A review of neonatal tetanus in University of Maiduguri Teaching Hospital, North-eastern Nigeria

Abstract

Background:Neonatal tetanus is a vaccine preventable disease and is a leading cause of neonatal mortality in developing countries. The effectiveness of immunization and hygienic umbilical cord care practices in the prevention of the disease has been established.Objective:The objective of this study was to audit the scourge of neonatal tetanus in a tertiary health facility in a resource-limited setting.Materials and Methods:The study was a retrospective study. Case notes of neonates admitted with clinical diagnosis of tetanus into the Special Care Baby Unit (SCBU) between January 2009 and December 2010 were retrieved and evaluated to identify socio-demographic and clinical characteristics, mode of acquisition and severity of the disease, presence of co-morbidities, duration of hospital stay and outcome.Results:Most of the mothers had no tetanus immunization (66.7%) and the main social class of the children was class V (45.1%) and IV (41.2%), respectively. Only 29.4% of the mothers attended ante-natal care (ANC) while majority of the patients were delivered at home (94.1%). Half of the neonates presented with the severe form of the disease (51.0%). Sepsis is a prominent co-morbidity (59.2%). Morality was high with case fatality of 66.7%.Conclusion:This high prevalence of neonatal tetanus with high mortality is not only disappointing but unacceptable in the 21st century. Therefore, all efforts must be re-focused on current preventive strategies while pursuing new areas such as slow-release mono-dose tetanus vaccine and school health programme as well as advocacy on political will for the sustainability of immunization programmes of women of child-bearing age.

A 14 year review of neonatal tetanus at Ahmadu Bello University Teaching Hospital, Zaria, Northwest Nigeria

“…The most probable explanation for these are that poor home delivery environment as well as harmful traditional cord care practices are all conditions that predispose to cord sepsis and fever. This is consistent with earlier studies (Alhaji et al, 2013;Ambe et al, 2009;AbhulimenhenIhoha et al, 2011). The fever may be as a result of sepsis from the infected site and or secondary bacterial infection arising from unhygienic practices which will further worsen the clinical condition of the patients and resulting in high mortality.…”

“…This is consistent with report of other studies with local practices of cutting the cord with potentially infectious instruments (Alhaji et al, 2013;Onalo et al, 2011;Mbarie and Abhulimhen-Iyoha, 2015). It is also a traditional practice to perform uvulectomy conducted by -local surgeons‖ using unsterile tools in the study area (Onalo et al, 2011) on the new born within the first seven days of birth.…”

“…Neonatal tetanus (NNT) usually arises from contamination of umbilical cord, unhygienic delivery practices, traditional midwifery practices (cutting the umbilical cord with dirty blade, bamboo, applying soil, cow dung, hot fermentation and charcoal or even engine oil to the umbilical stump). Gitta et al (2006) and Alhaji et al (2013) Ritual surgery (ear piercing) or circumcision, uvelectomy may also cause infection (Charles, 2004). Another source of infection is otitis media (Catherine and Lam, 2009;Charles, 2004).…”

Renal function of post neonatal tetanus cases as seen in University of Port Harcourt Teaching Hospital

“…The case fatality rate (CFR) of tetanus in our study was 16.7%, this is comparable to the CFR of 18.2% and 18% reported by Oyedeji et al (2012) and Alhaji et al (2013) respectively. However, in a previous study carried out between 1995-2009 in UPTH by Yaguo-ide and Nte (2011) a higher CFR of 30.5% was reported, this may probably be attributed to better immunization coverage in the years after this study.…”

“…Most cases of post neonatal tetanus in our study was recorded among children above 5years of age which is consistent with the findings of other workers in Nigeria. Oyedeji et al (2012), Oyelami et al (1996), Alhaji et al (2013),Yaguo Ide and Nte (2011). There was no significant sex difference in cases of tetanus seen in our study which contrasts with the reports from previous studies.…”