Factors associated with mortality in patients with tetanus in Cameroon

Abstract

Background Tetanus constitutes a significant cause of death in sub-Saharan Africa, with case fatality rates as high as 64%, 47%, and 43.1% reported in Nigeria, Uganda, and Tanzania, respectively. However, the knowledge gap on factors that influence tetanus mortality still exists in Cameroon. Objective To identify the factors that influence the mortality of tetanus patients in three regional hospitals in the North West and South West Regions of Cameroon. Methodology This was a 7-year retrospective case-series study. Socio-demographic and clinical data of tetanus cases admitted in Bamenda, Buea, and Limbe Regional Hospitals from January 2010 to March 2017 were collected and analysed. Results This study recorded 38 cases, but excluded five due to missing inpatient files. Of the 33 cases considered in this study, 27 (81.8%) were males. The mean age of the patients was 32 years. A tetanus mortality rate of 48.5% was recorded – thus, 16 tetanus-related deaths. Mortality was higher amongst patients with incubation periods less than 7 days; the onset of trismus and generalized spasms less than 8 days after exposure; the presence of autonomic dysfunction; the presence of respiratory dysfunction; application or introduction of local regimens, soil or animal waste at the portal of entry; delayed debridement greater than 2 days after onset of tetanus; and a severe clinical disease state. Conclusion This study, therefore, highlights the need to ensure universal vaccination coverage for high-risk populations; males, active population (20–40 years), and farmers. More still, this study emphasizes the need to improve access and utilisation of mechanical ventilation in severe tetanus cases.

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

“…Tetanus is an infectious disease caused by a toxin produced by the anaerobic bacteria Clostridium tetani, which, under favourable conditions, produces a toxin called tetanospasmin affecting the brain stem and spinal cord. Clostridium tetani belongs to the clostridia genus [3,8] . The autonomic dysfunction was defined as the presence of labile or persistent hypertension ( > 140/90 mmHg) or hypotension (< 90/60 mmHg) and persistent sinus tachycardia (heart rate > 100 bpm), tachyarrhythmia or bradycardia (heart rate <50 bpm) alternating with tachycardia on electrocardiograph (ECG) [9] .…”

“…The advanced program of vaccination against tetanus allowed massive progress in controlling the disease with an 89% reduction in tetanus cases and deaths since 1990 [5] . The mortality rate of tetanus is usually high in sub-Saharan countries due to a lack of standard ICU to manage tetanus complications such as airway obstruction [3] .…”

“…Tetanus is rare in the developed world, although it is associated with high case mortality worldwide, especially in regions where vaccination coverage is incomplete [1,2] . The mortality rate of tetanus is high in sub-Saharan African countries: reports have shown a mortality rate of 64% in Nigeria, 47% in Uganda, 43.1% in Tanzania [3] . Countries with the greatest rates of post-neonatal tetanus mortality (greater than five fatalities per 100 000 people) were Somalia, South Sudan, and Kenya [4] .…”

Seroprevalence of IgG antibodies against tetanus toxoid among different age groups in Poland

“…Differences in the frequency of detection of the protective level of tetanus antibodies depending on gender may be related to the compulsory vaccination of men during military service, as well as the frequent performance of occupations in which men are exposed to injuries and the associated risk of C. tetani infection. These professions include, among others, animal breeders, employees of sewage treatment plants, farmers and gardeners [25,26,27,28,29,30].…”

Assessment of tetanus Immunization among healthcare workers in Mogadishu, Somalia

“… 2 The tetanus mortality rate is high in sub-Saharan African countries: reports have shown a mortality rate of 64% in Nigeria, 47% in Uganda, 43.1% in Tanzania, and 48.5% in Cameroon. 3 More than 1,000 newborn tetanus fatalities per 100,000 people were recorded in Somalia, South Sudan, Afghanistan, and Kenya, the countries with the highest prevalence of the disease. The countries with the greatest rates of post-neonatal tetanus mortality (greater than five fatalities per 100,000 people) were Somalia, South Sudan, and Kenya.…”