海南省新生儿破伤风疫情监测

对海南省部分地区进行了新生儿破伤风状况调查发病率为２．７３‰，超过了国家规定的上限。病死率为９０．８２％，占新生儿死因首位，发病主要原因是接生工具落后、不清毒。无接生员。新法接生和接种破伤风类毒素（ＴＴ）是控制预防新生儿破伤风的当务之急。     

贫困地区新法接生健康教育效果分析

为实现卫生部、联合国儿童基金会妇幼合作项目中消除新生儿破伤风的规划目标,1998年10月至1999年3月在贵州省的纳雍、普定、盘县、务川4个新生儿破伤风死亡率较高的国家级贫困县开展了“强化新法接生、消除新生儿破伤风”活动。通过开展健康教育来提高农村育龄妇女新法接生知识水平,进而提高新法接生率,实现消除新生儿破伤风的目标。1　对象与方法11　调查对象111　知、信、行(ＫＡＰ)调查对象　对户口在4县1998年10月1日至1999年3月31日出生的新生儿(共计17110个)的母亲进行随机抽样调查,每县45人,4县共180人。112　快速评价方法(ＲＡＰ)调…     

建议生产和使用一次性无菌脐带处理袋

1990年我们对衡阳市农村妇幼卫生情况进行了一次调查,共调查了1.62万名活产婴儿,其中新生儿破伤风死亡122人,死亡率为7.5‰,这122例破伤风患儿均为家庭分娩。在1.62万名活产婴儿中,新法接生1.33万人.死于破伤风37例,死亡率为2.78‰。旧法接生2898人,死于破伤风85例,死亡率为29.33‰。由此可见,我市新生儿破伤风主要发生在家庭分娩,其旧法接生的新生儿破伤风死亡率大大高于新法接     

四川省50个县新生儿死亡及有关因素分析

我省卫Ⅵ项目县1992年平均新生儿死亡率为49.77％。,新生儿7天内死亡占73.1％,1天内死亡占43.1％。新生儿死亡的主要原因为新生儿窒息、肺炎、早产和新生儿破伤风。新生儿死前保健服务状况、人口出生率、年人均收入、文化水平、新法接生率、住院分娩率、产前检查率、产后访视率等都是新生儿死亡率的影响因素。要想从总体上改善儿童出生后的生存条件,必须采取综合措施,进一步落实计划生育基本国策,特别是增加妇幼卫生投入,将工作重点放在降低早期新生儿死亡率,做好孕产妇系统管理,提高新法接生率和住院分娩率。针对新生儿主要死因开展适宜技术培训,提高各级妇幼卫生人员的服务能力,加强孕期、产期、新生儿期有关医疗保健知识的宣传,提高人群的自我保健意识。     

四川省50个县5岁以下儿童死亡及其有关因素分析

通过对５０个县５岁以上儿童死亡及其有关因素的分析，得出１９９２年我省卫Ⅵ项目县平均婴儿死亡率、５岁以下儿童死亡率分别为７３．３‰和９８．７‰；婴儿死亡占５岁以下儿童死亡的７６．９％，新生儿死亡占婴儿死亡的６６．１％；５岁以下儿童死亡的主要死因为肺炎、新生儿窒息、意外、腹泻、早产和新生儿破伤风，死在家中途中的比例为７５．０％，死前未就医占４７．７％；年人均收入、人口出生率、文化水平、儿童四苗接种率、     

平顶山市222例新生儿破伤风流行病学调查报告

对我市４个县（市）区１９９０、１９９１年住院的新生儿破伤风病例２２２例进行了回顾性调查，１９９０年发病率为６．２８／１０万，发病专率为２．４４％，１９９１年发病率为４．８１／１０万，发病专率为１．９７‰，发病呈下降趋势，发病无明显季节性，男：女＝３：１；８９．６４％（１９９／２２２）的患儿来自农村，９９．６％（２２１／２２２）的患儿系采用旧法接生。因此，应对育龄妇女进行破伤风类毒素接种，以减少新生儿破伤风的发生。     

河北省芋县婴儿死亡情况调查

本文报导了河北省蔚县1986年死亡婴儿回顾性调查情况,该县新法接生率82.39%,旧法接生率9.49%,自接自产8.12%;婴儿死亡率高达52.58%,其中新生儿(未满28天的)死亡比重占婴儿死亡总数的71.65%,在新生儿疾病死亡中,破伤风占首位,占新生儿疾病的17.65%,同一县由农村(山区)组的婴儿死亡率比城镇(平川)组高10.06%(P<0.01);自开放二胎以来,计划外怀孕明显增加,由     

