A 10-year review of outcome of management of tetanus in adults at a Nigerian tertiary hospital.
BACKGROUND
Tetanus remains one of the major public health hazards of the developing world. Previous studies in Nigeria indicate that mortality ranged from 26% to 60%. Mortality is much lower in the developed world because of the availability of facilities for intensive care of cases, unlike in most developing countries.


OBJECTIVE
To report our experience with the management of adult tetanus at the University of Port Harcourt Teaching Hospital over the past 10 years (1996-2005).


METHODS
Data of all patients aged 16 years and above managed for tetanus in the medical wards between January 1996 and December 2005 were retrieved from their case records and analyzed.


RESULTS
Eighty-six patients were managed for tetanus (50 males and 36 females), constituting about 1% of all medical admissions over the 10-year period. Students, civil servants and commercial motorcyclists formed the major groups at risk. The commonest portal of entry was lower limb injuries (54%). Case fatality rate (CFR) was 42.9%, with a statistically significant higher CFR found among patients above 40 years of age (P= .000), patients with incubation period shorter than 7 days (P= .04), those with a shorter duration of hospitalization (P= .000) and those administered higher average daily diazepam doses (P= .044). Complications such as aspiration pneumonitis, laryngospasm and respiratory failure were major causes of mortality.


CONCLUSIONS
Case fatality rate of tetanus has remained consistently high at our center. Factors that were significantly associated with high mortality included older age, age above 40 years , incubation period of less than 7 days and higher degree of sedation with diazepam. It is recommended that preventive immunization against tetanus be given to all Nigerians with secondary vaccination at adulthood.
Chukwubike
Onwuchekwa Arthur
OA
Department of Internal Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria. ac_onwuchekwa@yahoo.com
God'spower
Asekomeh Eshiofe
AE
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009549:Nigeria / Q000453:epidemiology; D012189:Retrospective Studies; D017678:Sex Distribution; D012959:Socioeconomic Factors; D015996:Survival Rate; D013742:Tetanus / Q000150:complications / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D016896:Treatment Outcome; D055815:Young Adult