Cases Of Neonatal Tetanus Research Articles

Neonatal Tetanus in Gabon: About 2 Cases

Background: Poor information about neonatal tetanus cases are assembled in Gabon. Aim: To recall practitioner about the existing danger of neonatal tetanus despite efforts made by immunization in the country and worldwide. Observations: We write about two observations in two teaching hospitals at the same period. One treated, and the other lethal. We assess their cases with the commonly used scale in Africa: Dakar Classification. Conclusion: Despite the worldwide actions against neonatal tetanus, cases appear, and we must screen the mothers with exposure factors.

Clinical Profile and Outcome of Pediatrics Tetanus: The Experience of a Tertiary Hospital in Ethiopia.

Tetanus is an acute vaccine preventable illness manifested by neuromuscular dysfunction due to a potent exotoxin, tetanospasmin produced by Clostridium tetani. It is a common health problem in developing countries like Ethiopia. The aim of this study was to assess clinical profile and outcome of Pediatrics tetanus in a referral hospital, South Ethiopia. This is a retrospective cross-sectional study of medical records of 24 Pediatric tetanus patients who were admitted from July 2014 to June 2016 to the Pediatrics Department of Hawassa University Comprehensive Specialized Hospital, Hawassa-Ethiopia. Tetanus was diagnosed clinically. Data were entered and analyzed using SPSS statistical software. The median age at diagnosis was 8 years with 19 (79.2%)of the study subjects being males. There were 3 male neonatal tetanus cases with 2 deaths. From post-neonatal cases, only 8(38.1%) were fully vaccinated for infant Expanded Period of Immunization (EPI). Booster vaccination with TT (tetanus toxoid) was only given to 5(29.4%) of discharged patients. Trauma was common in above 5 years of age and documented in 19(79.2%) of patients. All tetanus cases were generalized type with mild, moderate and severe grades comprising 7(29.2%), 8(33.3%), 7(29.2%) and 2(8.3%) respectively. Case fatality rate was 29.2% (7) with more deaths in higher grades. Respiratory failure 6(85.7%), and aspiration pneumonia 1(14.3%) were causes of death. In this study, case fatality rate was high. Hence, health promotion with scale-up of EPI for infant tetanus immunization and large scale studies to provide support for booster vaccination schedules are recommended.

Neonatal Tetanus

Analysis of 108 cases of Neonatal Tetanus by using a scoring system (Tjandra et al., 1974) revealed that 18 patients belonged to Grade I with a mortality rate of 5.6%; 43 belonged to Grade II with a mortality nate of 58.1%; and 47 belonged to Grade III with 91.5% mortality. The differences of mortality between the 3 groups are statistically significant. Mortality rate of 1973 was the lowest (50%) compared to that of 1972 (75%); 1974 (72.2%) and 1975 (61.4%). However, the number of patients belonging to Grade I in 1973 was the highest, 36.4%; whereas that of 1972 was 16.7%; 1974 was 11.1% and 1975 was 9.1 %. Classification of severity in Neonatal Tetanus is therefore, not only important for selecting a "treatment of choice" by comparing mortality rates of those having the same grade of severity, but may be also very useful in determining the method of treatment for different levels of severity.

