Incidence and risk factors for neonatal tetanus in admissions to County Hospital, Kenya

dc.contributor.authorIbinda, Fredricken_ZA
dc.contributor.authorBauni, Evasiusen_ZA
dc.contributor.authorKariuki, Symon Men_ZA
dc.contributor.authorFegan, Gregen_ZA
dc.contributor.authorLewa, Joyen_ZA
dc.contributor.authorMwikamba, Monicaen_ZA
dc.contributor.authorBoga, Mwanamvuaen_ZA
dc.contributor.authorOdhiambo, Rachaelen_ZA
dc.contributor.authorMwagandi, Kipondaen_ZA
dc.contributor.authorSeale, Anna Cen_ZA
dc.date.accessioned2015-11-23T12:35:19Z
dc.date.available2015-11-23T12:35:19Z
dc.date.issued2015en_ZA
dc.description.abstractBACKGROUND: 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.en_ZA
dc.identifier.apacitationIbinda, F., Bauni, E., Kariuki, S. M., Fegan, G., Lewa, J., Mwikamba, M., ... Seale, A. C. (2015). Incidence and risk factors for neonatal tetanus in admissions to County Hospital, Kenya. <i>PLoS One</i>, http://hdl.handle.net/11427/15322en_ZA
dc.identifier.chicagocitationIbinda, Fredrick, Evasius Bauni, Symon M Kariuki, Greg Fegan, Joy Lewa, Monica Mwikamba, Mwanamvua Boga, Rachael Odhiambo, Kiponda Mwagandi, and Anna C Seale "Incidence and risk factors for neonatal tetanus in admissions to County Hospital, Kenya." <i>PLoS One</i> (2015) http://hdl.handle.net/11427/15322en_ZA
dc.identifier.citationIbinda, F., Bauni, E., Kariuki, S. M., Fegan, G., Lewa, J., Mwikamba, M., ... & Newton, C. R. (2015). Incidence and risk factors for neonatal tetanus in admissions to kilifi county hospital, kenya. PloS one, 10(4), e0122606. doi:10.1371/journal.pone.0122606en_ZA
dc.identifier.ris TY - Journal Article AU - Ibinda, Fredrick AU - Bauni, Evasius AU - Kariuki, Symon M AU - Fegan, Greg AU - Lewa, Joy AU - Mwikamba, Monica AU - Boga, Mwanamvua AU - Odhiambo, Rachael AU - Mwagandi, Kiponda AU - Seale, Anna C AB - 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. DA - 2015 DB - OpenUCT DO - 10.1371/journal.pone.0122606 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2015 T1 - Incidence and risk factors for neonatal tetanus in admissions to County Hospital, Kenya TI - Incidence and risk factors for neonatal tetanus in admissions to County Hospital, Kenya UR - http://hdl.handle.net/11427/15322 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/15322
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0122606
dc.identifier.vancouvercitationIbinda F, Bauni E, Kariuki SM, Fegan G, Lewa J, Mwikamba M, et al. Incidence and risk factors for neonatal tetanus in admissions to County Hospital, Kenya. PLoS One. 2015; http://hdl.handle.net/11427/15322.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentDivision of Immunologyen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis 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 credited.en_ZA
dc.rights.holder© 2015 Ibinda et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherEnzyme-linked immunoassaysen_ZA
dc.subject.otherTetanusen_ZA
dc.subject.otherAntibodiesen_ZA
dc.subject.otherNeonatesen_ZA
dc.subject.otherInfantsen_ZA
dc.subject.otherVaccination and immunizationen_ZA
dc.subject.otherKenyaen_ZA
dc.subject.otherHospitalsen_ZA
dc.titleIncidence and risk factors for neonatal tetanus in admissions to County Hospital, Kenyaen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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