Jimma University Teaching Hospital Research Articles

The prevalence and associated factors for delayed presentation for HIV care among tuberculosis/HIV co-infected patients in Southwest Ethiopia: a retrospective observational cohort.

BackgroundA delay presentation for human immunodeficiency virus (HIV) patient’s care (that is late engagement to HIV care due to delayed HIV testing or delayed linkage for HIV care after the diagnosis of HIV positive) is a critical step in the series of HIV patient care continuum. In Ethiopia, delayed presentation (DP) for HIV care among vulnerable groups such as tuberculosis (Tb) /HIV co-infected patients has not been assessed. We aimed to assess the prevalence of and factors associated with DP (CD4 < 200 cells/μl at first visit) among Tb/HIV co-infected patients in southwest Ethiopia.MethodsA retrospective observational cohort study collated Tb/HIV data from Jimma University Teaching Hospital for the period of September 2010 and August 2012. The data analysis used logistic regression model at P value of ≤ 0.05 in the final model.ResultsThe prevalence of DP among Tb/HIV co-infected patients was 59.9 %. Tb/HIV co-infected patients who had a house with at least two rooms were less likely (AOR, 0.5; 95 % CI: 0.3–1.0) to present late than those having only single room. Tobacco non-users of Tb/HIV co-infected participants were also 50 % less likely (AOR, 0.5; 95 % CI: 0.3–0.8) to present late for HIV care compared to tobacco users. The relative odds of DP among Tb/HIV co-infected patients with ambulatory (AOR, 1.8; 95 % CI, 1.0–3.1) and bedridden (AOR, 8.3; 95 % CI, 2.8–25.1) functional status was higher than with working status.ConclusionsThree out of five Tb/HIV co-infected patients presented late for HIV care. Higher proportions of DP were observed in bedridden patients, tobacco smokers, and those who had a single room residence. These findings have intervention implications and call for effective management strategies for Tb/HIV co-infection including early HIV diagnosis and early linkage to HIV care services.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-016-0193-y) contains supplementary material, which is available to authorized users.

Diabetes related knowledge, self-care behaviours and adherence to medications among diabetic patients in Southwest Ethiopia: a cross-sectional survey.

BackgroundThe provision of health education involving self-care and good adherence to medications has been acknowledged to be a cost effective strategy for improving quality of life of diabetes patients. We assessed levels of knowledge about type 2 diabetes mellitus (T2DM), self-care behaviours and adherence to medication among DM patients.MethodsA facility based cross-sectional survey of 325 adults with T2DM patients attending Jimma University Teaching Hospital, Southwest Ethiopia was conducted. We used diabetes Knowledge Test, Expanded Version of the Summary of Diabetes Self-Care Activities and Morisky 8-Item medication adherence as tools to measure diabetic knowledge, self-care behaviours and adherence to medications respectively. Multinomial logistic regression analyses were used to assess the independent predictors of diabetes knowledge and adherence to medications. The binary logistic regression was applied for self-care behaviours.Results309 respondents were included in the survey. Of all the respondents, 44.9 %, 20.1 % and 34.9 % had low, medium and high level diabetic knowledge respectively. High level of diabetic knowledge was the reference group. Being illiterate (AOR = 3.1, 95%CI: 1.03-9.3), having BMI <18 kg/m2 (AOR = 6.4, 95%CI: 1.2-34.9) and duration of DM < 5 years (AOR = 4.2, 95%CI: 1.9-9.5) were significantly associated with low level of diabetic knowledge. T2DM patients who practiced good self-care (AOR = 0.5, 95%CI: 0.3-0.9) were less likely to have low knowledge. Duration of DM < 5 years (AOR = 9.8, 95%CI: 3.2-30.2) was significantly associated with medium level of diabetic knowledge. 157(50.8 %) patients had poor self-care behaviour and this was associated with level of education and adherence to medication. The proportions of patients with low, medium and high adherence to medication were 24.9 %, 37.9 % and 37.2 % respectively. Being a merchant, having medium level of diabetic knowledge and having good glycemic control level were associated with low adherence to medications.ConclusionsSignificant number of DM patients had low level of knowledge, poor self-care behaviours and low level of adherence to medications. These findings call for the need of integrated interventional management on diabetic knowledge, self-care behaviours and adherence to medications. To ensure effective T2DM management, a strategic approach that improves health literacy could be a cross cutting intervention.Electronic supplementary materialThe online version of this article (doi:10.1186/s12902-016-0114-x) contains supplementary material, which is available to authorized users.