English

Neonatal tetanus (NNT) is still one of the major preventable causes of neonatal death in Nigeria. It is a disease of poverty, adverse social and environmental conditions. The aim of the study was to review neonatal tetanus cases, determine the prevalence, disease outcome and what possible interventions can be done in the study area to reduce its prevalence. This was a retrospective study of cases of NNT seen in Special Care Baby Unit of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria from 2001 to 2014. Case notes of neonates with clinical diagnosis of tetanus who were admitted into the unit were retrieved for analysis. Data extracted included: socio-demographic characteristics, antenatal clinic (ANC) history, TT immunization, place of delivery and disease outcome. There were a total of 60 cases of NNT during the period; this gave an annual prevalence of 4.3 per year. Mean age of neonates was 9.3 ± 5.1 days, M: F ratio was 4.0:1.0. Mean age of mothers was 23.2 ± 4.0 years, majority (55%) had no formal education, 48% had ≤ 2 ANC visits, and more than 70% had no TT immunization and delivered at home. Commonest probable portal of entry of infection was umbilicus (70%) and major presenting symptoms/signs were: spasms (81.7%), poor suckling (81.7%), inability to open mouth (45%) and fever 45%, respectively. Site of infection and presence of fever were associated poor outcome. Mortality among neonates who had short incubation period (≤ 6 days), umbilicus as probable site of infection (P=0.006) and presence of fever (P=0.014) were significantly higher for non-survivors than survivors. Overall, case fatality rate (CFR) was 56.7%. The review revealed that CFR is still unacceptably high for a disease that can be prevented and eventually eliminated with cost effective and affordable public health interventions. All the 3 tiers of government need to re-focus the National Immunization Policy together with sustained immunization programmes throughout all the communities in Nigeria. There is urgent need for health education at community level on the importance of ANC and mass immunization regardless of age in order to achieve the goal of NNT elimination. Key words: Neonatal tetanus (NNT), immunization, prevention, tertiary hospital, Nigeria.

Epidemiological and clinical aspects of neonatal tetanus from a tertiary care hospital.

Background and objectivesTo study the epidemiology, clinical presentation and outcome of all patients diagnosed with neonatal tetanus and to provide a recommendation for maternal and neonatal tetanus elimination.Design and settingRetrospective study of all cases of neonatal tetanus admitted from 1991 to 2013.Neonatal intensive care unit, King Fahad Central Hospital, Jazan, Saudi Arabia.ResultsThirty patients were diagnosed with neonatal tetanus over 22 years. Eighteen (60%) of the patients were born to Saudi mothers, and 12 (40%) were born to non-Saudi mothers. Twenty-seven (90%) deliveries occurred at home. Most of the mothers lived in the mountainous zone of the region. Two (10%) of the mothers had only a single dose of the tetanus toxoid; the status of the remaining pregnant women was unknown or unimmunized before or during conception. In 18 of the 30 patients (60%), the umbilical cord was severed using household knife, razor blade or plain scissors. Most of the patients presented with muscle spasms (96.7%), refusal to eat and abnormal posture. All of the patients were intubated and receiving mechanical ventilation. Six (20%) of the patients died.ConclusionIt is essential to begin campaigns or integrate complete maternal tetanus toxoid immunization at primary health centers (PHC) during antenatal care. Immunization needs to be arranged so pregnant women can be educated regarding the importance of ANC and the risks of unhygienic home delivery, and immunization should be addressed with adequate information. Pregnant women and those of childbearing age in mountainous areas should be the first targets for these activities.

Adapting Nepal's polio eradication programme.

ProblemMany countries have weak disease surveillance and immunization systems. The elimination of polio creates an opportunity to use staff and assets from the polio eradication programme to control other vaccine-preventable diseases and improve disease surveillance and immunization systems.ApproachIn 2003, the active surveillance system of Nepal’s polio eradication programme began to report on measles and neonatal tetanus cases. Japanese encephalitis and rubella cases were added to the surveillance system in 2004. Staff from the programme aided the development and implementation of government immunization policies, helped launch vaccination campaigns, and trained government staff in reporting practices and vaccine management.Local settingNepal eliminated indigenous polio in 2000, and controlled outbreaks caused by polio importations between 2005 and 2010.Relevant changesIn 2014, the surveillance activities had expanded to 299 sites, with active surveillance for measles, rubella and neonatal tetanus, including weekly visits from 15 surveillance medical officers. Sentinel surveillance for Japanese encephalitis consisted of 132 sites. Since 2002, staff from the eradication programme have helped to introduce six new vaccines and helped to secure funding from Gavi, the Vaccine Alliance. Staff have also assisted in responding to other health events in the country.Lesson learntBy expanding the activities of its polio eradication programme, Nepal has improved its surveillance and immunization systems and increased vaccination coverage of other vaccine-preventable diseases. Continued donor support, a close collaboration with the Expanded Programme on Immunization, and the retention of the polio eradication programme’s skilled workforce were important for this expansion.

