Field test of a rapid assessment technique against a probabilistic community survey: operational implications for neonatal tetanus elimination.

Neonatal tetanus (NNT) is a leading cause of neonatal mortality in developing countries and is frequently called ‘the silent epidemic’. It is endemic in over 90 countries throughout the world. Incidence is often not known, obstructing cost-effective resource management for control measures. In many developing countries NNT is responsible for one-half of the neonatal mortality and up to one-quarter of infant mortality. Case-fatality rates (CFR) can, even with treatment, reach 80–90%. Operational tools for the rapid identification of NNT risk areas need to be developed for WHO'S programme which calls for the elimination of NNT by 1995. Results of a rapid assessment technique, carried out in 1990, were compared with those found in a household survey, which was independently carried out in Jalisco, Mexico, in 1988. One approach used random sample survey techniques in rural communities, which in previous years had reported NNT. Of 40 neonatal deaths, 8 (20%) were attributable to NNT. The annual incidence rate was 4.6/1000 livebirths. Using this as the ‘gold standard’, a rapid assessment technique was evaluated. The NNT cases seen at health services were randomly matched with other neonatal illnesses obtained from health records and then mapped. Age-specific catchment areas for hospitals under investigation and risk areas for NNT were obtained. Areas without NNT cases but with other neonatal illnesses have been operationally considerd to be at low risk for NNT. The use of health services by neonates with other pathologies supports the hypothesis that an NNT case, if it occurred within the same time period and area under investigation, would most probably have been admitted. The rapid assessment technique could identify high-risk areas for NNT. Areas where neither NNT cases nor controls were reported should be considered as areas of unknown risk and should be subject to future investigation. Many factors associated with NNT are comparable between the two approaches, encouraging recommendation of the more economic rapid assessment technique as a tool for trend monitoring and impact assessment. Local programme managers, who do not have the resources and the capacity for performing probabilistic surveys, can use the proposed approach for targeting scarce resources effectively and can contribute to speeding up the NNT elimination effort in the context of national vaccination programmes. [ABSTRACT FROM PUBLISHER]

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