Metabolic syndrome and associated factors among outpatients of Jimma University Teaching Hospital.

BackgroundDeveloping countries are now experiencing the epidemiologic transition, whereby the burden of chronic diseases, like metabolic syndrome, is increasing. However, no study had previously been conducted to show the status of metabolic syndrome among outpatients of Jimma University Teaching Hospital. Therefore, this study was designed to determine the prevalence of metabolic syndrome and associated factors among adult (≥20 years) patients.MethodsA cross-sectional hospital-based study was conducted in July 2014 among adult (≥20 years) patients attending Jimma University Teaching Hospital, outpatient department. All patients attending the outpatient department and were willing to participate in the study were included. Anthropometric and biochemical measurements were undertaken for all the study subjects to know the status of metabolic syndrome. Metabolic syndrome was identified using the National Cholesterol Education Program’s Adult Treatment Panel III criteria.ResultsA total of 225 participants were included in the study, of whom 106 (47.1%) were males and 119 (52.9%) were females. A total of 59 (26%) adults were found to have metabolic syndrome, which was seen more than twice as much in females, 42 (35%), as compared with males, 17 (16%), (P<0.01). The most frequent metabolic syndrome parameters were hypertension (45%), hyperglycemia (39%), decreased high-density lipoprotein (HDL) (31%), central obesity (26%), and elevated triglycerides (18%). Elevated blood pressure is more common in females (44.5%) than in males (34.9%). Decreased HDL-cholesterol was observed among 37% of females versus 24% males (P<0.001) and 6% of males versus 45% females had central obesity (P<0.001). Hypertension and body mass index were significantly lower among males (35% and 14%) than females (45% and 41%) (P<0.01 and P<0.001), respectively.ConclusionIt is demonstrated that metabolic syndrome is prevalent in adult outpatients in Jimma and increases as age increases; it is more common among females than males. Among the five diagnostic criteria for metabolic syndrome, hypertension, hyperglycemia, and low HDL-cholesterol were the most prevalent. As metabolic syndrome is rising at an alarming rate, we recommend that relevant prevention, diagnostics, and therapy in adult outpatients are undertaken.

The role of social determinants on tuberculosis/HIV co-infection mortality in southwest Ethiopia: a retrospective cohort study.

BackgroundThe role played by social determinants of health including social, economic, environmental and cultural factors in influencing health outcomes for many health conditions has been widely described. However, the potential impact of these factors on morbidity and mortality of infectious diseases particularly tuberculosis (Tb)/HIV co-infection mortality is scantly addressed. We assessed the role that social determinants play in Tb/HIV co-infection mortality in southwest Ethiopia.MethodsA retrospective cohort study collated Tb and HIV data from Jimma University Teaching Hospital, Southwest Ethiopia for the period of September 2010 and August 2012. Data analysis was conducted using STATA version 14 for mackintosh. Both descriptive and inferential statistics analyses were performed. Logistic regression was applied to identify factors associated with Tb/HIV co-infection mortality at P value of ≤0.05 in the final model.ResultsFifty-five (20.2 %) patients died during the study period. Compared to their counterparts, more Tb/HIV co-infection death was observed in young age groups between 25 and 34 years (47.3 %), females (58.2 %), daily labors (40 %) and Muslim followers (54.5 %). 43.6 and 41.8 % of study participants respectively had single and double bedrooms, and 25.5 and 23.6 % of deceased study participants did not have water and electricity in the household respectively. Logistic regression analyses demonstrated the following factors significantly associated with Tb/HIV co-infection mortality: being a commercial sex worker (AOR, 5.6; 95 % CI, 1.2–25.8), being of bed ridden functional status (AOR, 3.9; 95 % CI, 1.5–10.3) and being a rural resident (AOR, 3.4; 95 % CI, 1.4–8.4).ConclusionsOne-fifth of Tb/HIV co-infected patients died due to the co-infection. Social determinants including type of occupation, severity of disease and residing in rural areas seemed to have a significant association with the poor disease outcome. Findings of this study inform the role that social determinants play in influencing mortality due to Tb/HIV co-infection. Consistent with principles of primary health care as stated by Alma Ata declaration, and in order to achieve better disease outcomes, intervention frameworks that address Tb/HIV mortality should not only focus on the medical interventions of diseases, but should also integrate and improve social determinants of affected populations.

