Review of Tetanus Admissions to a Rural Ugandan Hospital

Tetanus, which can be eliminated through an effective immunization programme, remains a significant cause of morbidity and mortality in Uganda with a high case fatality rate. This study was carried out in St Francis Hospital Buluba (SFHB) after observing that the hospital was registering an abnormally high number of tetanus patients. Its aim was to retrospectively establish the socio-demographic characteristics of the patients and determine the case-fatality rate among tetanus patients admitted between 20052008. Records of all patients registered and treated for tetanus up to the time of death or discharge on the Medical and Pediatric wards were evaluated. Case notes of 71 patients were retrieved and analyzed for clinical characteristics. During the three-year period under study, 163 patients (0.65% of all admissions) were managed for tetanus. Analysis was done for only 154 (94.5%) patients because records of the others lacked basic data. The majority of the patients (67%) were males and most were young (81% were below 13 years of age). Forty two percent (42%) came from areas outside Mayuge district. The registered case-fatality rate was 47%, with mortality being highest in the extremes of age. This paper recommends scaling up and sustaining immunization service to the whole population. Presentation of an immunization certificate should be made compulsory for all children joining school at all levels. Finally, programmes that help the population to access booster doses later in life should also be implemented. Introduction Though an effective tetanus vaccine has been available since 1923, tetanus remains a major cause of mortality in developing countries. In 2000, World Health Organisation (WHO) reported that tetanus infection was still widespread worldwide though accurate information about the disease, especially in the developing world, was very scanty (WHO, 2001). The incidence of tetanus in the developed world is markedly low and this has been attributed to an effective immunisation programme (Thwaites et al, 2003). Currently in Uganda, the percentage of children below 1 year receiving 3 doses of DPT/ Pentavalent vaccine according to schedule averages 90% (MoH Uganda, 2009). This may be much lower in the rural countryside where the systems needed to support a comprehensive immunisation programme may be lacking. Also, programmes that may help the population access booster doses have been designed to specifically target females in the reproductive age group leaving the males out (MOH Uganda, 2002). In countries like Uganda where manual agriculture is the key socio-economic activity, the majority of the population is prone to cuts and wounds in body extremities which predispose them to infection, including tetanus. Proper wound care after injury and awareness about the likelihood of tetanus infection are low and not guaranteed, making the chance of getting tetanus infection high. Unfortunately, though tetanus is a disease of the developing countries, it requires very good facilities for its management so as to improve survival, which are often not available. In developing countries, mortality from tetanus averages above 50% whereas in the developed world where intensive care services (ICU) are available, only a mortality rate of up to 10% is deemed acceptable (George et al, 2005). This study was conducted to determine the mortality rate from tetanus at a rural hospital with no ICU services. REVIEW OF TETANUS ADMISSIONS TO A RURAL UGANDAN HOSPITAL: 7(3) 199-202 UMU Press 2009