Post-neonatal Tetanus Research Articles

Delayed presentation and management approach of autonomic dysfunction associated with severe tetanus

Introduction: In 2019, there were over 73 000 estimated tetanus cases globally, including more than 27 000 cases of neonatal tetanus, and the worldwide deaths caused by tetanus were almost 34 684. The mortality rate of tetanus is greater than 50% in countries without ICUs and 10% in developed countries, mostly attributed to autonomic dysfunction. Countries with the greatest rates of post-neonatal tetanus mortality (greater than five fatalities per 100 000 people) were Somalia, South Sudan, and Kenya. Case presentation: A 66-year-old unvaccinated male patient came to our hospital emergency department with generalized rigidity, neck stiffness, lockjaw, and an altered level of consciousness for 5 days. His symptoms started with stiffness in his neck and back 4 days before. The patient was diagnosed with tetanus, as he was unimmunized, had a recent injury, and presented clinical findings. The authors started treatment by administering intramuscular human tetanus immunoglobulin and metronidazole. He was admitted to the ICU and placed in an isolation room with minimal auditory and visual stimuli. Following 2 weeks after admission his blood pressure began to fall, and his pulse rate started to fluctuate with alternating tachycardia and bradycardia. After 1 month in the ICU, he was discharged from the ICU and transferred to the ward. A catch-up immunization regimen was established. Clinical discussion: Tetanus is a rare condition in the Western world, primarily due to widespread vaccination programs from infancy to adulthood. There are crucial barriers that still exist to overcoming this disease in our country, including a lack of reliable immunization programs. In tetanus, the increase in survival is associated with the use of intensive care facilities for the management of tetanus, besides expanding the knowledge of the disease, which is a challenge for developing countries. Conclusion: It is essential to have enough immunization at an early stage of trauma since severe autonomic dysfunction linked to tetanus might be lethal.

Post Neonatal Tetanus as Seen in Rivers State University Teaching Hospital, Nigeria: Prevalence, Clinical Profile and Outcome

Background: Post neonatal tetanus, a vaccine preventable disease is a cause of childhood morbidity and mortality in many developing countries including Nigeria. This study was carried out to determine the prevalence, clinical profile and outcome of children with post-neonatal tetanus.
 Methods: This prospective observational study carried out over 3years in the Paediatric ward of the Rivers State University Teaching Hospital, was among children older than 28days and up to 16years.
 Result: Of 966 children admitted during the period of study, 12 had post-neonatal tetanus giving a prevalence of 1.2%. Six (50%) were > 10years old with a M:F ratio of 5:1, 5(41.7%) resided in rural areas and all (100%) were of low socioeconomic status. Six (50%) did not receive tetanus toxoid vaccine and no child had booster doses. Portal of entry for the infection was majorly via injuries on their limbs, 7(58.3%). The mean incubation period was 10.58±7.39 days while the mean onset interval was 31.58±27.85 hours. Three (25%) children had severe tetanus using Ablett’s classification with spasm 11(91.7%) documented as the commonest symptom. Half, 6(50%) of the children had autonomic complications and an overall case fatality rate of 25%.
 Conclusion: The prevalence of post-neonatal tetanus in the Rivers State University Teaching Hospital was low being 1.2%, although unacceptable. The mortality rate of post-neonatal tetanus of 25% was high. Thus, there is a need to strengthen existing immunization program and immediately adopt the commencement of booster doses of tetanus toxoid vaccines for eligible children in Nigeria.

Neonatal and postneonatal tetanus at a referral hospital in Kamsar, Guinea: a retrospective audit of paediatric records (2014-2018).

BackgroundTetanus is a vaccine-preventable disease caused by the bacterium Clostridium tetani. In 2018, all of Guinea was considered to be at risk of the disease and the country is currently in the elimination phase.MethodsA 5-y audit (1 January 2014–31 December 2018) of all admissions to the neonatal and general paediatric units of Kamsar Hospital (Western Guinea) was undertaken to identify cases of neonatal tetanus (NNT) and postneonatal tetanus (PNNT).ResultsThere were 5670 admissions during the study period, of which 39 (0.7%) were due to tetanus (22 NNT and 17 PNNT). Among NNT patients, the bacterial entry site was the umbilical cord (n=20) or wound following circumcision (n=2). For PNNT, the entry site was surface wound (n=12), limb fracture (n=1) or could not be established (n=4). A majority of the patients (36/39, 92.3%) were born to unvaccinated mothers or those who received suboptimal vaccination during pregnancy. Overall, 21 (53.8%) children died within 7 d of admission with a higher mortality observed among neonates (16/22, 72.7%) compared with postneonates (5/17, 29.4%).ConclusionsTetanus was a rare cause of admission at Kamsar Hospital with a very high case fatality rate. The disease primarily occurred among children born to mothers who were unvaccinated/inadequately vaccinated during pregnancy.

