Five years review of cases of adult tetanus managed at Gondar University Hospital, North West Ethiopia (Gondar, Sep. 2003-Aug. 2008)

Abstract

Background: Tetanus is a life threatening preventable infection relatively uncommon in the developed world but occurs frequently in developing countries with case fatality rate of 40-60%. We conducted the study as there is no recent review regarding adult tetanus in Ethiopia which looked at the predisposing factors, presenting features and case fatality rate.

Objective: The study aims to evaluate clinical characteristics of adult tetanus as related to predisposing factors, presenting features and treatment outcome.

Methods: This is a retrospective review of adult tetanus cases admitted to medical ward of Gondar University Hospital, North West Ethiopia, over a period of 5-years.

Results: A total of 29 adults were admitted with the diagnosis of generalized tetanus during the study period. There were more male then female patients (sex ratio 1.9:1) with rural dwellers constituting the majority. The mean age of patients was 35 +/- 14 yrs (range, 18-70 yrs. Majority of patients (72.4%) sustained acute injury preceding symptom onset, often on lower extremity. Three rural mothers, who denied history of trauma, developed puerperal tetanus with in 2 weeks of delivery, genital tract thought to be the portal of entry. Almost all patients, who had sustained acute injury, did not seek medical help for their wounds and missed the chance to receive prophylaxis for tetanus. Over all, 48.3% had severe, 37.9% moderate, and 13.8% mild form of tetanus at presentation. The most common clinical presentation was trismus (100%), followed by stiff neck and back (93.1%) and neck rigidity (86.2).Over all mortality rate was 41.4%. Respiratory failure requiring ventilatory support (66.7%) was the major cause of death.

Conclusion: The study recommends a need for tetanus immunization in those who had acute injury and planning to educate individuals at risk to recognise symptoms early, and seek medical care to combat this fatal disease.