Epidemiological trend of post-neonatal tetanus in a Nigerian teaching hospital

Abstract

Background. In sub-Saharan Africa, tetanus is one of the causes of childhood deaths with public health significance. Objective. To determine the current epidemiological trend of post-neonatal tetanus (PNT) in a Nigerian tertiary health facility. Methods . A retrospective study was done of the cases of tetanus (patients of age 28 days to 15 years) managed at the Olabisi Onabanjo University Teaching Hospital, Sagamu, south-west Nigeria, between January 2010 and December 2017. Results. There were 67 cases of PNT out of 3 171 admissions over the study period. The annual prevalence rates ranged from 3.9% in 2010 to 1.2% in 2017. The majority of patients were aged 6 - 12 years (55.2%) and 64.2% male and fell into the lower socioeconomic classes IV and V (98.4%). The mean (SD) duration of illness was 3.1 (2.2) days while the mean incubation period was 10.4 (5.4) days. The portal of entry was identifiable among 54 (88.5%) children. Most patients were not immunised against tetanus (45; 73.8%), had an incubation period >1 week (30; 49.2%), period of onset >24 hours (29; 47.5%) and severe and very severe disease (35; 57.4%).The case fatality rate was 35.8%, contributing 12.6% of total childhood deaths. Death was significantly associated with duration of illness less than 24 hours ( p =0.032) and severe and very severe cases ( p =0.005). Conclusion. Although the prevalence rates of PNT declined over the 8-year study period, the disease still contributed major proportions of post-neonatal childhood deaths from unmet intensive care needs among severe cases.