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

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.

Non-accidental broom sticks injury as a cause of post-neonatal tetanus.

IntroductionNon accidental injury sustained following deliberate self-harm or inflicted by parents or caregivers for disciplinary, traditional and therapeutic measures have grave consequences including exposing the incompletely child to post neonatal tetanus. This contributes to the continuing high incidence of post neonatal tetanus in developing countries.MethodsA 12 year retrospective review of all children admitted into the children’s ward of the University of Calabar Teaching Hospital with diagnosis of post neonatal tetanus was carried out. The demographic characteristics of the children were documented. Immunization status, possible portal of entry and outcome status were also recorded. Data obtained was analysed using SPSS version 22.ResultsThere was a male preponderance of 70.5% amongst the 44 children with post neonatal tetanus. Non-accidental injuries accounted for 20(45.5%). Broom stick injury sustained during corporal punishment was responsible for 60% of tetanus from the non-accidental injury group. Low socio economic class and Inadequate or no immunizations are major risk factors for tetanus infection.ConclusionNon accidental injuries inflicted on children as disciplinary measures accounted for about half of children with post neonatal tetanus. Broom stick injury was a major contributory factor. Lack of immunization and low social class remains major risk factors for post neonatal tetanus. Post neonatal tetanus presents another reason for sustained campaign against physical abuse of children.

The Prevalence and Case-Fatality Rates of Post-Neonatal Tetanus in a Population of Hospitalized Nigerian Children: An 8-Year Retrospective Review.

Although tetanus is a vaccine-preventable disease, reports indicate that it remains a significant cause of morbidity and mortality in both neonatal and post-neonatal periods especially in most developing countries. This study aimed to determine the prevalence and case fatality rates of post-neonatal tetanus among children managed at the Federal Medical Centre Asaba, Delta State, Nigeria over 8 years. The study was a retrospective review of the records of the children above 1 month of age admitted into Federal Medical Centre, Asaba, with a clinical diagnosis of tetanus from January 2008 to May 2016. Data analysis was conducted on descriptive and inferential statistics using Statistical Package for Social Sciences version 22.0. Mean, standard deviation and other relevant parameters were calculated. Level of significance was set at p < 0.05. During the study period, 32 out of 3693 admitted Paediatric patients had post-neonatal tetanus: giving a prevalence rate of 0.9%. The male:female ratio was 1.9:1 and patients' ages ranged from 2 to 15 years with a mean age 8.9 ± 3.1 years. Twenty-nine percent of them had complete immunization during infancy, but none had booster doses. Also, 60.9% of them presented with lower limb injuries as the portal of entry. Over 17.4% of the patients had very severe tetanus. Of the 32 patients studied, 62.5% resided in the neighbouring rural communities, while 50.0% were admitted for ≤10 days. The calculated case fatality rate was 50%. The prevalence and case fatality rates of post-neonatal tetanus are still relatively high in this clime. Given the prevalent nature of the disease in children aged 5 years and above, there is a need to include the booster doses of tetanus toxoid in the country's National Programme on Immunization schedule.

A 6-year review of Post-Neonatal Tetanus at Usmanu Danfodiyo University Teaching Hospital, Sokoto

A 6-year review of Post-Neonatal Tetanus at Usmanu Danfodiyo University Teaching Hospital, Sokoto

Demographic survey and management outcome of Post-Neonatal Tetanus at the Ekiti state university teaching hospital, Ado Ekiti

Demographic survey and management outcome of Post-Neonatal Tetanus at the Ekiti state university teaching hospital, Ado Ekiti

Prognostic factors and outcome of Post-Neonatal Tetanus in an intensive care unit of a Tertiary Care Hospital.

