This discussion describes the problem of neonatal tetanus as seen in the Ahmadu Bello University Teaching Hospital (ABUTH) Zaria, Northern Nigeria over the January 1975 to December 1977 period. Appropriate health actions to be taken regarding prevention and management of neonatal tetanus are described. The pediatric ward of ABUTH, Zaria, admitted 4600 during the study period. Of these, 54 (1.2%) were neonatal tetanus cases. For these tetanus babies, information was available as to the age, sex, apparent portal of entry of the organisms, and the outcome of the infection. Analysis of their mothers included antenatal clinic attendance, residence, and place of delivery. More perinatal babies were infected and died than the other age groups. By the end of the 2nd week of life, over 90% of all the infected babies died. Home delivered babies were more infected than other babies delivered in hospitals. Only 7.4% of the mothers had any form of antenatal care. Zaria City, the traditional residence of the indigenous, had the highest number of cases and deaths. 44 (81.5%) of the babies had septic umbilical cord stumps with 35 deaths among them. The best treatment for an established case of tetanus is total muscle relaxation with anesthetic agents and intermittent positive pressure ventilation. This requires a specialized intensive care unit and a highly skilled personnel that are not yet available in Zaria. Simple sedation and expert and dedicated nursing and medical supervision can go far in reducing the mortality rate.

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The results of iron supplementation among 171 pregnant women registered at the maternal and child health (MCH) clinic of the Urban Health Training Center of Preventive and Social Medicine, S.M.S. Medical College, Jaipur, are reported. The registration of pregnant women was done at home visits. Initial hemoglobin level was estimated with Sahli's hemoglobinometer and 2 tablets of iron folic acid, each containing 60 mg of elemental iron and 0.5 mg folic acid were given each day for 90 days. Hemoglobin estimation was repeated every month. The regularity of intake was ensured by the MCH staff and women who consumed up to 75% of the period were considered as regular. Most of the women receiving iron supplementation were between 21-30 years of age, accounting for 62.6%. 29.2% of the women were under age 20. 51.5% were registered in their 2nd trimester and 1/3 in the 1st trimester. 14.6% were registered as late as the 3rd trimester. Only 9.4% had normal hemoglobin levels; the remaining 90.6% were anemic, 83% mild to moderate anemia and 7.6% severe anemia. The prevalence was highest in the 2nd trimester, in which 95.8% of the women were anemic. The prevalence was marginally lower in 1st and 3rd trimester, being 86.2% and 88.9%. Severity of anemia increased with increasing gestational age. The proportion of severely anemic women was as much as 25.9% in women in the 3rd trimester as compared to women in the 2nd trimester (8%) and none in the 1st trimester. The mean hemoglobin levels were almost similar in various trimesters, but the lowest mean levels were recorded in the 3rd trimester. The maximum changes were recorded in the 1st trimester, when the mean hemoglobin level increased but not significantly. Practically no change in mean hemoglobin was observed in the 2nd trimester, and there was a slight increase in the 3rd trimester after completion of iron supplementation. Trials are now on to fortify the common food commodity, particularly in wheat flour and common salt for continued iron supplementation.

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