The economic value of increasing geospatial access to tetanus toxoid immunization in Mozambique

BackgroundWith tetanus being a leading cause of maternal and neonatal morbidity and mortality in low and middle income countries, ensuring that pregnant women have geographic access to tetanus toxoid (TT) immunization can be important. However, immunization locations in many systems may not be placed to optimize access across the population. Issues of access must be addressed for vaccines such as TT to reach their full potential. MethodsTo assess how TT immunization locations meet population demand in Mozambique, our team developed and utilized SIGMA (Strategic Integrated Geo-temporal Mapping Application) to quantify how many pregnant women are reachable by existing TT immunization locations, how many cannot access these locations, and the potential costs and disease burden of not covering geographically harder-to-reach populations. Sensitivity analyses covered a range of catchment area sizes to include realistic travel distances and to determine the area some locations would need to cover in order for the existing system to reach at least 99% of the target population. ResultsFor 99% of the population to reach health centers, people would be required to travel up to 35km. Limiting this distance to 15km would result in 5450 (3033–7108) annual cases of neonatal tetanus that could be prevented by TT, 144,240 (79,878–192,866) DALYs, and $110,691,979 ($56,180,326–$159,516,629) in treatment costs and productivity losses. A catchment area radius of 5km would lead to 17,841 (9929–23,271) annual cases of neonatal tetanus that could be prevented by TT, resulting in 472,234 (261,517–631,432) DALYs and $362,399,320 ($183,931,229–$522,248,480) in treatment costs and productivity losses. ConclusionTT immunization locations are not geographically accessible by a significant proportion of pregnant women, resulting in substantial healthcare and productivity costs that could potentially be averted by adding or reconfiguring TT immunization locations. The resulting cost savings of covering these harder to reach populations could help pay for establishing additional immunization locations.

Morbidité et mortalité du tétanos des nouveau-nés et des enfants dans les Centres hospitaliers universitaires d’Abidjan, Côte d’Ivoire (2001-2010)

The lack of data on neonatal tetanus and children in university hospitals (UH) in Abidjan for over a decade has motivated the realization of this study. The objective of this study is to evaluate the morbidity and mortality related to neonatal tetanus (NT) and child tetanus (CT) in Abidjan University Hospital from 2001 to 2010. It is a retrospective study, multicenter analysis with records of newborns and children suffering from tetanus in the three UH of Abidjan. The collection and analysis of data were made by the SPHINX 4.5 and EPI.INFO 6.0 software. In ten years, 242 cases of tetanus (53 NT cases and 189 CT cases) were collected with a predominance of cases after the fifth year of life (59.5%). The incidence rate of NT was less than 1 case per 1,000 live births. All mothers of the newborns were inhabiting the city of Abidjan. Their median age was 19 years [16-32] and 64% were teenagers. Gateways were dominated by umbilical wounds (77.3%) in the NTand skin wounds (59%) in CT. The cure rate was 30.2% in the NT and 60% in the CT. Lethality was 60% for NT and 22% for CT with a positive correlation with young age (neonates: p = 4.10-7, age <5 years: p = 0.01), lack of intraspinal injection of tetanus serum (p = 8.10-6), the absence of conventional antibiotic therapy (p = 0.023), the existence of metabolic complications (p = 2.10-5), the score of ≥ 4 Dakar (p = 0.005). Tetanus remains a real morbidly cause among children in Abidjan University Hospital with high lethality. However, the incidence of NT seems consistent with the incidence threshold desired by WHO.

