Management of neonatal tetanus. Role of mothers in increasing survival rates

Neonatal Tetanus (NNT) is caused by clostridium tetani, which is spore bearing gram positive anaerobic organism and can be cultivated in culture media in the absence of oxygen. NNT is one of the most important causes of death in newborn babies in many developing countries of the world accounting for nealy 700,000 deaths every year globally. Various studies on management show that mortality in NNT remained above 60%. In this study two management protocols were developed:- 1. 1976 involving trained nursing staff and 2. 1977 to 1989 involving mothers for feeding and nursing care in the management of NNT. In 1976, survival rate was low i.e. 27.07%. From 1977 to 1989 when nursing and day to day care was handed over to mothers survival rate improved to an average of 66.1% for a period of 13 years. Sophisticated tertiary care facilities requiring intermittent positive pressure respiration, team of skilled manpower, excellent laboratory back up etc. can improve the outcome in NNT management even further, but these facilities are still a dream in many developing countries were NNT is a major cause of morbidity and mortality. Prevention by immunizing women of child bearing age with tetanus toxoid (TT) is the best safeguard against NNT. Since TT coverage worldwide is low, NNT will remain a problem in present decade. Our study conclusively shows that mothers can play a vital role in improving survival rates in management of NNT.