Determinants of tetanus and sepsis among the last neonatal deaths at household level in a peri-urban area of India.

Background: India contributes to one quarter of the total number of newborn deaths in the world. Less explored are the causes of these deaths, and household factors and decision makers for antenatal and postnatal care and their association with neonatal mortality.

Objective: This study estimated neonatal mortality rate due to tetanus and sepsis (TS) and tried to identify the risk factors for TS in a peri-urban area of India characterised by a high level of infant and neonatal mortality rate.

Methods: An intensive cross-sectional study was conducted during January to March 2008. A structured interview schedule was developed, after reviewing major demographic and health studies done in India, to collect data from all women selected in the sample villages, situated at a distance of 3-5 km from a primary health centre.

Results: Of the 894 married women (<50 years of age), 109 reported their last pregnancy outcome as neonatal death, and 84 cases of TS were noted. Using forward conditional stepwise logistic regression the risk factors of TS identified were women's age, socioeconomic score, antenatal care, pregnancy complications, and treatment after delivery during the neonatal period.

Conclusions: Independent of social class there is high prevalence of neonatal mortality. There is a close association between utilisation of health care services during pregnancy, postnatal period and neonatal deaths due to TS. It is argued that there is a need for a two pronged approach to reduce neonatal mortality due to TS: (1) to train traditional birth attendants, and expand the reach of existing antenatal care and childbirth facilities; and (2) to empower women to increase their awareness to take decisions about seeking proper medical assistance during pregnancy and childbirth.