Protective effects of topical antimicrobials against neonatal tetanus.

A population-based case-control study in Pakistans Punjab province evaluated the capability of topical application of antimicrobials to the umbilical cord wound in the first days of life to prevent neonatal tetanus infection. A 1990 cluster survey of 23670 live births occurring in rural areas of Punjab Province in the preceding year identified 229 neonatal tetanus deaths. Overall neonatal tetanus accounted for 64% of all neonatal deaths. The 18 cases where circumcision had occurred before tetanus onset were excluded leaving 211 cases and 211 matched controls who survived the neonatal period for analysis. The greatest protection against neonatal tetanus (odds ratio 0.27) was found when antimicrobial substances were used continuously. Hand washing and delivery by a trained birth attendant were also protective against neonatal tetanus while maternal exposure to ghee and delivery on a surface prepared with dried cow dung increased the risk. The risk of neonatal tetanus was increased more than 2-fold (odds ratio 2.5) for infants with dry cord care compared with those who had non-hazardous substances including antimicrobials applied. Efforts to protect the umbilical wound are especially important in villages where animals and animal dung exist in close proximity to living areas. The routine application of topical antimicrobials to the umbilical cord is recommended at all deliveries to complement maternal immunization with tetanus toxoid. The most promising agents for use in developing countries appear to be nitrofurazone bacitracin and povidone-iodine ointments.