Factors associated with glycemic control among adult patients with type 2 diabetes mellitus: a cross-sectional survey in Ethiopia.

BackgroundEven though the prevalence of type 2 diabetes mellitus is swelling rapidly in Ethiopia, data regarding glycemic control, a key strategy for marked reduction of diabetes mellitus complications, is scant. We have assessed the status of glycemic control and its contributing factors among adult patients with type 2 diabetes mellitus.MethodsThis was a facility based cross-sectional survey of 325 adults with type 2 diabetes mellitus attending in Jimma University Teaching Hospital, South west Ethiopia. Data from all the patients were collected between February and April 2014. Glycemic level was assessed by using fasting blood glucose level, and ‘poor glycemic control’ was defined when fasting blood glucose level was above 130 mg/dL (7 mm/L). Analysis included both descriptive and inferential statistics, and SPSS version 20.0 was used for all analysis.Results309 respondents were included in the survey. More than two-third (70.9 %) of the patients had poor blood glycemic control. Patients who were illiterate (AOR = 3.46, 95 % CI 1.01–11.91) and farmer (AOR = 2.47, 95 % CI 1.13–5.39) had high odds of poor glycemic control. In addition, taking combination of insulin and oral medication (AOR = 4.59, 95 % CI 1.05–20.14) and poor medication adherence (AOR = 5.08 95 % CI 2.02–12.79) associated statistically with poor glycemic control.ConclusionMajority of patients had poor glycemic control. Patients with low level of education, being employed, on combinations of insulin and oral medication, and lower adherence to their medication were likely to have poor glycemic control. Education and awareness creation could be a cross cutting intervention for the significant factors.

Timing of Prophylactic Antibiotic Administration in Elective Surgical Patients at Jimma University Teaching Hospital: South West Ethiopia

Study objective: To evaluate the timing of prophylactic antibiotic administration in elective surgical patients, and anesthetists’ opinion regarding this issue. Design: Prospective, facility based cross-sectional study was employed. Setting: Jimma university teaching hospital (JUTH) Patient: Elective surgical patients and anesthesia professional of the hospital. Measurement: Data were collected prospectively from all elective surgical patients (except emergency, obstetric cases) and interred in predesigned forms as per existing protocol in JUTH from February 01 to March 30, 2014. The time of antibiotic prophylactic administration in respect to incision time was analyzed and descriptive result was presented as percentages of total responses. Main results: Prophylactic antibiotics was given before skin incision for 107 (79.9%) patients and 27 (20.1%) after skin incision. However; only 75 (56%) patients were get administered within proper time (60minutes) and the mean time of preoperative administration was 66+24 minutes. Prophylactic antibiotic medication was continued for >24 hours in 95% cases and re-dosing were not given for six surgical procedures which lasted >3 hours. Out of 26, only 71% anesthetists could mention the recommended time of antibiotic prophylaxis administration. About 21(80.8%) of anesthetists agreed that its surgeon’s responsibility for preoperative antibiotic selection and shared with nurses for preoperative administration. Anesthetists assume that they are responsible for confirmation of pre-incision administration and repeat administration during prolonged surgery. They indicated training was inadequate and deemed necessary in 77% of participants. Conclusion: The timing of prophylactic antibiotic administration was below the standard of practice. Hospital administration and infection control officer should work to improve compliance in accordance with published evidence-based guidelines.

Perinatal Mortality and associated Factor in Jimma University Specialized Hospital, South West Ethiopia

Background: Ethiopia is one of country with highest perinatal mortality among Sub-Sahara region. The aim of this study to determine perinatal mortality and associated factors in Jimma University specialized Hospital. Methods: A cross-sectional hospital based study done for one year in Jimma university teaching hospital. Structured questionnaires were used to collect maternal demographic charecterstics, reproductive performance, mode delivery and neonatal out come at discharge and maternal chart were revised to document weight and Apgar score. Data were entered cleaned and analyzed using SPSS 16 version. Binary logistic regression performed to see the existence of association between dependent and independent variable. Finally multivariate logistic regression model used to identify independent predictor of perinatal outcome. Results: During the study period, there were 3786 new born were delivered. Among them 372 babies were either still birth or dead within a week making perinatal mortality 98.2/1000 births. Being lack of antenatal care (AOR, 2.86; CI 1.96-3.33), malpresentation (AOR ,5.96; CI 2.11-16.86) and vaginalbreech delivery are important determinant factors for perinatal mortality. Conclusion: In general perinatal mortality in sub-Saharan Africa unacceptable high. The main contributing factor for high perinatal mortality are avoidable with good antenatal care, referral system and intrapartum supervision

