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[Unpublished] 1987 Apr 30. , 53 p.Neonatal tetanus, caused by the toxin of Clostridium tetani, is transmitted via unclean instruments used to cut the umbilical cord or contaminated dressings applied to the stump. The symptoms are inability to suck, trismus, convulsions, and (in 80-90% of cases) death on the 7th or 8th day. In the US between 1982 and 1984 only 2 cases of neonatal tetanus were reported; in the developing world an estimated 800,000 infants die of neonatal tetanus every year. The survey methodology used to determine the neonatal tetanus death rate was a 2-stage sampling method, known as the Expanded Program on Immunization 30 cluster sampling method, followed by questionnaires. Such surveys contain a certain amount of built-in bias due both to fact that the final selection of households is never completely random and that retrospectively gathered information is subject to recall bias. The surveys indicated that neonatal tetanus incidence was highest in rural areas, especially where animals were present; in the slums of cities; among families with many children; where mothers received no prenatal care; and where birth attendants were untrained. The best preventive strategy against neonatal tetanus is provided through immunization of the mother with tetanus toxoid, since the antibodies cross the placenta and protect the infant through the neonatal period. Unfortunately, the tetanus vaccination program lags at least 30% behind other World Health Organization Expanded Program on Immunization coverage. The World Health Organization recommends an initial immunization with .01 antitoxin International Units per milliliter of serum, a 2nd dose 4 weeks later (at least 2 weeks before delivery) and booster doses on each successive pregnancy up to 5; the 5th booster provides lifetime protection. Immunization should also be carried out among nonpregnant women of childbearing age and children. The World Health Organization has proposed that neonatal tetanus be made a reportable disease, which should be combatted by prenatal immunization of mothers and training of traditional birth attendants. Between 60% and 80% of all births in developing countries are attended by traditional birth attendants, but, except in China, the training of traditional birth attendants has not contributed as much to reduction of neonatal tetanus as has immunization. Alternative strategies for carrying out tetanus immunization programs include integrating them into prenatal clinics, schools, family planning programs, maternal food distribution programs, well-baby care centers, mass campaigns (especially in urban areas), and mobile team outreach strategies in rural areas. Tetanus immunization could also be linked to other Expanded Program on Immunization programs even though these are mainly targeted at children rather than mothers and other women of childbearing age. Indonesia initiated a tetanus immunization program in 1977 and a traditional birth attendant training program with assistance from the UN Childrens Fund in 1978. However, 3 neonatal tetanus surveys, conducted in 19 provinces, the city of Jakarta, and Java, estimated the total number of deaths/year from neonatal tetanus as 71,150--a neonatal tetanus mortality rate of 11/1000. 3 provincial level studies, also using the Expanded Program on Immunization 30 cluster sampling method, in Nusa Tenggara Barat, West Sumatra Province, and Daerah Istemewah Aceh revealed neonatal tetanus mortality rates of 8.3/1000, 18.5/1000, and 8.4/1000 respectively. In the Health portion of Indonesia's 4th 5-year plan (Pelita IV), the 1st priority is given to reducing the neonatal death rate of 93/1000 live births; the 7th priority is reduction of mortality due to neonatal tetanus by ensuring adequate immunization as part of routine health services and by requiring 2 tetanus immunizations of all women applying for a marriage certificate.
Journal of Nurse-Midwifery. 1982 Fall-Winter; 8(2):31-4.This study investigates the contraceptive decision-making processes of 132 sexually active 15 to 19 year old girls. The subjects completed a questionnaire designed to elicit information on their assessment of the personal and social costs of contraceptive use; the personal and social benefits of pregnancy, and their biological ability to become pregnant. Approximately 175 questionnaires were collected from 3 Planned Parenthood clinic sites in Indiana. The only questionnaire item which significantly predicted contraceptive use was the girl's assessment of the financial costs related to contraceptive use. The study confirmed several demographic trends demonstrated in earlier empirical studies: the older a sexually active girl becomes, between the ages of 15 and 19, the more likely she is to be a good contraceptor and the longer a sexually active girl has been dating a particular person the more likely she is to be a good contraceptor. Within the sexually active subsample, only 6.1% agreed that hindrance to spontaneity was a reason for nonuse of contraception, and only 7.1% stated that their partner objected to birth control use. The common assumption that teenagers do not like to appear prepared for sex received only minimal support: 15% said they did not like to think of themselves as prepared, and 8% said they did not like their partners to think of them as prepared for sex. A theme of general embarrassment over the whole process of obtaining birth control was evident, however: 47% said they found going to a clinic for birth control embarrassing; 53.5% said going to a private doctor was embarrassing; and 61.2% agreed that buying foam or condoms in a drug store embarrassing. The study attempted to determine which of the costs of contraception, and which of the benefits of pregnancy, are perceived by teenagers to weigh most heavily in their own informal process of deciding whether or not to use contraception.