Birth care practice and neonatal tetanus in a rural area of Bangladesh.

Untrained personnel attend 2/3 of all births in the world. In many villages and urban areas of Asia; Africa and Latin America TBAs (traditional birth attendants) deliver majority of births. This paper reports the type 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 infants born between 7/76 to 6/77 in Teknaf area of rural Bangladesh. Most of the deliveries were conducted by untrained birth attendants and only <1% were delivered by trained midwives or physicians. 32% of the births were delivered by dais or TBAs; 35% by neighboring women; 30% by relations of the women and 3% were unattended. Razor blades were used to cut the umbilical cords in 22% and bamboo splits in 78%. Overall neonatal mortality rate due to tetanus was 27/100 live births. Among neonates whose umbilical cords were cut by razor blades mortality rate was 21/1000 live births compared to 29/1000 live births for those cut by bamboo splits. These rates were not considered statistically signficant. Mortality rate due to tetanus was significantly higher among the neonates whose umbilical cords were not tied with a thread than those tied with a thread. Incidence of neonatal tetanus can be lo considerably through improvement of rural sanitation and delivery techniques in home. Tetanus toxoid immunization of mothers was suggested as an effective remedy for the prevention of neonatal tetanus.