Knowledge, Attitude and Practices of Infection Prevention among Anesthesia Professional at Jimma University Teaching Hospital; Oromia Region, South West Ethiopia, May 2015

Background: Employing standard precautions for infection prevention is increasingly concerned in operating theater. The KAP of Anesthetists plays a vital role in minimizing the risk of infection in surgical patients. Objective: To assess knowledge, attitude and practices of Anesthetists' on standard precaution of infection prevention. Methodology: Facility based cross sectional study was conducted in JUTH from MAY 08 -22/2015. Data was collected from all Anesthetists using pretested self-administered questionnaire. The knowledge level, attitude and practice of respondents were analyzed as predefined scale levels using scientific calculator and computer. Finally the result was presented as total percentage using tables and descriptive statements. Result: Eighteen questionnaires were distributed and 17 (94.44%) were found to be valid and analyzed. Based on grading of knowledge level 14 (82.35%) of them has good knowledge while the rest of 3 (17.64%) have poor knowledge. Among 17, 14 (82.35%) attitude score was ＞ 15 and 3 (17.64%) score was below 15. Therefore 14 (82.35%) Anesthetists have favorable attitude and 3 (17.64%) have unfavorable attitude on standard precaution. Out of 17, 4 (23.52%) was exposed and 3 (75%) of them wash with soap and water and use hand antiseptics as immediate measure after exposure. Conclusion and Recommendation: The majority of Anesthetists had poor practice of hand washing before and between every patient they intended to care. So a continual training program should be arranged for Anesthetists to follow the trend of hand washing with standard protocols for hand hygiene in the health care environment.

Assessment of Prevalence and Reasons for Termination of Pregnancy at Jimma University Teaching Hospital, Ethiopia

Background: Increasing legal access to abortion is associated with improvement in sexual and reproductive health. Conversely, unsafe abortion and related mortality are both highest in countries with narrow grounds for legal abortion. The objective of this study was to determine the prevalence and reasons for terminations of pregnancy at Jimma university teaching hospital. Methods: A retrospective cross sectional study was conducted at JUTH from June15-28, 2015, a total of 194 cards of women who came for abortion services from January 2012-January 2014 were included by systematic random sampling with inclusion and exclusion criteria. Chi square (x2) test calculated to analyze the statistical association between abortion types and other variables, p-value less than 0.05 was considered statistically significant. Result: According to this study, of the total calculated 194 sample size from clients admitted for both spontaneous and induced abortion 125(64.4%) were spontaneous and 69(35.6%) were induced abortion. 28(14.4%) of incomplete spontaneous abortion occurs between age of 25-years.one of the most common complication in this study was sepsis 23(11.9%). This study revealed that the main reason for induced abortion was due to rape and economic problem which holds 30(15.5%) and 16(8.2%) respectively Occupation and marital status are strongly associated with types of abortion with p-value of P<0.001. Conclusion and recommendation: The study concludes that majority of abortion were spontaneous abortion which almost hold all septic abortion and majority of induced abortion were teenage, single students and most of them presented after 2nd trimester of pregnancy which increases the complication of abortion. Thus, health education on dangers of induced abortion, spontaneous abortion and utilization of contraceptive methods services to all women are highly recommended.

An adolescent with significant emotional and medically unexplained complaints: case report and proposal of an intervention

