Cargando…
Incidence and Risk Factors for Neonatal Tetanus in Admissions to Kilifi County Hospital, Kenya
BACKGROUND: Neonatal Tetanus (NT) is a preventable cause of mortality and neurological sequelae that occurs at higher incidence in resource-poor countries, presumably because of low maternal immunisation rates and unhygienic cord care practices. We aimed to determine changes in the incidence of NT,...
Autores principales: | , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2015
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4388671/ https://www.ncbi.nlm.nih.gov/pubmed/25849440 http://dx.doi.org/10.1371/journal.pone.0122606 |
_version_ | 1782365422495989760 |
---|---|
author | Ibinda, Fredrick Bauni, Evasius Kariuki, Symon M. Fegan, Greg Lewa, Joy Mwikamba, Monica Boga, Mwanamvua Odhiambo, Rachael Mwagandi, Kiponda Seale, Anna C. Berkley, James A. Dorfman, Jeffrey R. Newton, Charles R. J. C. |
author_facet | Ibinda, Fredrick Bauni, Evasius Kariuki, Symon M. Fegan, Greg Lewa, Joy Mwikamba, Monica Boga, Mwanamvua Odhiambo, Rachael Mwagandi, Kiponda Seale, Anna C. Berkley, James A. Dorfman, Jeffrey R. Newton, Charles R. J. C. |
author_sort | Ibinda, Fredrick |
collection | PubMed |
description | BACKGROUND: Neonatal Tetanus (NT) is a preventable cause of mortality and neurological sequelae that occurs at higher incidence in resource-poor countries, presumably because of low maternal immunisation rates and unhygienic cord care practices. We aimed to determine changes in the incidence of NT, characterize and investigate the associated risk factors and mortality in a prospective cohort study including all admissions over a 15-year period at a County hospital on the Kenyan coast, a region with relatively high historical NT rates within Kenya. METHODS: We assessed all neonatal admissions to Kilifi County Hospital in Kenya (1999–2013) and identified cases of NT (standard clinical case definition) admitted during this time. Poisson regression was used to examine change in incidence of NT using accurate denominator data from an area of active demographic surveillance. Logistic regression was used to investigate the risk factors for NT and factors associated with mortality in NT amongst neonatal admissions. A subset of sera from mothers (n = 61) and neonates (n = 47) were tested for anti-tetanus antibodies. RESULTS: There were 191 NT admissions, of whom 187 (98%) were home deliveries. Incidence of NT declined significantly (Incidence Rate Ratio: 0.85 (95% Confidence interval 0.81–0.89), P<0.001) but the case fatality (62%) did not change over the study period (P = 0.536). Younger infant age at admission (P = 0.001) was the only independent predictor of mortality. Compared to neonatal hospital admittee controls, the proportion of home births was higher among the cases. Sera tested for antitetanus antibodies showed most mothers (50/61, 82%) had undetectable levels of antitetanus antibodies, and most (8/9, 89%) mothers with detectable antibodies had a neonate without protective levels. CONCLUSIONS: Incidence of NT in Kilifi County has significantly reduced, with reductions following immunisation campaigns. Our results suggest immunisation efforts are effective if sustained and efforts should continue to expand coverage. |
format | Online Article Text |
id | pubmed-4388671 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-43886712015-04-21 Incidence and Risk Factors for Neonatal Tetanus in Admissions to Kilifi County Hospital, Kenya Ibinda, Fredrick Bauni, Evasius Kariuki, Symon M. Fegan, Greg Lewa, Joy Mwikamba, Monica Boga, Mwanamvua Odhiambo, Rachael Mwagandi, Kiponda Seale, Anna C. Berkley, James A. Dorfman, Jeffrey R. Newton, Charles R. J. C. PLoS One Research Article BACKGROUND: Neonatal Tetanus (NT) is a preventable cause of mortality and neurological sequelae that occurs at higher incidence in resource-poor countries, presumably because of low maternal immunisation rates and unhygienic cord care practices. We aimed to determine changes in the incidence of NT, characterize and investigate the associated risk factors and mortality in a prospective cohort study including all admissions over a 15-year period at a County hospital on the Kenyan coast, a