Objective:To determine the prognostic factors and outcome of tetanus in children of post-neonatal age admitted in the intensive care unit (ICU) of a tertiary care hospital.Methods:This prospective cross sectional study, carried out in the Pediatric ICU of The Children’s Hospital Lahore from Jan 2013 to March 2017. Children of both genders with age range of two months to 16 years diagnosed clinically as tetanus were included. All 132 patients were scrutinized for all possible risk factors, need for mechanical ventilation and outcome. Data was analyzed by SPSS version 20.Results:Mean age of children was 7.5±3.4 years with male predominance (70.5%). Only (38.6%) received three doses of vaccination but none had booster dose. Trauma (43.2%) encompassed maximum predisposing factor followed by ear or nose prick and ear discharge. Mean duration of ICU stay was 20±13.3 days. Mortality rate was (17.4%). Ventilator support was given to (78.8%). Neurological outcome was normal in (82.6%). Trauma, ear or nose prick in girls and ear discharge were significantly associated with poor outcome and death with p-value of <0.001, 0.011 and <0.001 respectively. Other factors associated with poor outcome were need for mechanical ventilation and neurological impairment with p-value of 0.001 and <0.001 respectively.Conclusion:Tetanus is causing our children to suffer from devastating disease. Vaccination status is not satisfactory and along with trauma, ear discharge and ear or nose prick are identifiable risk factors. To combat these issues large scale vaccination and booster doses remains promising option.

How common is post-neonatal tetanus in Rasheed Shekoni Specialist Hospital, Jigawa, North Western Nigeria?

Background: Tetanus, caused by Clostridium tetani neurotoxin, is still an important cause of morbidity and mortality in children in developing countries. Children usually present with trismus followed by spasms of skeletal muscles. Tetanus infection can easily be prevented through immunization. However, despite provision of routine immunization schedule by government-based hospital at all levels of care, there is still poor immunization uptake which in association with dangerous traditional practices in the area leads to high burden of the disease. Materials and Methods: This was a retrospective hospital-based study. It was conducted at the Department of Paediatric of Rasheed Shekoni Specialist Hospital, Dutse, Nigeria. Medical records of all children between the ages of 1 month and 13 years, who were admitted between May 2014 and April 2017, with a diagnosis of tetanus were retrieved and analyzed. Diagnosis of tetanus is clinical based on the presence of trismus and spasms. Information obtained included biodata, immunization status, onset and duration of symptoms, length of hospitalization, and outcome. Results: Children admitted with tetanus in the period of study were 25, but only 20 qualified for analysis. The prevalence of tetanus was 1.03%. Twelve (60%) were in the 5–9 years age group. Majority (75%) were males, from rural areas (75%), and did not receive any immunization (65%). Circumcision was the portal of entry in 30%. All had generalized tetanus, and mortality rate was 25%. Conclusion: There is need to strengthen routine immunization and introduce booster immunization into the area to prevent post-neonatal tetanus.

Tetanus Toxin Antibody Levels in Pre-School Nigerian Children after Three Doses of Diphtheria-Pertussis-Tetanus/Pentavalent Immunization: A Cross-Sectional Study

Background: Post-neonatal tetanus is an important problem. Prevention of tetanus in Nigeria is via immunization with three doses of Diphtheria-Pertussis-Tetanus (DPT)/Pentavalent vaccine at 6, 10 and 14 weeks. The anti-tetanus antibody levels of these children are not known after they had received DPT3/Pentavalent vaccines. Aim: This work was to determine the anti-tetanus antibody (IgG) response in Nigerian children aged six months to five years who had received three doses of DPT vaccine in early infancy. Methods: Children aged six months to five years who were attended to in the University of Calabar Teaching Hospital for acute illnesses were recruited. Their anti-tetanus IgG levels were measured using Enzyme Linked Immunosorbent Assay (ELISA). The optimal cut-off level of ≥0.1 IU/ml was used as the protective level. Data was analysed using the Statistical Package for Social Sciences (SPSS) version 20.0 with simple proportions and percentages. Students’ “t” test and ANOVA were used to compare quantitative variables while Chi-square and Fisher’s exact test were used to compare categorical data. Results: Four hundred and eighteen children participated in the study. The mean IgG antibody level was 1.021 ± 0.9 IU/ml. Four hundred children (95.7%) had protective levels of antibodies. The highest proportion of subjects with protective levels was in infants, 6 - 11 months (99%) and lowest in children aged 36 - 47 months (92.2%). Conclusion: The proportion of children with protective levels was above 90% in all age groups studied. The current national immunization schedule is adequate. Further studies in older age groups are needful.