Neonatal tetanus: Case series

Neonatal tetanus occurs in developing countries, particularly those with the least developed health infrastructure. It usually occurs through infection of the unhealed umbilical stump, particularly when the stump is cut with a nonsterile instrument. World Health Organization defines it as an illness in a child who has the normal ability to suck in the first 2 days of life, but who loses the ability between 3 and 28 days of life and becomes rigid and has spasms. The overall incidence of tetanus is reducing globally and is rare in developed nations. We describe four cases of neonatal tetanus with regard to demography, clinical profile, and outcome. From them, 3 newborns were delivered at home by untrained birth attendants. All the mothers were from lower socio-economic class, illiterate and were below 25 years of age. Common symptoms were unable to feed, difficulty in respiration, episodes of spasms, and convulsions. Mortality was 50%.

Neonatal Tetanus, Yet Not Gone: Infectious Disease Hospital Experience

Background: Although neonatal tetanus (NT) has been declared eliminated from Bangladesh in June 2008, it is not uncommon in Infectious Disease Hospital (IDH) in Dhaka. There are various presentations of NT cases and treatment practices also vary.Objective: This study was conducted to describe our experiences with NT at IDH outlining the clinical characteristics, maternal immunization and treatment outcome.Materials and Methods: Thirty neonates admitted with tetanus in IDH from March 2011 to December 2012 were observed prospectively to study risk factors, clinical features and outcomes during hospital stay.Results: Among 30 neonates with tetanus 80% were male. Eighty seven percent of these cases were delivered at home and 83% of mothers did not receive any dose of tetanus toxoid (TT). Fifty percent of the neonates were admitted within 3–5 days of age. Shidur (Vermillion) was applied to the cord stump in 23% neonates. Hot soak was applied to the umbilicus in 5 (17%) neonates. Presenting features were convulsion and/or stiffness or rigidity (93%), inability to suck (90%) and umbilical infection (70%). During hospital care multiple cardiac arrests developed in 86% neonates and apnea developed in 60% of the neonates. Treatment was given in pediatric ward. Case fatality rate was 50%.Conclusion: Risk factors observed in NT cases were maternal non-immunization, unhygienic delivery practices and application of substances in the umbilicus. Antenatal TT administration and universal immunization under school health program should be more emphasized to prevent NT.J Enam Med Col 2015; 5(3): 161-165

Vaccines for women for preventing neonatal tetanus.

Tetanus is an acute, often fatal, disease caused by an exotoxin produced by Clostridium tetani. It occurs in newborn infants born to mothers who do not have sufficient circulating antibodies to protect the infant passively, by transplacental transfer. Prevention may be possible by the vaccination of pregnant or non-pregnant women, or both, with tetanus toxoid, and the provision of clean delivery services. Tetanus toxoid consists of a formaldehyde-treated toxin that stimulates the production of antitoxin. To assess the effectiveness of tetanus toxoid, administered to women of reproductive age or pregnant women, to prevent cases of, and deaths from, neonatal tetanus. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 January 2015), CENTRAL (The Cochrane Library 2015, Issue 1), PubMed (1966 to 28 January 2015), EMBASE (1974 to 28 January 2015) and reference lists of retrieved studies. Randomised or quasi-randomised trials evaluating the effects of tetanus toxoid in pregnant women or women of reproductive age on numbers of neonatal tetanus cases and deaths. Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Two effectiveness trials (9823 infants) and one safety trial (48 mothers) were included. The main outcomes were measured on infants born to a subset of those randomised women who became pregnant during the course of the studies. For our primary outcomes, there was no high-quality evidence according to GRADE assessments.One study (1182 infants) assessed the effectiveness of tetanus toxoid in comparison with influenza vaccine in preventing neonatal tetanus deaths. A single dose did not provide significant protection against neonatal tetanus deaths, (risk ratio (RR) 0.57, 95% confidence interval (CI) 0.26 to 1.24; 494 infants; GRADE: low-quality evidence). However, a two- or three-dose course did provide protection against neonatal deaths, (RR 0.02, 95% CI 0.00 to 0.30; 688 infants; GRADE: moderate-quality evidence). Administration of a two- or three-dose course resulted in significant protection when all causes of death are considered as an outcome (RR 0.31, 95% CI 0.17 to 0.55; 688 infants; GRADE: moderate-quality evidence). No effect was detected on causes of death other than tetanus. Cases of neonatal tetanus after at least one dose of tetanus toxoid were reduced in the tetanus toxoid group, (RR 0.20, 95% CI 0.10 to 0.40; 1182 infants; GRADE: moderate-quality evidence).Another study, involving 8641 children, assessed the effectiveness of tetanus-diphtheria toxoid in comparison with cholera toxoid in preventing neonatal mortality after one or two doses. Neonatal mortality was reduced in the tetanus-diphtheria toxoid group (RR 0.68, 95% CI 0.56 to 0.82). In preventing deaths at four to 14 days, neonatal mortality was reduced again in the tetanus-diphtheria toxoid group (RR 0.38, 95% CI 0.27 to 0.55). The quality of evidence as assessed using GRADE was found to be low.The third small trial assessed that pain at injection site was reported more frequently among pregnant women who received tetanus diphtheria acellular pertussis than placebo (RR 5.68, 95% CI 1.54 to 20.94; GRADE: moderate-quality evidence). Available evidence supports the implementation of immunisation practices on women of reproductive age or pregnant women in communities with similar, or higher, levels of risk of neonatal tetanus, to the two study sites.

