A survey of neonatal tetanus and perinatal mortality in southern Muslim communities in Thailand.

Beginning in May 1991 in Thailand research assistants used a standard 30-cluster sampling technique to interview residents of 14446 households in Narathiwat Yala and Pattani provinces so they could obtain an accurate perinatal mortality rate and incidence rate of neonatal tetanus. The most common perinatal deaths were still births (15.6/1000 live births) followed by early neonatal deaths (11.3). The late neonatal death rate was 3.9. The overall perinatal mortality rate was 26.9. The maternal mortality rate was 1.7/1000 live births. The neonatal tetanus incidence rate was 0.9/1000 live births. Neonatal tetanus was responsible for only 6% of all neonatal deaths. Both the perinatal mortality and maternal mortality rates were 5 times greater than the respective national averages while the incidence of neonatal tetanus was perhaps about 5 times lower than the national average. The perinatal mortality rate was even around 5 times greater than that in an official report for the same area. Traditional birth attendants (TBAs) performed 80% of deliveries. The risk of perinatal death was higher for deliveries assisted by modern health personnel than by a TBA (57 for midwife/nurse and 47 for physician vs. 22; p = 0.007). Yet it was higher among women who did not receive modern prenatal care (3 vs. 1.7; p < 0.001). Selection and referral bias may explain this paradox. 58% of the pregnant women received at least 2 injections of tetanus toxoid. The risk of perinatal death was higher for newborns living in a temporary shelter than other structures (58 vs. 25 for a wooden shelter and 27 for a cement shelter; p = 0.04). Probable leading causes of neonatal death among the 35 cases were premature birth (11) asphyxia (5) sepsis (2) and neonatal tetanus (2). Key reasons for hospitalization among 15 cases included diarrhea (4) umbilical infection (3) pneumonia (3) and neonatal ophthalmia (3).