Post-Neonatal tetanus from broomstick injuries: a word of caution for caregivers

Tetanus is a vaccine-preventable disease that is acquired through exposure to the spores of the bacterium Clostridium tetani which are ubiquitous in the soil. Post-neonatal tetanus is an increasing problem in developing countries, including Nigeria. This is mainly as a result of inadequate immunization coverage, unsustainable immunization programmes, and non-administration of booster doses of tetanus toxoid at appropriate periods to eligible children. The spores of the bacterium can get into the body through broken skin, commonly through injuries from contaminated objects. There have also been reports of broomstick injury as the portal of entry. Indeed, it has been reported to be the commonest portal of entry in a center in Nigeria. This is important because flogging (of children) with brooms is common in parts of Nigeria, despite it being forbidden in several cultures in the country. Two cases of post-neonatal tetanus arising from broomstick injuries in Uyo, Nigeria, are herein reported, to illustrate the inherent dangers and implications of broomstick injuries in children. It is hoped that advocacy campaigns will be conducted at different public health fora to raise awareness of the general population concerning post-neonatal tetanus from broomstick injuries. Furthermore, there is urgent need to institutionalize the administration of booster doses of tetanus toxoid at primary and secondary school entry.

Post-neonatal Tetanus in a PICU of a Developing Economy: Intensive Care Needs, Outcome and Predictors of Mortality.

To evaluate pediatric intensive care unit (PICU) needs, outcome and predictors of mortality in post-neonatal tetanus. Review of 30 consecutive post-neonatal tetanus cases aged 1 months to 12 years admitted to a PICU in north India over a period of 10 years (January 2006 to December 2015). Chronic suppurative otitis media was the commonest portal of entry. All received tetanus toxoid, human tetanus immunoglobulin (HTIG) and appropriate antibiotics; 7 (23.3%) received intrathecal HTIG. Common complications were respiratory failure, rhabdomyolysis, autonomic dysfunction, acute kidney injury and healthcare-associated infections. PICU needs were as follows: ventilation; benzodiazepine, morphine and magnesium sulfate infusion; neuromuscular blockers, inotropes, tracheostomy and renal replacement therapy. Mortality rate was 40%; severity Grade IIIb, autonomic dysfunction, use of vasoactive drugs and those who did not receive intrathecal HTIG were significantly associated with mortality. Post-neonatal tetanus is associated with high mortality, and PICU needs include management of spasms, autonomic dysfunction and complications and cardiorespiratory support.

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

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.

Profile and outcome of patients with post-neonatal tetanus in a tertiary centre in south west Nigeria: any remarkable reduction in the scourge?

IntroductionThe incidence of tetanus has remained unacceptably high in developing countries. We aimed to describe the profile and outcome of children with tetanus admitted at the Lagos State University Teaching Hospital (LASUTH), Ikeja.MethodsA prospective and cross-sectional study of children aged 1 month to 12 years of age admitted with clinical diagnosis of tetanus, between January 2011 and December 2013, at the Paediatric department of LASUTH. The age, sex, presenting complaint, immunization status, portal of entry, socio-economic class, complications, duration of admission and outcome of the subjects were analyzed using Microsoft Excel supplemented with Statistical Package for Social Sciences (SPSS) version 17.0. Level of significance set at p< 0.05.ResultsA total of 49 subject participated in the study. Male: Female ratio was 1.7: 1.0. mean age ± SD of 6.5± 3.2 years. Only 24.5% of the subjects were fully immunized, lower limb injury was the most common portal of entry (34.7%). Majority (79.6) were of the middle and lower social classes. Most of the subjects (67.3%) presented with generalised spasm. Only 1 patient (2.0%) did not have trismus. Case fatality rate was 4.1%.ConclusionTetanus is still prevalent among children in our environment. It is commoner among those with no immunization or incomplete immunization, commoner in those in the middle and lower social class. Lower limb injury was the most common portal of entry. Trismus was a common presenting feature. There is a need to develop programmes with will help improve compliance to immunization.

The Socio-Economic Challenges in Post Neonatal Tetanus

Background: Tetanus has remained a major public health problem worldwide although it is a vaccine preventable disease. It is a major contributor to under-five morbidity and mortality globally. Its effect is worse in developing countries such as Nigeria. Aims and Objectives: To highlight the socio-economic challenges in the management of Post neonatal tetanus at the University of Port Harcourt Teaching Hospital, Nigeria. Study Design: A Retrospective Descriptive study. Place of Study: University of Port Harcourt Teaching Hospital. Methods: Report of the socio-economic challenges in the management of three consecutive cases of Post neonatal tetanus at the University of Port Harcourt Teaching Hospital from February to April 2015 was studied. Data on socio-economic variables were retrieved from case notes of the patients. Results: These were three patients, two females and a male. Their ages were 11 years old of the two females and 14 years old of the male. None was immunized with tetanus toxoid in infancy. All three children survived. They were all from low socio-economic class, two mothers were petty traders while one was unemployed, only one mother had complete secondary education. One mother was immunized in pregnancy, while one mother was married. Conclusions: The socio-economic challenges of tetanus are immense, but could be prevented by simple measures such as education of the girl child, immunization of all school children, raising community awareness among other measures, and strengthening the school health program.

