Assessment of neonatal tetanus elimination in an African setting by lot quality assurance cluster sampling (LQA-CS).

Neonatal tetanus (NT) elimination, < 1 case per 1,000 live births (LB), was assessed at district level in Zimbabwe using a combined lot quality assurance-cluster sampling survey (LQA-CS). Three of the highest risk districts were selected. NT was considered eliminated if fewer than a specified number of NT deaths (proxy for NT cases) were found in the sample determined using operating characteristic curves and tables. TT2 + vaccine coverage was measured in mothers who gave birth 1-13 months before the survey and women aged 15-49 years. NT was considered as eliminated, TT2+ coverage was 78% (95% CI 71-82%) in women aged 15-49 and 83% (95% CI 76-89%) in mothers. The survey cost 30,000 US dollars excluding costs of consultants. NT incidence was below the elimination threshold (< 1/1,000 LB) in the surveyed districts and probably in all districts. LQA-CS is a practical, relatively cost effective field method which can be applied in an African setting to assess NT elimination status.

Traditional smoking of children under five years in Gwanda District

Health workers in Gwanda district have seen children presenting with respiratory infections; measles and diarrhoea with dehydration; whose condition was worsened by the practice of traditional smoking. In traditional smoking; an infant is held over a fire; in which herbs are burnt. Inhalation of the smoke is thought to protect the child against witchcraft and at times is used to treat illnesses. The extent of the practice and its adverse effects have not been known. This study describes the prevalence; methods; indications and perceptions of hazards related to traditional smoking. In a descriptive study 200 mothers; 20 traditional healers and 15 faith healers were selected for interview by a stratified sampling method. In addition; 5 focus group discussions were held with traditional midwives. Doctors in Gwanda district and paediatricians from the referral hospitals in Bulawayo were asked to complete a self-administered questionnaire. The practice of traditional smoking is common in Gwanda district with 98.5of the mothers/guardians interviewed confirming the practice in their villages. The major indication for smoking is for prophylaxis at birth to prepare the child to face the world and to prevent evil spirits.