A 10-year review of outcome of management of tetanus in adults at a Nigerian tertiary hospital

Background: Tetanus remains one of the major public health hazards of the developing world. Previous studies in Nigeria indicate that mortality ranged from 26% to 60%. Mortality is much lower in the developed world because of the availability of facilities for intensive care of cases, unlike in most developing countries. Aim: To report our experience with the management of adult tetanus at the University of Port Harcourt Teaching Hospital over the past 10 years (1996-2005). Methods: Data of all patients aged 16 years and above managed for tetanus in the medical wards between January 1996 and December 2005 were retrieved from their case records and analyzed. Results: Eighty-six patients were managed for tetanus (50 males and 36 females), constituting about 1% of all medical admissions over the 10-year period. Students, civil servants and commercial motorcyclists formed the major groups at risk. The commonest portal of entry was lower limb injuries (54%). Case fatality rate (CFR) was 42.9%, with a statistically significant higher CFR found among patients above 40 years of age (P=.000), patients with incubation period shorter than 7 days (P=.04), those with a shorter duration of hospitalization (P=.000) and those administered higher average daily diazepam doses (P=.044). Complications such as aspiration pneumonitis, laryngospasm and respiratory failure were major causes of mortality. Conclusion: Case fatality rate of tetanus has remained consistently high at our center. Factors that were significantly associated with high mortality included older age, age above 40 years, incubation period of less than 7 days and higher degree of sedation with diazepam. It is recommended that preventive immunization against tetanus be given to all Nigerians with secondary vaccination at adulthood.