Neonatal and post-neonatal tetanus in Nnamdi Azikiwe University Teaching Hospital, Nnewi, South-East, Nigeria: A 10-year review

Abstract

Introduction: Tetanus, a disease that is easily preventable by vaccination continues to be a public health problem in Nigeria and other developing countries. This study reviewed the socio-demographic and clinical characteristics of children admitted with tetanus in NAUTH over a 10-year period. Materials and Methods: This is hospital based 10-year retrospective study. Medical records of all the children admitted with tetanus in both neonatal and post-neonatal wards of NAUTH between January 2003 and December 2012 were retrieved and studied. Data was analyzed using SPSS version 16 and a P value < 0.05 was considered significant. Results: There were 26 cases of neonatal and post-neonatal tetanus. Three out of the 26 were from the neonatal group, while remaining 23 were from the post-neonatal group. All the patients in the neonatal group were males aged 2-10 days, with a mean of 5.66 ± 4.04 days. Fourteen (60.9%) of the post-neonatal group were males while nine (39.1%) were females. Their age ranged from 2 to 16 years with a mean of 9.8 ± 4.5 years. Eleven (47.8%) were aged 6 years and above, 9 (39.1%) were aged 5-10 years. Majority of the patients 21 (91.3%) among the post-neonatal group and all the patients in the neonatal group were from the rural area. Twenty-one (91.3%) of all post-neonatal patients were either not immunized at all or were not sure of their immunization status during infancy. Lower limb injury was the most common source of infection accounting for 56.5% of cases in the post-neonatal group while infected cord accounted for 66.6% of cases in the neonatal group. Thirteen (56.5%) of all the post-neonatal cases were discharged home, nine (39.1%) died while one was discharged against medical advice. Mortality was very high at 100% in the neonatal group. There was no statistical association between portal of entry and outcome. Conclusion: Tetanus remains a significant contributor to childhood morbidity and mortality in Nigeria. There is strong need to strengthen the present immunization coverage especially in the rural communities of our country.