Abstract

PIP: The hospital incidence of neonatal tetanus cases in Maputo, Mozambique, from 1976 to 1982 is presented. After fluctuating between 173 and 254 cases/year in 1976-1978, the incidence has declined to 26 cases in 1982. The seasonal distribution of cases before the decline showed a bimodal pattern. A survey of 175 neonatal tetanus admissions in 1978-79 showed that most mothers delivered at home and many used traditional methods, including placing a variety of substances on the cord. Between May 29, 1978 and April 30, 1979, nurses in the infectious diseases ward administered a standard questionnaire form to all mothers of babies admitted with neonatal tetanus. The questionnaire consisted of 3 parts: general information, childbirth practices and health service use. The % of tetanus admissions caused by neonatal tetanus has fallen from 72% in 1976 to 39% in 1981. 144 of the mothers had delivered at home, 19 on the way to a maternity unit, and 12 in health facilities. The mothers reported that 1/2 of the deliveries outside health facilities were supervised by a relative, and 1/3 by a neighbor. The others were either alone or attended by strangers of health service personnel on the way to a maternity unit. In most of the home deliveries, the cord was cut with a new razorblade. 12 cords were cut with scissors, and 4 with a sharpened sliver of reed. Sewing cotton was used to tie the cord in all except 5 deliveries. Other materials included sisal thread, pineapple fibre, and strips of cloth. 87 mothers specified that a substance had been placed on the cord at home. 76% of these substances contained traditional ingredients and comprised 3 main categories: ashes, plant derivatives, and animal feces. The most common plant derivative came from pumpkin flowers. The most common type of ash came from burning a reed mat. The remaining 24% used modern substances, usually bought in a pharmacy.