Neonatal tetanus associated with topical umbilical ghee: covert role of cow dung
| Autor: | John R. Boring, S B Agha, J Bennett, H Traverso, C Ma |
|---|---|
| Rok vydání: | 1999 |
| Předmět: |
Male
Fossil Fuels Veterinary medicine Epidemiology Administration Topical Population Umbilical Cord Feces Health services Risk Factors Animals Humans Medicine Pakistan education education.field_of_study Tetanus business.industry Infant Newborn Hygiene General Medicine Neonatal tetanus Case-Control Studies Recien nacido Multivariate Analysis Butter Cattle Female business Cow dung |
| Zdroj: | International Journal of Epidemiology. 28:1172-1175 |
| ISSN: | 1464-3685 |
| DOI: | 10.1093/ije/28.6.1172 |
| Popis: | Previous studies in Pakistan have shown that ghee (clarified butter) is commonly applied to umbilical wounds of neonates, and have documented that such applications are a risk factor for neonatal tetanus (NNT). In-use contamination of ghee with Clostridium tetani has been demonstrated, but mechanisms underlying the risk of ghee have been incompletely evaluated epidemiologically.Detailed information on ghee usage, including fuels used to heat it, was obtained from cases of NNT (n = 229) and their matched controls (n = 687) from a population-based study of NNT in Punjab Province, Pakistan. Design variables were created to evaluate the impact of different fuel sources on risk of ghee applications.Nearly one-third of all infants had ghee applied, and it was nearly always heated before application to umbilical wounds of newborns. After controlling for all factors found to be significantly associated with NNT in conditional logistic regression, only ghee that had always been heated with dried cow dung fuel was significantly associated with NNT. Topical antimicrobials and ghee were never applied together.Ghee applications to umbilical wounds, when heated with 'clean' fuels, appear to pose no increased risk of NNT, although handling practices undoubtedly result in hazardous microbial contamination. In contrast, ghee heated with dung fuel was significantly associated with NNT. The effective promotion of topical antimicrobials might help reduce ghee use, since the intended purpose of each is to enhance healing.Ghee, a clarified butter used for cooking, is also applied to neonate umbilical wounds in India and Pakistan and is prepared using dried cow dung as fuel. It has been documented that the application of ghee increases the risk for neonatal tetanus (NNT), which results from contamination of the umbilical wound with spores of Clostridium tetani found in soil and cattle droppings. This population-based study examined ghee preparation and use, and other known NNT risk factors in rural areas of Punjab, Pakistan, in 1990. Detailed information on ghee usage and preparation was gathered among 229 cases and 687 matched controls. Evaluation of the ghee application risk factors in relation to fuel sources utilized four design variables. Results reveal that one-third of infants received umbilical wound applications of ghee, which was often heated beforehand. Using a logistic regression to control all factors significantly associated with NNT, ghee heated with dried cow dung was found to be significantly associated with NNT. In addition, simultaneous application of ghee and topical antimicrobials was found to be rare among the populace. In conclusion, ghee heated with clean fuels appears to pose an insignificant risk when applied to umbilical wounds, although unhygienic handling practices would eventually result in microbial infection. The authors suggest effective promotion and use of topical umbilical antimicrobials to control NNT and eradicate ghee use. |
| Databáze: | OpenAIRE |
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