OBJECTIVE Identify factors that influence the high rate of tetanus among infants born in rural areas. METHODS Home-born infants (n = 39) admitted to a medical center with fever. Males (n = 24) and females (n = 15); age range 3-15 days. METHODS Retrospective, descriptive design. The author used a 10-item interview schedule and a 9-item clinical checklist, including observation of infants' umbilical cords and physical state. RESULTS Of the 39 infants, 27 contracted neonatal tetanus; 11 died. All infants with tetanus were delivered at home by traditional, nonprofessional attendants. Factors contributing to high tetanus incidence included: lack of sepsis control, cord care, mothers' lack of immunization, delivery in settings. CONCLUSIONS Traditional nonprofessional attendants need training by professional nurses and midwives, and integration into the national health services. Immunization programs and health education are necessary, and can be delivered by nurses and midwives.