Predictors of mortality among adult tetanus patients in Northwestern Nigeria

Background & Objective: Tetanus remains an important health problem in Kano, Northwestern Nigeria. It is associated with a high mortality rate, it is therefore necessary to identify predictors of mortality with the view to reducing the mortality rate. Methods: Demographic and clinical data of all adult tetanus patients managed at Aminu Kano Teaching Hospital and Murtala Muhammad Specialist Hospital between Jan 2004 to Dec 2009 were collected and analyzed. Results: A total of 146 patients were identifi ed during the study period, out of which complete information was obtained in 126 patients. All the patients had generalized tetanus. There were 93 (73.8%) males and 33 (26.2%) females. Their age ranged between 17 and 62 with mean age of 35.2. Two fi fth (39%) of the patients were in the age group of 21 – 30 years. The risk factors of high mortality were: age >40 years, incubation period <48 hours, onset <48 hours, absence of previous tetanus immunization, evidence of autonomic dysfunction, and severity. Mortality was not related to fever and gender. Binary logistic model revealed that severity of tetanus at presentation was the most signifi cant (p= 0.029) prognostic factor to mortality. Conclusion: The mortality rate of adult tetanus in Northwestern Nigeria is high. Several risk factors for high mortality have been identifi ed. Neurology Asia 2011; 16(3) : 199 – 203 Address correspondence to: Dr Owolabi Lukman Femi, Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria. PMB 3452 Kano, Nigeria, E mail: [email protected] INTRODUCTION The World Health Organization has reported that tetanus is seen in one million people per year, and that more than 715,000 per year die from tetanus or its complications. While incidence of tetanus and mortality from tetanus in the developed countries is on the downward trend, it remains a major cause of mortality in developing countries like Nigeria, in spite of the availability of cheap and effective vaccines. Tetanus remains an important health problem in Nigeria possibly because of the large number of traffi c and work accidents, extensive agricultural activity, and abortion and ⁄ or delivery under non-hygienic conditions in addition to low vaccination rate. Moreover, adult tetanus is not uncommon in Nigeria because injured adults do not usually go to heath facilities for tetanus prophylaxis. Published data reports of mortality, mostly from the health facilities in the Southern and Eastern part of Nigeria, ranged between 26% and 60%. The facilities available to manage severe tetanus have a major impact on the therapeutic options and mortality. In the United Kingdom intensive care costs USD1,500–2,500/patient/ day; such costs are clearly beyond the means of average patients in most of the regions of the world where tetanus is a major problem. Without facilities to artifi cially ventilate patients, airways obstruction, respiratory failure, and renal failure are the major contributory factors to poor outcome. Availability of artifi cial ventilation should prevent most deaths caused directly by acute respiratory failure even in very severe cases. Tetanus is still common among residents of Kano; it is the sixth most common cause of neurologic admissions at Aminu Kano Teaching Hospital (AKTH) and one of the most common cause of medical admission in Murtala Muhammad Specialist Hospital (MMSH). MMSH and AKTH are the two tertiary centres in Kano which is the most populous state in Nigeria. The two centres have a wide coverage area including the neighboring states in the Northwestern Nigeria. In addition to limited availability of intensive care facilities, mortality from tetanus can be infl uenced by a patient’s age, the incubation time, type of injury, clinical signs, and delays in treatment or prophylaxis. It is against this background that this study was designed to determine common predictive factors of deaths Neurology Asia September 2011 200 from tetanus among adults in Northwestern Nigeria.