Patterns of presentation and mortality in tetanus: a 10-year retrospective review.

Background: Tetanus, an ubiquitous disease still ravages our population despite the fact that it is totally preventable. The mortality had remained high with its attendant socio-economic implications as it affects mainly farmers in their prime of life. We conducted this retrospective review to be able to determine pattern of presentation, case fatality rate and factors influencing mortality with a view to mapping out control strategies.

Patients, Materials And Methods: The case records of all managed patients aged 16 and above over a ten-year period (1992-2001) were retrieved and socio-demographic and clinical data as well as results of laboratory investigations were collated. Analysis was done using SPSS package. Chi-square analysis and student t-test were used for comparison of means as appropriate. P-values of <0.05 were taken as significant.

Results: There were a total of 114 patients managed during the period, which comprised 85 males and 29 females. The mean age (+/- SD) was 35.96 years (+/- 17.76). Sixty-six (57.89% ) patients are either jobless or farmers. Majority of the patients had injuries in the lower limb (59.65% ) when compared with 20.18% that had theirs in the upper limb. 107 (93.86% ) of the patients presented with trismus while only 82 (71.93% ) had opsthotomus. Only 51 (44.73% ) patients survived while 61(53.5% ) died. The mean age (+/- SD) of the survivors was 32.35 (+ 14.45) years while that of those that died was 39.4 (+/- 19.89) years (P = 0.036). Other factors that significantly influenced survival included severity of spasms (P = 0.003), tachycardia (P = 0.044), and degree of sedation (P<0.0001). No association was found between survival and incubation period, period of onset, site of injury and associated medical conditions.

Conclusions: Tetanus is still associated with high mortality rate. Factors such as severity of spasms, age, sedation and tachycardia were found to significantly influence mortality. It is recommended that prophylactic life immunisation against tetanus be given to all Nigerians.