Risk factors of neonatal tetanus in Wenzhou, China: a case-control study.

Neonatal tetanus is a major cause of neonatal mortality in many developing countries and remains a major public health problem. This study aimed to determine risk factors associated with neonatal tetanus in Wenzhou, China. Medical records of neonatal tetanus cases from 17 hospitals over a 13-year period (2000-2012) were reviewed for potential risk factors. Controls were selected from neonates with diseases other than tetanus who were admitted to the same facility during the same period. The potential risk factors of the neonatal tetanus group were compared with the control group using univariate analysis and an unconditional logistic regression model. A total of 246 neonates with tetanus and 257 controls were included in this study. Univariate analysis showed that having untrained birth attendants, home delivery, an unsterile method of delivery and being a migrant to Wenzhou were significantly different between the two groups (P<0.001). Logistic regression analysis revealed that the odds of having an untrained birth attendant, home delivery and an unsterile method of delivery were significantly higher in the tetanus group than the control group (odds ratio: 1371.0; 95% confidence interval: 206.0, 9123.5). This study identified that the main risks of neonatal tetanus in cases from Wenzhou were having an untrained birth attendant, home delivery and an unsterile method of delivery. Preventive measures directed to these risk factors may reduce the occurrence of neonatal tetanus in the studied area.

Renal function of post neonatal tetanus cases as seen in University of Port Harcourt Teaching Hospital

Renal function of post neonatal tetanus cases as seen in University of Port Harcourt Teaching Hospital

Incidence and Risk Factors for Neonatal Tetanus in Admissions to Kilifi County Hospital, Kenya

