A cluster survey of mortality due to neonatal tetanus in Kenya

Abstract

Three house-to-house surveys were conducted in three different districts in Kenya, using a cluster survey technique for estimation of neonatal tetanus death rates. The results showed neonatal death rates of 10, 16 and 23 per 1000 livebirths and neonatal tetanus death rates of 6, 11 and 16 per 1000 livebirths respectively. A recall method based on interviews with women attending antenatal clinics gave much lower rates. The community surveys indicate a total neonatal tetanus death rate of 8 per 1000 livebirths and it is estimated that each year between 8000 and 12,000 children die in Kenya from this preventable disease.

PIP: The incidence of neonatal tetanus mortality was determined in Kenya by household surveys randomly selected by 2-stage cluster sampling in 3 districts. The districts were Tana, a poor pastoral area, and Meru and Kisii districts, both farming areas with literacy and health levels around the Kenyan average. Interviews were conducted by teams of 3 including a locally trained person, usually a student nurse, a guide and a representative of the village elders. Live neonates delivered during the previous 12-month period ending 1 month before survey were recorded until 70 births were reached in each cluster. Respondents were asked if a child had died during the 1st month, was born alive, did suck but stopped when it became ill, had fever, convulsions, became stiff or had tetanus (local name). The neonatal death rates ranged from 10-23 per 1000 live births. Neonatal tetanus mortality ranged from 6-16 per 1000 live births. Neonatal tetanus death rates were 14.1 for home deliveries and 4.3 for deliveries in health clinics. Tetanus deaths occurred between Days 6 and 12, while other neonatal deaths took place on Day 1. Tetanus accounted for nearly 70% of all neonatal deaths. These figures are lower than those reported for Ivory Coast, Malawi and rural India, but higher than data for urban Egypt. If these areas are representative of Kenya as a whole, then 8000-12,000 tetanus deaths occur among newborns in the country.