region with relatively high historical NT rates within Kenya. METHODS: We assessed all neonatal admissions to Kilifi County Hospital in Kenya (1999–2013) and identified cases of NT (standard clinical case definition) admitted during this time. Poisson regression was used to examine change in incidence of NT using accurate denominator data from an area of active demographic surveillance. Logistic regression was used to investigate the risk factors for NT and factors associated with mortality in NT amongst neonatal admissions. A subset of sera from mothers (n = 61) and neonates (n = 47) were tested for anti-tetanus antibodies. RESULTS: There were 191 NT admissions, of whom 187 (98%) were home deliveries. Incidence of NT declined significantly (Incidence Rate Ratio: 0.85 (95% Confidence interval 0.81–0.89), P<0.001) but the case fatality (62%) did not change over the study period (P = 0.536). Younger infant age at admission (P = 0.001) was the only independent predictor of mortality. Compared to neonatal hospital admittee controls, the proportion of home births was higher among the cases. Sera tested for antitetanus antibodies showed most mothers (50/61, 82%) had undetectable levels of antitetanus antibodies, and most (8/9, 89%) mothers with detectable antibodies had a neonate without protective levels. CONCLUSIONS: Incidence of NT in Kilifi County has significantly reduced, with reductions following immunisation campaigns. Our results suggest immunisation efforts are effective if sustained and efforts should continue to expand coverage. Public Library of Science 2015-04-07 /pmc/articles/PMC4388671/ /pubmed/25849440 http://dx.doi.org/10.1371/journal.pone.0122606 Text en © 2015 Ibinda et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited. |
spellingShingle | Research Article Ibinda, Fredrick Bauni, Evasius Kariuki, Symon M. Fegan, Greg Lewa, Joy Mwikamba, Monica Boga, Mwanamvua Odhiambo, Rachael Mwagandi, Kiponda Seale, Anna C. Berkley, James A. Dorfman, Jeffrey R. Newton, Charles R. J. C. Incidence and Risk Factors for Neonatal Tetanus in Admissions to Kilifi County Hospital, Kenya |
title | Incidence and Risk Factors for Neonatal Tetanus in Admissions to Kilifi County Hospital, Kenya |
title_full | Incidence and Risk Factors for Neonatal Tetanus in Admissions to Kilifi County Hospital, Kenya |
title_fullStr | Incidence and Risk Factors for Neonatal Tetanus in Admissions to Kilifi County Hospital, Kenya |
title_full_unstemmed | Incidence and Risk Factors for Neonatal Tetanus in Admissions to Kilifi County Hospital, Kenya |
title_short | Incidence and Risk Factors for Neonatal Tetanus in Admissions to Kilifi County Hospital, Kenya |
title_sort | incidence and risk factors for neonatal tetanus in admissions to kilifi county hospital, kenya |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4388671/ https://www.ncbi.nlm.nih.gov/pubmed/25849440 http://dx.doi.org/10.1371/journal.pone.0122606 |
work_keys_str_mv | AT ibindafredrick incidenceandriskfactorsforneonataltetanusinadmissionstokilificountyhospitalkenya AT baunievasius incidenceandriskfactorsforneonataltetanusinadmissionstokilificountyhospitalkenya AT kariukisymonm incidenceandriskfactorsforneonataltetanusinadmissionstokilificountyhospitalkenya AT fegangreg incidenceandriskfactorsforneonataltetanusinadmissionstokilificountyhospitalkenya AT lewajoy incidenceandriskfactorsforneonataltetanusinadmissionstokilificountyhospitalkenya AT mwikambamonica incidenceandriskfactorsforneonataltetanusinadmissionstokilificountyhospitalkenya AT bogamwanamvua incidenceandriskfactorsforneonataltetanusinadmissionstokilificountyhospitalkenya AT odhiamborachael incidenceandriskfactorsforneonataltetanusinadmissionstokilificountyhospitalkenya AT mwagandikiponda incidenceandriskfactorsforneonataltetanusinadmissionstokilificountyhospitalkenya AT sealeannac incidenceandriskfactorsforneonataltetanusinadmissionstokilificountyhospitalkenya AT berkleyjamesa incidenceandriskfactorsforneonataltetanusinadmissionstokilificountyhospitalkenya AT dorfmanjeffreyr incidenceandriskfactorsforneonataltetanusinadmissionstokilificountyhospitalkenya AT newtoncharlesrjc incidenceandriskfactorsforneonataltetanusinadmissionstokilificountyhospitalkenya |