BackgroundNeonatal Tetanus (NT) is a preventable cause of mortality and neurological sequelae that occurs at higher incidence in resource-poor countries, presumably because of low maternal immunisation rates and unhygienic cord care practices. We aimed to determine changes in the incidence of NT, characterize and investigate the associated risk factors and mortality in a prospective cohort study including all admissions over a 15-year period at a County hospital on the Kenyan coast, a region with relatively high historical NT rates within Kenya.MethodsWe assessed all neonatal admissions to Kilifi County Hospital in Kenya (1999–2013) and identified cases of NT (standard clinical case definition) admitted during this time. Poisson regression was used to examine change in incidence of NT using accurate denominator data from an area of active demographic surveillance. Logistic regression was used to investigate the risk factors for NT and factors associated with mortality in NT amongst neonatal admissions. A subset of sera from mothers (n = 61) and neonates (n = 47) were tested for anti-tetanus antibodies.ResultsThere were 191 NT admissions, of whom 187 (98%) were home deliveries. Incidence of NT declined significantly (Incidence Rate Ratio: 0.85 (95% Confidence interval 0.81–0.89), P<0.001) but the case fatality (62%) did not change over the study period (P = 0.536). Younger infant age at admission (P = 0.001) was the only independent predictor of mortality. Compared to neonatal hospital admittee controls, the proportion of home births was higher among the cases. Sera tested for antitetanus antibodies showed most mothers (50/61, 82%) had undetectable levels of antitetanus antibodies, and most (8/9, 89%) mothers with detectable antibodies had a neonate without protective levels.ConclusionsIncidence of NT in Kilifi County has significantly reduced, with reductions following immunisation campaigns. Our results suggest immunisation efforts are effective if sustained and efforts should continue to expand coverage.

Neonatal tetanus in Kano: A ten-year review

Background: Neonatal tetanus (NNT) is one of the childhood's preventable diseases and a leading cause of neonatal death especially in developing countries. It is entirely preventable through effective immunisation of women of child-bearing age, and through simple and basic precautionary measures in child delivery. Objective: This study highlighted the burden of neonatal tetanus in Kano over a period of ten years. Materials and Methods: We retrospectively studied the case notes of neonatal tetanus admitted over a ten-year period (2000-2009). The records of neonates admitted as cases of neonatal tetanus into the special care baby unit of Aminu Kano Teaching Hospital, a tertiary health facility in Kano, northern Nigeria, over a ten-year period were reviewed. Data on age at presentation, local government area from which the neonates presented, antenatal history, maternal immunisation status, clinical feature, complications and the outcome were noted. Results : Majority of the cases (74%) were concentrated in the cosmopolitan areas of Kano. Only 33% of the mothers had antenatal care (ANC) while only 18 (24%) of the mothers received immunisation against tetanus. In all, 76% of the mothers delivered outside the medical facility. The umbilical cord was the route of infection in 52.7% of cases. The case-specific fatality rate was 51.4%. Conclusion: The incidence of NNT is still very high in Kano and this scourge can be tackled through improved quality and accessibility of ANC services and tetanus toxoid (TT) vaccination, provision of skilled attendants at delivery under hygienic conditions and avoidance of harmful traditional practices.

A 6-year review of neonatal tetanus at the Stella Obasanjo Hospital, Benin City, South-South Nigeria

Background: Neonatal tetanus is a lethal disease which has remained an important public health problem in developing countries. The global efforts at eliminating neonatal tetanus have resulted in many nations having less than one case of neonatal tetanus per 1,000 live births per district- a goal that Nigeria is striving to achieve. Objective: To evaluate the contribution of neonatal tetanus to morbidity and mortality in the neonatal unit of Stella Obasanjo Hospital (SOH), Benin City, Nigeria. Methods: A retrospective study in which records of admissions over a six-year period (June 2008 to May 2014) were obtained from the neonatal unit records paying particular attention to cases of tetanus. Information retrieved included age, sex, duration of stay in the unit and outcome. Results: A total of 2,324 patients were admitted into the neonatal unit during the study period. Of these, 23 had tetanus, giving an overall prevalence of 1.0% and an annual incidence of four cases. All the cases were out-born. Nine (39.1%) were males while 14 (60.9%) were females giving a M: F ratio of 1: 1.6. The median and modal age at presentation was seven days (range being 2-21 days). Ten (43.8%) patients were discharged home, four (17.4%) discharged against medical advice while nine died; giving a case fatality rate of 39.1% and contributing 3.1% out of the overall mortality of 286 neonates. Conclusion: Neonatal tetanus contribute significantly to morbidity and mortality. The global efforts for disease elimination should be unrelenting. To be counted among nations that have successfully eliminated the disease, we must pay particular attention to public enlightenment.