兴宁市2001-2005年新生儿破伤风发病情况与分析

目的分析兴宁市2001-2005年新生儿破伤风发病情况，为控制和消除该病提供科学依据。方法对2001-2005年兴宁市新生儿破伤风法定传染病系统数据和破伤风监测系统资料进行分析。结果2001-2005年兴宁市新生儿破伤风共发病14例，发病率在0．017％～0．038％之间，年均发病率0．25‰；死亡2例，病死率14．3％，病人中流动人口占71．4％，在家接生和母亲未接种破伤风类毒素者占100％。结论加强流动人15和计划外生育人群的管理，提高住院分娩率，培训合格接生员，普及新法接生，开展育龄妇女接种破伤风类毒素，最终实现消灭新生儿破伤风应是切实可行的。     

清远市1999-2007年新生儿破伤风流行病学分析

目的探讨清远市新生儿破伤风（新破）发病情况及其影响因素和防制措施。方法采用描述性流行病学方法,对清远市1999—2007年新破专报系统的监测资料和个案调查材料进行统计分析。结果清远市1999—2007年共报告新破267例,年平均发病率0．80‰;死亡63例,年平均死亡率0．19‰;年平均病死率23．60％。报告发病率呈逐年下降趋势。病例主要集中在农村和边远山区。男、女要总发病率分别为1．08‰、0．46‰,差异有统计学意义（Х^2=8．734,P〈0.05）,男女性别比为2．84：1。在家中分娩的病例占94．70％;由未经培训的人员接生占93．63％;病例母亲94．01％未接种过破伤风类毒素,82．77％未接受过产前检查或不详;属计划外生育的病例占36．70％。结论产妇卫生知识缺乏和不安全接生是清远市新生儿破伤风发病的主要影响因素。普及住院分娩、新法接生,加强流动人口中育龄妇女的妇幼保健工作,育龄妇女接种破伤风类毒素是预防和消除新破的主要措施。     

云南省沧源县佤族婴儿死亡情况研究

为了摸清佤族婴儿死亡率及主要死因，１９９４年在云南沧源佤族自治县进行了一次调查，结果如下：（１）６个乡佤族婴儿死亡率为６５．８４‰～１２４．０４‰，平均９２．９９‰；（２）婴儿的主要死因是肺炎，腹泻，新生儿窒息，早产，新生儿破伤风，占全部死因的８６．４３‰，其中感染性疾病占６５．０７‰；（３）婴儿死亡漏报率高达６２．７７％，漏报者均发生在县以下基层卫生部门；（４）产前检查率，住院分娩率，患病率儿就     

Neonatal tetanus: mortality rate and risk factors in Loralai District,Pakistan

BACKGROUND: This study was conducted to estimate the neonatal tetanus (NNT) mortality rate and to identify the risk factors for NNT deaths in Loralai District, Pakistan. METHOD: We conducted a community-based cross-sectional survey during July-September 1997. We stratified the sample proportionate to population of union councils. The most populous village in a union council was selected first. We interviewed the women, selected randomly, who had a live birth in the 18 months preceding the survey. We conducted a matched case-control study to identify the risk factors for NNT deaths. We used the World Health Organization criteria to enrol cases, identified during the cross-sectional survey or registered at the district hospital. We enrolled three community-based controls per case, matched on the area of residence, immunization status and date of birth. RESULTS: Of the 1547 live births, there were 36 neonatal deaths due to tetanus. The NNT mortality rate in the district was 23 per 1000 live births (95% CI: 16-30). For the case-control study, we enrolled 41 cases and 123 controls. Using conditional logistic regression, the risk of NNT death was increased with the use of soil as delivery surface (O.R = 3.2, 95% CI: 1.1-10.2), father's illiteracy (OR = 3.2, 95% CI: 1.3-8.1) and possession of sheep at home (OR = 2, 95% CI: 1.0-5.0). The population attributable risk per cent for soil as delivery surface was 64%. CONCLUSION: Transmission of infection while using soil as the delivery surface can occur through direct or indirect contamination of the fresh umbilical wound. Use of safer delivery practices in general and clean surfaces in particular should be encouraged to reduce the NNT mortality rate in the area.     

