Tetanus Situation in Pakistan; Comparison of Medical Versus Surgical Management

Abstract

To determine demographic and clinical profile of Tetanus patients and to highlight various management strategies as well as the outcome of the tetanus patients. Background: Tetanus, a preventable disease still found in high frequency in developing world. Globally one million cases are recorded annually. This disease found more frequently in patients who are either non vaccinated or partially immunized. Diagnosis of Tetanus is solely made on clinical grounds with no definitive investigation available to confirm the diagnosis. Mortality of Tetanus is directly related to the grade of tetanus at presentation. Study Design: Descriptive observational study. Setting: Public and private sector hospitals of Hyderabad, Pakistan. Period: 1st Nov 2008 to 31 st Oct 2015. Materials & methods: It includes patients of either sex above the age of 13 years who were clinically diagnosed as case of Tetanus. Data was collected for variables related to demography, incubation period, site of injury, history of tetanus vaccination, co morbidity, stage of presentation, management & outcome of treatment, complications & mortality. Results: Total 131 patients of Tetanus were finally analyzed. It includes 124 (94.65%) male and 07 (5.34%) female patients with mean age of 34.06 years. 69 (52.67%) were farmers by occupation. History of injury was present in 109(83.20%) patients & incubation period was < 10 days in 39(29.77%) patients. Lower limb was the commonest site of injury noted in 86(65.64%) patients. Tetanus immunization history was positive in 63 (48.09 %) patients. Among the clinical findings, generalized bodyache or stiffness with backache was noted in 107(81.67%) patients, restricted mouth opening in 101 (70.09%) patients. Grade I Tetanus was noted in 63(48.09%) patients. Complications of tetanus were noted in 43(32.82%) patients. Mortality rate was noted in 33 (25.19%) patients. Mean hospital stay was 12.3±9.0 days. Conclusion: Tetanus is found in significant frequency in our setup which carries substantial morbidity and mortality.

Five years study of mortality and morbidity patterns of Tetanus cases in a Tertiary Care PICU (Pediatric Intensive Care Unit), Multan Pakistan.

“…In an adult study in Pakistan the autonomic dysfunction was found to be 12%. 29 Paralytic illus was seen strikingly high in our sudy45.4% as compared to other local study in Pakistan 13%. 29 Hypotension was found in 25(32.4%) cases all of which needed inotropic support to maintain BP between50th and 90th centile.…”

“…29 Paralytic illus was seen strikingly high in our sudy45.4% as compared to other local study in Pakistan 13%. 29 Hypotension was found in 25(32.4%) cases all of which needed inotropic support to maintain BP between50th and 90th centile. It was much less than found by Naseem et al which showed 73.91% cases developing hypotention.…”

“…27 It seems to be the reflection of poor coverage of our immunization programmed in our country. In adult studies in Pakistan Talpur A et al 29 showed 48%, Muazzam M et al 30 showed 76% cases who were unimmunized or unaware of the immunization status. Unlike other diseases, tetanus is entirely preventable by immunization.…”