Post-neonatal tetanus in Abeokuta, south-western Nigeria

Abstract

Objectives: To describe the socio-demographic and clinical characteristics, treatment outcome and predictors of mortality in patients under 18 years of age with post-neonatal tetanus (PNT) in Abeokuta.

Methods: This retrospective study of 108 PNT cases admitted over a 10-year period between July 2012 and June 2022 was undertaken at two major referral hospitals in Abeokuta, Nigeria. Data on patient demographics, vaccination history, clinical features, management and outcome were analysed.

Results: PNT accounted for 0.82% of paediatric admissions during the study period. The median age was 9.0 years, with a slight male predominance (male-to-female ratio 1.1:1). None of the children under-5 were fully vaccinated; only 5.4% of older children received post-exposure prophylaxis. The lower limb was the most common site of injury. The incubation period ranged from 1 to 60 days with a median (IQR) of 8.0 (9.0) days. The case fatality rate was 18.52%. Mortality was significantly associated with lower limb wounds, rapid onset of spasms (<24 h) and the presence of autonomic dysfunction.

Conclusion: The burden of PNT in Abeokuta is considerable, driven by low vaccination coverage and delayed wound care. Prompt immunisation, early wound management and improved access to critical care are essential to reduce mortality.

Keywords: Nigeria; Post-neonatal tetanus; autonomic dysfunction; case fatality rate; mortality predictors; vaccination.