified butter) and delivery on a surface prepared with dried cow du ng were risky, with significant interaction noted between them, Mortal ity and NNT were far more likely among previous births to mothers of c ases. Conclusions. Topical antimicrobials offer a new, effective and i nexpensive means to p-event NNT, and could usefully complement materna l immunization with tetanus toroid in controlling the disease. Special prevention efforts should be directed towards mothers of NNT cases.