Epidemiological trends of tetanus from East Delhi, India: A hospital-based study

To study the demographic profile, prognostic indicators, and mortality of tetanus patients and treatment outcomes following intramuscular anti-tetanus immunoglobulin (ATG) alone or combined intrathecal and intramuscular ATG. Retrospective study. Inpatients from a tertiary care hospital. One hundred children under 12 years of age diagnosed with tetanus and admitted from January 2003 to December 2007 were included in the study. Case records of patients with neonatal tetanus (n=30) and post-neonatal tetanus (n=70) were evaluated retrospectively. The diagnosis of tetanus was based on World Health Organization (WHO) criteria. The outcomes of patients treated with either intramuscular ATG or both intrathecal and intramuscular ATG were separately compared in the neonatal and post-neonatal groups. Our study revealed difficulty in feeding, trismus, spasms, rigidity, and opisthotonus posturing as the predominant clinical manifestations. The survival rate for children receiving tetanus immunoglobulin by the dual route was significantly higher than for children receiving the immunoglobulin via the intramuscular route. Seizures and tremors were poor prognostic factors associated with tetanus.

Prevalence and predictors of hypoxaemia in respiratory and non-respiratory primary diagnoses among emergently ill children at a tertiary hospital in south western Nigeria

Hypoxaemia is a potentially harmful complication of both acute lower respiratory tract infections (ALRI) and non-ALRI in children but its contribution to burden and outcomes of hospital admissions in Africa is unclear. We investigated prevalence and predictors of hypoxaemia in ALRI and non-ALRI according to age and primary diagnoses in emergently ill children in south western Nigeria. In 1726 emergently ill children admitted to a tertiary hospital in Ibadan, south western Nigeria, oxygen saturation was measured shortly after admission. Hypoxaemia was defined as oxygen saturation <90%. Clinical features and the primary admission diagnoses were recorded. Prevalence of hypoxaemia according to age and diagnoses was calculated. Symptoms and signs associated with hypoxaemia were compared between children with ALRI and those with non-ALRI. Hypoxaemia was detected in 28.6% (494/1726) of admissions. Prevalence of hypoxaemia varied in different conditions: it was 49.2% (154/313) in ALRI, 41.1% (188/454) in neonates, 27.2% (6/22) in post-neonatal tetanus, 23.3% (14/60) in sickle cell anaemia, 22.6% (38/168) in septicaemia and 14.4% (76/527) of malaria cases. Nasal flaring (OR 3.86; 95% CI 1.70 to 8.74) and chest retraction (OR 4.77; 95% CI 1.91 to 11.92) predicted hypoxaemia in ALRI but not in non-ALRI. Hypoxaemia is common among Nigerian children admitted to an emergency unit and is associated with a poor outcome irrespective of primary admission diagnosis. Provision of equipment to measure oxygen saturation and facilities for effective oxygen delivery might substantially reduce mortality.

Post-neonatal tetanus in University of Maiduguri Teaching Hospital, North-eastern Nigeria

Background: Tetanus is a public health problem in Nigeria. This study examines the demographic and clinical profile of postneonatal tetanus (PNT) seen in University of Maiduguri Teaching Hospital (UMTH), North- eastern Nigeria.Methods: This is a hospital-based prospective study of PNT. All childrenbeyond the neonatal period to 14 years of age admitted into the Paediatrics unit of UMTH, Maiduguri from June 2009 to July2011 with the diagnosis of PNT were studied.Results: A total of 39 cases of PNT were admitted over the period underreview. The male: female ratio was 2.3:1.0. Their ages at presentationranged between 16 months and 14 years, with mean +SD of 6.9+3.87 years. Over 90 percent of the children were either not immunizedagainst tetanus or their immunization status was unknown and onlytwo of the children were fully immunized. No booster immunizationwas received by any of the eligible children. The portal of entry of the infection was injury to the lower limbs and otogenic route in 53.9% and 33.3% respectively. Majority of patients were of low socioeconomicstatus. The duration of hospital stay ranged between 1-50 days with mean + SD (18.68+ 11.51).The mortality rate was (7)18 %.Conclusion: Tetanus still remains a major cause of childhood morbidityand mortality in Nigeria. Severe disease and the first one week of admission are the main variables identified to influence outcome.Therefore, there is need to strengthen routine immunization and booster doses of tetanus toxoid (TT) should be mandatory at primary and secondary school entry. Close monitoring of patients with severe tetanus during the critical period is imperative for successful management.