Effect on neonatal tetanus mortality after a culturally-based health promotion programme

The Maasai have high rates of death from neonatal tetanus, partly due to their custom of packing the umbilical stump with cow dung. We report on the effect of a simple health promotion programme, designed in consultation with the local community and carried out by local women. After introduction of the programme in 1981, neonatal (<6 weeks of age) tetanus rates fell sharply, and by 1988 annual death rates had dropped to 0·75 (range 0–3) per 1000 births in the intervention areas compared with 82 (74–93) per 1000 in control areas.