Neonatal Tetanus and Gender Disparity

Background: Neonatal tetanus (NNT) is a deadly vaccine preventable disease and one of the most underreported diseases in the developing countries seen in the newborn within the first 28 days of life. NNT remains one of the leading causes of deaths among neonates in the developing countries with about 130,000 neonatal deaths recorded in 2004. Despite the global success recorded in the NNT elimination strategy, Nigeria remains among the 25 remaining countries that record NNT cases. Study Design: Retrospective study Methods: This quantitative cross-sectional study involved mothers who gave birth to children with NNT within their first 28 days of life. The study used secondary data collected between January 2008 and December 2013 from northeast region of Nigeria. Results: The results revealed that 58% had male children (n =182) and the remaining 42% had female children (n = 130). The predominance of the male neonates could partly be as a result of the socio-cultural preference given to the male child in Nigerian. Conclusion: There is the need for parents to promptly seek urgent medical attention for all suspected NNT cases irrespective of the gender of the child to reduce neonatal mortality rates.

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

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.

Prognosis of neonatal tetanus in the modern management era: an observational study in 107 Vietnamese infants

Most data regarding the prognosis in neonatal tetanus originate from regions where limited resources have historically impeded management. It is not known whether recent improvements in critical care facilities in many low- and middle-income countries have affected indicators of a poor prognosis in neonatal tetanus. We aimed to determine the factors associated with worse outcomes in a Vietnamese hospital with neonatal intensive care facilities. Data were collected from 107 cases of neonatal tetanus. Clinical features on admission were analyzed against mortality and a combined endpoint of 'death or prolonged hospital stay'. Multivariable analysis showed that only younger age (odds ratio (OR) for mortality 0.69, 95% confidence interval (CI) 0.48-0.98) and lower weight (OR for mortality 0.06, 95% CI 0.01-0.54) were significantly associated with both the combined endpoint and death. A shorter period of onset (OR 0.94, 95% CI 0.88-0.99), raised white cell count (OR 1.17, 95% CI 1.02-1.35), and time between first symptom and admission (OR 3.77, 95% CI 1.14-12.51) were also indicators of mortality. Risk factors for a poor outcome in neonatal tetanus in a setting with critical care facilities include younger age, lower weight, delay in admission, and leukocytosis.

Neonatal Tetanus in Federal Medical Center, Ido-Ekiti, South West Nigeria in a five year Retrospective Study

Introduction: Neonatal Tetanus, though a preventable disease through simple measures, still remains a cause of neonatal mortality in Nigeria. Methodology: This was a review of all cases of neonatal tetanus in Federal Medical Centre, Ido- Ekiti between January 2007 and December 2012. It was performed using patients’ case notes and the diagnosis of tetanus was clinical in all cases. Results: There were six patients admitted during the five- year period. The mean age was 7.7 days. There were 5 females (83.3%) and 1 male (16.7%). The average number of days spent on admission in the hospital was 15.2 days with the minimum being 1 day and the maximum 33 days. The mean age at which the first spasm occurred was at 7.5 days. Only 1 (16.7%) was delivered in a health facility, 67.7% had fomentation done on their umbilical cords, 33.3% had septic umbilical cords only 1 (16.7%) was delivered in a health facility. Three of the patients were delivered in religious centres called mission homes. Five (83.3%) of the mothers were teenagers and unmarried, 2 (33.3%) had partial antenatal care, 4 (67.7%) had no antenatal care while none of them received up to 2 doses of tetanus toxoid vaccine. The case fatality rate was 50%. Conclusion: Teenage motherhood, poor antenatal care, inadequate immunization of mothers with tetanus toxoid vaccine and poor umbilical cord care are identified as risk factors for neonatal tetanus. It should be ensured that gender equality campaigns are strengthened, traditional birth attendants trained in issues of maternal and child health, and immunization campaigns for mothers and neonates improved.