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. 2022 Sep 7;14(5):468-474.
doi: 10.1093/inthealth/ihab021.

Neonatal and postneonatal tetanus at a referral hospital in Kamsar, Guinea: a retrospective audit of paediatric records (2014-2018)

Ibrahima Condé  1   2 , Mahamoud Sama Cherif  1 , Prabin Dahal  3 , Marie Elisabeth Hyjazi  1   2 , Facely Camara  1 , Macka Diaby  1   2 , Abdoul Salam Diallo  1   2 , Adeniyi Kolade Aderoba  4   5 , Foumba Conde  2 , Mohamed Lamine Diallo  1 , Fatoumate Binta Diallo  1 , Hasmiou Dia  1 , Mamadou Pathé Diallo  1 , Alexandre Delamou  1 , Telly Sy  1
Affiliations

Neonatal and postneonatal tetanus at a referral hospital in Kamsar, Guinea: a retrospective audit of paediatric records (2014-2018)

Ibrahima Condé et al. Int Health. .

Abstract

Background: Tetanus is a vaccine-preventable disease caused by the bacterium Clostridium tetani. In 2018, all of Guinea was considered to be at risk of the disease and the country is currently in the elimination phase.

Methods: A 5-y audit (1 January 2014-31 December 2018) of all admissions to the neonatal and general paediatric units of Kamsar Hospital (Western Guinea) was undertaken to identify cases of neonatal tetanus (NNT) and postneonatal tetanus (PNNT).

Results: There were 5670 admissions during the study period, of which 39 (0.7%) were due to tetanus (22 NNT and 17 PNNT). Among NNT patients, the bacterial entry site was the umbilical cord (n=20) or wound following circumcision (n=2). For PNNT, the entry site was surface wound (n=12), limb fracture (n=1) or could not be established (n=4). A majority of the patients (36/39, 92.3%) were born to unvaccinated mothers or those who received suboptimal vaccination during pregnancy. Overall, 21 (53.8%) children died within 7 d of admission with a higher mortality observed among neonates (16/22, 72.7%) compared with postneonates (5/17, 29.4%).

Conclusions: Tetanus was a rare cause of admission at Kamsar Hospital with a very high case fatality rate. The disease primarily occurred among children born to mothers who were unvaccinated/inadequately vaccinated during pregnancy.

Keywords: Guinea; clinical audit; elimination; neonates; tetanus; vaccination.

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Figures

Figure 1.
Figure 1.
Total reported cases of tetanus in Guinea, 1980–2019.
Figure 2.
Figure 2.
Kaplan-Meier estimate of survival probability within 7 d of hospital admission for (left panel) neonatal tetanus (NNT) and postneonatal tetanus (PNNT), and (right panel) disease severity graded using Dakar scoring rule. Log-rank test: p=0.003 for left panel and p<0.001 for right panel.
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