Profile and outcome of patients with post-neonatal tetanus in a tertiary centre in south west Nigeria: any remarkable reduction in the scourge?

Abstract

IntroductionThe incidence of tetanus has remained unacceptably high in developing countries. We aimed to describe the profile and outcome of children with tetanus admitted at the Lagos State University Teaching Hospital (LASUTH), Ikeja.MethodsA prospective and cross-sectional study of children aged 1 month to 12 years of age admitted with clinical diagnosis of tetanus, between January 2011 and December 2013, at the Paediatric department of LASUTH. The age, sex, presenting complaint, immunization status, portal of entry, socio-economic class, complications, duration of admission and outcome of the subjects were analyzed using Microsoft Excel supplemented with Statistical Package for Social Sciences (SPSS) version 17.0. Level of significance set at p< 0.05.ResultsA total of 49 subject participated in the study. Male: Female ratio was 1.7: 1.0. mean age ± SD of 6.5± 3.2 years. Only 24.5% of the subjects were fully immunized, lower limb injury was the most common portal of entry (34.7%). Majority (79.6) were of the middle and lower social classes. Most of the subjects (67.3%) presented with generalised spasm. Only 1 patient (2.0%) did not have trismus. Case fatality rate was 4.1%.ConclusionTetanus is still prevalent among children in our environment. It is commoner among those with no immunization or incomplete immunization, commoner in those in the middle and lower social class. Lower limb injury was the most common portal of entry. Trismus was a common presenting feature. There is a need to develop programmes with will help improve compliance to immunization.

Demographic survey and management outcome of Post-Neonatal Tetanus at the Ekiti state university teaching hospital, Ado Ekiti

“…There is prolonged duration of hospital stay in this study with the mean duration of 13.61 ± 8.10 days. Similar inding has been reported by Animasahun et al [6] in Lagos and Alhaji et al [16] in Maiduguri. This is due to the natural course of tetanus in which the symptoms are pronounced in the irst week, reach a plateau in the second week and begins to improve by the 3 rd week.…”

“…The symptoms that most of the patients presented with were spasm and rigidity while the most common portal of entry was wound on the lower limb. This is similar to indings from previous studies [6,15,16,22,23]. It becomes imperative that health care workers should endeavor to take immunization history while attending to children with injury/injuries sustained on the limbs and vaccinate appropriately.…”

“…The mortality rate was 19% in this study which is similar to 18% reported in Calabar [15] and Maiduguri [16] but higher than 4.1% reported by Animasahun et al in Lagos [6]. The lower value in Lagos was explained by the availability of free health during the period of the study which made accessing health care less dif icult.…”

“…The prevalence of post-neonatal tetanus in the index study is 0.3%. This is lower than the previous prevalences of 0.6% reported by Animasahun et al [6], in Lagos (2011-2013), 1.8% by Oyedeji et al [14], in Ilesha (2012), 1.1% by Anah [15] in Calabar (1997Calabar ( -2006 and 1.4% by Alhaji et al [16], in Maiduguri (2009Maiduguri ( -2011. This declining prevalence could be attributed to the improvement in immunization coverage, health education as well as improved approach to the care of wound and hygiene in the society which is brought about by increased civilization.…”

“…i.e. January 2011 and December 2013 [6]. A study by Adegboye et al [7], over a three-year period (April 2008 -March 2011) showed that 70 of the 95 children with childhood tetanus at the University Teaching Hospital Ilorin, Nigeria had neonatal tetanus while the remaining 15 patients had post-neonatal tetanus.…”