East African Journal of Public Health East African Public Health Association ISSN: 0856-8960 Vol. 2, Num. 2, 2005, pp. 22-23

East African Journal of Public Heath, Vol. 2, No. 2, Oct, 2005, pp. 22-23

Tetanus and its Treatment Outcome in Dar Es Salaam: Need for Male Vaccination

Mabula D Mchembe and Victor Mwafongo

Dept. of Surgery
Correspondence: MDP Mchembe,  P.O. Box 65001, Muhimbili University College Health Sciences, Dar es Salaam –Tanzania. E-mail: mmchembe@yahoo.com

Code Number: lp05013

Abstract

Objective: Tetanus is a life threatening infection relatively uncommon in developed Countries but occurs frequently in developing Countries with a high case fatality rate.A retrospective study for the period of twelve months (January-to- December 2004), twenty-two cases of tetanus were admitted in the intensive care unit (I.C.U) of Muhimbili National Hospital, which is the largest referral and teaching hospital situated in Dar-es-salaam.
Methods: All patients with clinical tetanus (regardless of their age and sex) admitted at the intensive care unit (ICU) at Muhimbili National referral hospital in Dar-es-salaam Tanzania.
Results: Among these patients, majority were males 91% and only two were females. Their age ranged between 20-40 years and no neonatal tetanus. Most of them died in I.C.U. (72.7%) after staying for about 1-10 days. Those who survived some stayed in hospital (I.C.U) for about 31 days. The nature of injury was cut wounds to the extremities in 40.9% and 18.2% the source of injury could not be established.
Conclusions: The National immunization program against tetanus is highly needed as a basis for prevention of tetanus to reduce morbidity and mortality among young, energetic male age group in Tanzania. The program puts more emphasis on children and women, it is high time the campaign involves young men who are the bread earners. This will also minimize costs of caring tetanus patients in the hospital. Apart from National campaign of immunization against tetanus health education is required in the general public in Dar-es-salaam on the early hygienic care of wounds to reduce the source of infection.

Key words: Tetanus, management, vaccination, male, and mortality      

Introduction

Tetanus is an intoxication manifested primarily by neuromuscular dysfunction. It is caused by tetanus toxin (tetanospasmin), an extraordinarily potent exotoxin elaborated by clostridium tetani. The disease can be prevented by immunization with tetanus toxoid (1).

Though tetanus occurs worldwide the disease is most frequently encountered in developing countries. In U.S.A, both the incidence and mortality of tetanus have dropped approximately ten fold over the last 25 years (1)

Tetanus is still common among residents of Dar es Salaam. It is the second commonest cause of admission at Muhimbili Intensive care unit with relatively high morbidity and mortality (2). The disease is affecting more males (who are young, energetic and productive) than females. It is the purpose of this short paper to determine the characteristics and treatment outcome of tetanus in Dar-es-salaam and sensitize the society to vaccinate against tetanus.

Materials and Methods

All patients with clinical tetanus admitted at Intensive Care Unit at Muhimbili National hospital, which is the largest national referral and teaching hospital from January to December 2004, were included in this retrospective study.

Details about age, sex, site and nature of wound, hospital stay, and outcome were entered in the questionnaire before analysis. The three objectives of therapy i.e. supportive care; neutralization of circulating toxin and removal (eradication) of the source of tetanospasmin (infected sites) was applied to all cases depending on the severity of spasms and availability of all essential facilities.

Results

During the study period, a total of 22 patients were admitted in the unit. All patients had the generalized type of the disease with the classical symptoms of trismus, dysphagia and muscular rigidity. Among these, only two (2) patients were female (9%) and the rest were males (91%).

Majority of the patients were in the age group of 20 – 40 years and no neonatal tetanus was recorded. Most of these patients died (72.7%) and only few recovered and discharged home (27.7%). The hospital stay was between 1 – 10 days for all patients who died (54.5%) and only few survived beyond ten days. Majority who survived stayed in hospital beyond 10 days 5patients (22.7%) and one patient stayed beyond 31 days.

Nature of wound was cut wounds at different sites; mostly the extremities and being home related injuries and few took place on farms and assaults.

Table 1. Age and sex distribution of tetanus patients.

Table 2. Portals of entry of clostridium tetani in patients with clinical tetanus at Muhimbili Nationa Hospital – ICU

Table 3. Distribution of hospital stay and outcome

Discussion

In developed countries tetanus incidence is low and is no longer responsible for significant mortality, this is because of high level of health awareness in terms of vaccination and availability of human and material resources to manage the disease. The twelve months study revealed a high mortality rate of 72.7% that is almost similar to the results presented five years ago in Tanzania and to the study results reported in other part of Africa like Nigeria and Ghana (2-4). However, these figures in this study are high compared to other studies (5-7).

The high proportion of admission among males in this study reflects the low vaccination rates among males in the community as compared to females and children who gets their vaccination during pregnancy and childhood respectively. Immunization has all along being a major way of preventing development of the disease (4, 8-9). These will also reduce the costs of hospital stay and resource utilization (i.e. human and equipments). This study revealed that, young male patients are commonly affected; because these are the active and productive individuals in the society. Health education on the importance of vaccination among males is highly needed to prevent from contracting this serious disease.

The high mortality rate could also be due to the gross inadequacy of human and material resources to manage severe tetanus in the intensive care unit, typical of developing countries like Tanzania (3).

Management of tetanus patients is too demanding, prolonged, and expensive both in terms of materials and manpower. A way to alleviate these problems is by adopting a rigorous tetanus immunization discipline in our community. The National policy needs to extend its programme to vaccinate the whole vulnerable population in Tanzania against tetanus. There is a need to do a further study in Tanzania to cover a big population.

References

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