BackgroundEthiopia is a country in which child and adolescent mental health needs are often not met. In order to promote capacity building, a Collaborative International Exchange Programme has been established between Jimma University at Jimma, Ethiopia, and Ludwig-Maximilian University in Munich, Germany. The programme focuses on training non-physician health professionals in mental health speciality. One of the courses in the training programme, child psychiatry, involves a child psychiatrist and a children’s nurse supporting the management of a patient described in this case report. Its conceptual framework is based on the section “significant emotional and medically unexplained complaints” of the “WHO mental health GAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings”.ObjectiveThe purpose of this case report is to promote confidence in mental health professionals when managing patients with similar conditions, and to stimulate further evaluation of the conceptual approach in developing countries.PatientThe subject of this case report is a 14-year-old adolescent girl admitted to the psychiatric clinic at Jimma University Teaching Hospital. She was admitted for intractable retching, inability to eat, weight loss, and inability to walk. Challenges included the combination of medical and psychiatric symptoms, and the significant impairment of functioning in this adolescent. The first aim in the management of this patient was to guarantee vital functions. In a problem-oriented approach, different domains were addressed to restore nutritional, social, emotional, and motor functions. Treatment consisted of various elements of psychosocial interventions. The patient improved in 2 weeks and the final diagnosis was conversion disorder.ConclusionPsychosocial interventions can be developed in cooperation, and applied in a setting where little child mental health expertise is available. Case-based learning relying on local expertise is suitable in meeting local needs and in developing mental health services for children and adolescents.

Pseudomonas aeruginosa isolates and their antimicrobial susceptibility pattern among catheterized patients at Jimma University Teaching Hospital, Jimma, Ethiopia.

BackgroundPseudomonas aeruginosa is among the most common bacterial pathogens with wide spread distribution in health care settings. Despite advances in medical and surgical care and introduction of wide variety of antimicrobial agents, Pseudomonas aeruginosa continues to cause life threatening infection. Thus, this study aims to isolate and determine antimicrobial susceptibility patterns of Pseudomonas aeruginosa from catheterized patients with urinary tract infection.ResultA cross-sectional study was conducted from January to May, 2013. Urine specimens of 73 catheterized patients who developed urinary tract infection after catheterization were collected from sampling port of the catheter. The urine samples were inoculated on MaConckey and blood agar plates, and incubated at 37 °C for 24 h. The isolates were identified by conventional microbiological tests. Antimicrobial susceptibility pattern was determined by modified Kirby-Bauer disk diffusion method. From a total of 73 urine samples collected P. aeruginosa was isolated from 36 (49.32 %) catheterized patients; 17 (23.29 %) males and 19 (26.03 %) females. While all P. aeruginosa isolates were found to be susceptible to Norfloxacin and Ciprofloxacin most isolates were also susceptible to Gentamicin (86.12 %).ConclusionThe result shows higher prevalence of P. aeruginosa isolates among catheterized patients and the isolates were susceptible to the antimicrobials studied. All P. aeruginosa isolates were susceptible to Ciprofloxacin and Norfloxacin with some of the isolates shown resistance to Gentamicin. While the susceptibility of the isolates to the two fluoroquinolones is a good news for the prescribers their future rational prescription and use should be the main focus.

Prospective Study of Proportions and Causes of Cancellation of Surgical Operations at Jimma University Teaching Hospital, Ethiopia

Most hospitals in developed countries invest considerable resources in maintaining operating suites and having surgeons and theatre staff available on an agreed schedule [2]. However, in developing countries where resources are limited, cancellation of elective surgical operations due to various preventable reasons is a common phenomenon in most hospitals [2, 3]. It is well recognized that cancellation of patients from elective theatre operating lists increases cost, decreases efficiency, duplicates workload and wastes operating room time [1, 4]. Cancellation of elective surgical procedures also causes significantly emotional trauma to the patients as well as their families and the community in general, and its impact on hospital resources is great due to prolonged hospitalization and high cost of health care [1, 5, 6]. Elective surgery cancellations always lead to insufficient utilization of manpower and hospital resources and can also lead to an increase in patients’ treatment expenses due to prolonged hospital stay and in many cases, repetitions of pre-operative preparations and management [6, 7].

Survival Experience and its Predictors among TB/HIV Co-infected Patients in Southwest Ethiopia