镇江市流动儿童新生儿破伤风监测分析

目的：分析镇江市流动儿童新生儿破伤风（NNT）的流行病学特征,为消除NNT提供科学依据。方法：利用描述流行病学方法分析镇江市2003—2010年流动儿童NNT监测资料。结果：镇江市2003—2010年NNT年平均总发病率为0.17‰,其中流动儿童NNT发病率为1.36‰,病死率为32.14%;NNT发病率总体呈下降趋势,但2006年出现一个相对高峰期;病例散在分布,无明显地区聚集性,患儿主要来自于四川、云南和贵州;男女性别比为1.55∶1,在家分娩者占89.29%;母亲均无破伤风类毒素（TT）接种史。结论：镇江市流动儿童NNT为散在发病,病死率高。提高流动妇女住院分娩率与提倡TT接种,才能彻底消除非高危地区NNT疫情。     

Function of tetanus immunoglobulin in case of injury: administration often unnecessary

OBJECTIVE: To calculate the number of tetanus immunoglobulin (TIG) injections given in order to prevent one patient developing tetanus (number needed to treat (NNT)) and the accompanying costs. DESIGN: Functional study. METHOD: The risk of developing tetanus was calculated from the results of a national study on tetanus immunity in the general population of the Netherlands (1995-1996; n = 7715) and from official notifications of tetanus in the period 1984-1996 (n = 30 persons born before 1945). According to current vaccination policy TIG is advised for unvaccinated persons and those with an unclear vaccination status as well as those vaccinated more than 15 years ago. RESULTS: The tetanus risk after injury was estimated at 0.5-2 per million for unvaccinated individuals. Immunity was lowest (< 50%) in men born before 1936 and women born before 1950. The NNT for these groups was a minimum of 530.000. With a mortality of 10% and costs of 20 Euro per TIG injection, the cost of each life saved was found to be a minimum of 105 million Euro. The NNT and cost per life saved were astronomical for those persons born after 1955. CONCLUSION: The current TIG policy is inefficient. Thanks to the success of the National Immunisation Programme it is now justified to limit the administration of TIG to those who are at the highest risk i.e. those who are known to be unvaccinated, women born before 1950 and men born before 1936.     

海南省新生儿破伤风监测系统的建立及运行效果分析

目的　掌握新生儿破伤风（ Ｎ Ｎ Ｔ） 实际发病水平及发病因素,以便为制定消除策略提供依据,海南省于１９９７ 年开展了 Ｎ Ｎ Ｔ 监测工作。方法　监测运用急性弛缓性麻痹（ Ａ Ｆ Ｐ） 监测方法,并与之同时运行。结果　全年共监测病例２１６ 例,远高于疫情报告７８ 例。监测结果表明：在家分娩、旧法接生是发病主因。病儿母亲８８ ．８９ ％ 无破伤风类毒素（ Ｔ Ｔ） 免疫史。三亚市、琼中县的监测资料表明,由于育龄妇女 Ｔ Ｔ 免疫率提高, Ｎ Ｎ Ｔ 发病率较１９９６ 年分别下降６１ ．２９ ％ 、８２ ．０５ ％ 。结论　提高育龄妇女 Ｔ Ｔ 接种率是实现消除 Ｎ Ｎ Ｔ 最经济简便的措施,将 Ｎ Ｎ Ｔ 监测工作纳入 Ａ Ｆ Ｐ监测系统同时运行是行之有效的。     

喀什地区育龄期妇女破伤风类毒素突击接种活动分析与评价

新疆维吾尔自治区喀什地区在５个新生儿破伤风高危县,对育龄期妇女开展了破伤风类毒素（ＴＴ）两针突击接种．登记育龄期妇女１３６１９０人,占总人口数的１３．７３％;估计应种数为１６３６４７人,登记率为８３．２２％（５４．３７％～９２．００％）．报告接种率分别为ＴＴ　９２．７３％（８７．３３％～９６．３２％）,ＴＴ２８６．１３％（４６．６０％～９３．００％）;估算接种率分别为ＴＴ１７９．３９％（５２．０４％～９１．９１％）,ＴＴ２７３、７４％（４．５３％～８４．４１％）;３个县的抽查接种率分别为ＴＴ１８７．７９％（１５１／１７２）,ＴＴ２７３．８４％（１２７／１７２）．     

Acceptability of tetanus toxoid vaccine by pregnant women in two health centres in Abidjan (Ivory Coast)

A study was conducted in two health centres in Abidjan, Ivory Coast (Abobo and Port Bouet) to compare the knowledge of pregnant women regarding tetanus and hepatitis B and to evaluate the acceptability of tetanus immunisation. A total of 124 women were interviewed. In spite of Information Education Communication (IEC) meetings held by midwives focusing on both diseases, knowledge about tetanus appeared to be substantially higher than that about hepatitis B. The acceptability of tetanus toxoid vaccine was good, the only barrier being the fear of useless injections. However, the risk of tetanus transmission during delivery should be better explained to women, who often give birth at home in the presence of traditional birth assistants. The awareness of men should also be raised by information campaigns, using different local networks.     

