Evaluating tetanus neonatorum as a child survival risk in rural Egypt in the absence of reliable cause-of-death registration

Abstract

The principal finding of the investigation is that neonatal tenanus is, indeed an important cause of infant death in rural Egypt even though the normal cause-of-death reporting system had not altered health authorities to the problem. The finding is based on a comparison of registration statistics with (anthropological) reconstruction of pregnancies and child survival using the case-history rather than the epidemiological method. The histories go back ten years and refer to 102 women in two villages of Egypt. An incidental finding is confirmation of the known deficiency of infant death reporting, and associated births, with the extra dividend of showing how serious this may be in the neonatal period. Another incidental finding is the identification of induced abortion as a health problem.

PIP: A short-term study of pregnancy, births, and child mortality was conducted in 2 Egyptian villages to assess the reliability of official statistical records that suggest that neonatal tetanus is rarely a cause of death. Through an anthropologic interview technique based on several visits, reproductive histories were collected from 102 women from 3 age groups: 15-29 years, 30-44 years, and 45 years and over. Respondents from village A, in Upper Egypt, had experienced an average of 8.2 pregnancies, while those from village B, in Lower Egypt, reported 7.3 pregnancies. A total of 114 abortions (14% of all pregnancies) and 14 stillbirths (1.7%) were recorded. Official statistics indicate that 82% of infants in village A and 89% of those in village B survived to age 5 years; however, data from the present study suggest that the 5-year survival rates in these 2 villages were actually 56% and 77%, respectively. Moreover, although vital statistics indicate a rate of neonatal tetanus of 1/6 or less, 75% of the 87 neonatal deaths identified in this study were attributed to tetanus neonatorum/septicemia. Prematurity was the cause of an additional 13% of neonatal deaths in this survey compared with 0.1% of such deaths in official statistics. The results of this study indicate that the underregistration of births and deaths may be a major problem in these 2 villages and probably in other villages in rural Egypt. Neonatal tetanus as a cause of infant mortality was more prevalent in village A (39%) than in village B (9%), presumably because of the higher level of socioeconomic development in the latter region. It is estimated that tetanus immunization of eligible women would have reduced neonatal mortality from 193 to 33/1000 in village A and from 51 to 36/1000 in village B.