Birth Care Practice and Neonatal Tetanus in a Rural Area of Bangladesh

Abstract

The types of birth attendants, methods of cutting and dressing the umbilical cords and their relationship with the incidence of neonatal tetanus for a cohort of 1351 live births occurring between July 1976 and June 1977 in Teknaf, Bangladesh were evaluated. The births were attended by relations of the mothers, neighbours or dais (traditional births attendants) in equal proportion. A few births were unattended; trained midwives or physicians attended a negligible number. Bamboo-splits (78%) and razor blades (22%) were most frequently used tools to cut the umbilical cords. There was no significant difference in mortality rate of neonatal tetanus between the group using bamboosplits (29 deaths per 1,000 live births) or razor blades (21 deaths per 1,000 live births). Mortality rate from neonatal tetanus was 24 per 1,000 live births when most of the umbilical cords were tied with a thread with or without application of ash or burnt earth. In a smaller number of cases the umbilical cords were left untied when the mortality rate from neonatal tetanus was 111 deaths per 1,000 live birth: This difference was statistically significant (P < 0.01). It appears that leaving the umbilical cords untied predisposes the development of neonatal tetanus.