Background: HIV-TB co-infection is “bidirectional and synergistic”. HIV promotes the progression of latent tuberculosis infection to disease and tuberculosis accelerates the progression of HIV disease to its advanced stage. To date, there have been limited clinical data regarding survival rates among TB/HIV co-infected patients and the impact of antiretroviral therapy on clinical outcomes in developing countries. Therefore, this study assessed the predictors of TB/HIV associated mortality in a cohort of HIV infected patients treated with antiretroviral therapy in Jimma University Teaching Hospital. Methods: Retrospective study was conducted in Jimma University Teaching Hospital from September 01, 2010 to August 31, 2012. All records of adult TB-HIV co-infected patients who follow TB-HIV care in Jimma University Teaching Hospital between 01 September of 2010 and 31 August of 2012 were retrieved. Data were entered by Epidata and was exported to SPSS version 19. Data were analyzed using proportional hazards cox model with stepwise variable selection to identify independent predictors. P value below 0.05 was considered statistically significant in the final model. Results: Fifty five (20.2%) Tb HIV co-infected patients were died in the year September 2010 to August 2012, and 272 study subjects contributed 3, 082.7 person month observations. Age between 35-44 years (AHR=2.9; 95%CI: 1.08-7.6), being commercial sex worker (AHR=9.1; 95%CI: 2.7-30.7), bed ridden functional status (AHR=3.2; 95%CI: 1.2-8.7), and WHO stages 2 (AHR=0.2; 95%CI: 0.06-0.5), 3(AHR=0.3; 95%CI: 0.1-0.8) and 4(AHR=0.2; 95%CI: 0.04-0.55) were the independent factors affecting mortality of TB-HIV co-infected patients. Conclusions: More than 1 in 5 TB-HIV co-infected individuals died. The independent predictors were age between 35-44 years, being student and commercial sex worker, bed ridden functional status, and WHO stages 2, 3, and 4. Therefore, attention should be given to reduce the considerable amount of death, and specific intervention should be designed focusing on the independent predictors.

Magnitude and Associated Risk Factors of Perioperative Pediatrics Laryngospasm under General Anesthesia

Background: Several investigators have studied and made recommendations on literatures to reduce the incidence of laryngospasm during anesthesia. Contrastingly it is more frequently happening incident in pediatrics patient and brings a great challenge to anesthesia providers. Objective: The aim of this study was to identify the magnitude and risk factors associated with perioperative pediatrics laryngospasm and intervention strategies undertaken. Methodology: Hospital based cross sectional study was conducted on elective pediatrics patients (n=187) operated in Jimma University Teaching Hospital from February 1, 2015 to June 30, 2015. Result: Of the 53 (28.3%) laryngospasm events identified as cases, 30 (56.6%) occurred during induction, 4 (7.6%) during maintenance and 19 (35.8%) during emergence. 41 (77%) and 12 (23%) events were occurred during perioperative period on the hands of BSC and MSC anesthesia providers respectively. About 62.3% were precipitated by direct airway stimulations. Desaturation occurred in 42 (79.2%) of cases, bradycardia in 37 (69.2%), and cardiac arrest in 3 (5.7%) and there was death in 1.9% of case. There is a strong statistical associations between status of the providers with the incident of laryngospasm (P value is 0.01852356). 35 (66%) of cases were managed by removing the offending stimulus and administration of 100% oxygen with continuous positive pressure and in the absence of response 15 (28.3%) cases were treated with intravenous succinylcholine (0.25 to 1 mg x kg). 3 (5.7%) of children required cardiopulmonary resuscitation. There was no correlation across types of airway management devices utilized with the occurrence of laryngospasm (OR=0.6889, 95% C.I. 0358-1.3257, P=0.263552). Conclusions: Incidences of laryngospasm and its adverse events at pediatrics age group anaesthetized by junior anesthesia providers were high. Patient with upper respiratory tract infection and operated under general anesthesia with ETT were significant factors

Case-fatality of adult tetanus at Jimma University Teaching Hospital, Southwest Ethiopia.

Tetanus remains a major health problem in Ethiopia like in most other developing countries. To assess the clinical presentation, complications and outcome of tetanus patients. In this retrospective study, patients (age > 13 years) who were admitted to Jimma University Teaching Hospital from 1996 to 2009 were included. Data from 171 patients were analyzed (129 males, 42 females, mean age 33 years). The mean hospital stay for patients discharged cured and deceased was 21.5 ± 12 and 6.5 ± 6.7 days, respectively. None of our patients was immunized for tetanus. Tracheostomy and mechanical ventilation (MV) was done in 10.5% and 11 %, respectively. The case-fatality was 38%. The mean annual admission and case-fatality increased over the study period from 9 to 20.5 and from 21 % to 51%, respectively. Establishment of intensive care unit (ICU) did not improve mortality due to infrequent tracheostomy and MV. The case-fatality was high like in most other studies and the majority of patients died in the first few days indicating that adequate respiratory support was not given. Establishment of ICU did not improve mortality. Tetanus can be prevented by vaccination and if it occurs it needs well equipped ICU.