Ten-year experiences with Tetanus at a Tertiary hospital in Northwestern Tanzania: A retrospective review of 102 cases

World Journal of Emergency Surgery

Japhet M Gilyoma²  Stephen E Mshana³  Nkinda Mbelenge¹  Ramesh M Dass¹  Joseph B Mabula²  Phillipo L Chalya² 

[1] Department of Orthopedics, Weill-Bugando University College of Health Sciences, Mwanza, Tanzania;Department of Surgery, Weill-Bugando University College of Health Sciences, Mwanza, Tanzania;Department of Microbiology, Weill-Bugando University College of Health Sciences, Mwanza, Tanzania

关键词: Tanzania;    predictors of outcome;    treatment outcome;    clinical characteristics;    Tetanus;   

Others  :  792745
DOI  :  10.1186/1749-7922-6-20

 received in 2011-05-03, accepted in 2011-07-08,  发布年份 2011

【 摘 要 】

Background

Tetanus is still a major health problem in developing countries and it is associated with a high morbidity and mortality rate. There is paucity of published data regarding the management of tetanus in Tanzania, especially the study area. This study was conducted to describe our own experiences with tetanus outlining the clinical characteristics and treatment outcome of tetanus patients in our environment and to identify predictors of outcome of these patients.

Methods

This was a ten-year period retrospective study of patients who presented with a clinical diagnosis of tetanus at Bugando Medical Centre between January 2001 and December 2010. Data was analyzed using SPSS computer software system.

Results

A total of 102 patients were studied. The male to female ratio was 11.8: 1. The majority of patients (74.5%) were aged < 40 years and 51.0% of them were farmers. Only 23.5% of patients had prior tetanus immunization. 53.5% of patients had a reasonably identifiable acute injury prior to the onset of tetanus and commonly involved the lower limbs (53.8%). The majority of patients (97.1%) had generalized tetanus. The mean incubation period and period of onset were 8.62 ± 4.34 and 3.8 ± 2.2 days respectively. Complication rate was 54.9%. The average overall duration of hospitalization was 34.12 ± 38.44 days (1-120 days). Mortality rate was 43.1%. According to multivariate logistic regression analysis, the age ≥ 40 years (P = 0.002), incubation period < 7 days (P = 0.014), tracheostomy (P = 0.004), severity of tetanus (P = 0.001) and need for ventilatory support (P = 0.013) were found to be significantly associated with higher mortality.

Conclusion

Tetanus remains a major public health problem in our centre and still carries unacceptably high morbidity and mortality despite the available advanced management facilities including ICU care. Young adult males are commonly affected. The incidence of tetanus can be reduced significantly by an effective immunization program and proper wound management of the patients. Early recognition, intense support and prompt treatment improves morbidity and mortality of patients diagnosed with tetanus.

【 授权许可】

   
2011 Chalya et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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