Tetanus in developing countries: an update on the Maternal and Neonatal Tetanus Elimination Initiative

Tetanus is a vaccine-preventable disease that yearly causes a total of 309,000 deaths. Of particular concern is maternal and neonatal tetanus (MNT), which can be prevented through immunization of the mother in pregnancy. In 2000, neonatal tetanus alone was responsible for an estimated 200,000 deaths. While the focus is on 57 priority countries, 90% of the neonatal tetanus deaths occur in 27 countries. UNICEF is spearheading the effort to eliminate MNT by the year 2005, with the support of numerous partners. MNT elimination is defined as less than one case of neonatal tetanus per 1000 live births at district level. The main strategies consist of promotion of clean delivery practices, immunization of women with a tetanus toxoid (TT) containing vaccine, and surveillance. Maternal tetanus immunization is, in most developing countries, implemented as part of the routine immunization program. However, large areas remain underserved, due to logistical, cultural, economical or other reasons. In order to achieve the target of MNT elimination by 2005, and to offer protection to women and children otherwise deprived from regular immunization services, countries are encouraged to adopt the "high risk approach". This approach implies that, in addition to routine immunization of pregnant women, all women of child bearing age living in high risk areas are targeted for immunization with three doses of a tetanus toxoid containing vaccine (TT or Td), implemented as "supplemental immunization activities" (SIAs). Through SIAs, about 17 million women have been reached with at least two doses of TT vaccine in the past 3 years, and it is estimated that another 200 million need to be targeted in the years to come. SIAs should substantially reduce the burden of disease. Countries will also have to improve their existing immunization and clean delivery programs to ensure that the elimination of maternal and neonatal tetanus is maintained.     

Cluster survey for poliomyelitis and neonatal tetanus in Ilorin, Nigeria

The incidence of poliomyelitis and neonatal tetanus in Ilorin Local Government Area was estimated using a 40-cluster, retrospective survey of neonatal tetanus deaths and lameness from poliomyelitis in March and April 1988. The survey identified 19 neonatal tetanus deaths among 1601 livebirths, giving an incidence rate of 14.9/1000 livebirths. Some 31 residual paralytic polio cases were identified among 4576 children aged five to nine years, giving a prevalence rate of 6.8/1000 children in this age group and an annual incidence rate of 38.3/100,000 general population. Immunization of pregnant women with tetanus toxoid, had a greater impact on mortality from neonatal tetanus than delivery in hospital or birth at home attended by a traditional birth attendant. Antenatal coverage with two doses of tetanus toxoid was 62.6%. Poliomyelitis and neonatal tetanus still constitute important causes of childhood morbidity and mortality in Ilorin and antenatal tetanus immunization coverage is not yet sufficient to control neonatal tetanus in this population. The target age for immunization with tetanus toxoid should be extended to include all women of childbearing age. Further retrospective surveys from other Nigerian states are needed to determine the magnitude of the neonatal tetanus problem throughout the country.     

A reassessment of risk factors for neonatal tetanus

A hospital-based case-control study was conducted to further examine the risk factors for neonatal tetanus (NNT) in the North-west Frontier Province of Pakistan. Three control infants were concurrently evaluated for each of 102 consecutively diagnosed NNT cases hospitalized over an 8-week period. Application of clarified butter (ghee) during the first few days of life was shown to be a significant risk factor, confirming our previously reported finding. However, the risk appeared to be limited to ghee made in the home from cow's milk. The tool used to cut the umbilical cord was again refuted to be a risk factor; application of topical antibiotics conferred significant protection. Multivariate analysis of the matched data showed that delivery by persons with academic training (physicians, nurses, and lady health visitors) was also protective. Mothers with a past history of NNT babies were shown to have a significantly increased risk, and accounted for more than one-third of all cases in the present study. The findings suggest possible ways to augment the effectiveness of NNT elimination programmes.