Tetanus in Uganda: Clinical Outcomes of Adult Patients Hospitalized at a Tertiary Health Facility Between 2011 and 2020

Abstract

Background Tetanus is a vaccine-preventable infectious disease associated with high mortality rates. Increased vaccination coverage globally and locally has resulted in substantial declines in the number of individuals diagnosed with tetanus. We report annual trends in tetanus admissions and deaths over a decade at a national referral hospital in Uganda. Methods This was a retrospective cohort study, using data from an electronic database of patients admitted to medical wards at a national referral hospital between 2011 and 2020. Data was abstracted on demographic characteristics; length of hospital stay and mortality outcome. Admission and mortality rate trends were analyzed using the Mann Kendall’s trend test, while Kaplan – Meier survival curves were used to compare gender survival rates. Results During the study period, 459 individuals were admitted with tetanus. Of these,85.8% (394/459) were males, 26.1% (120/459) were aged 20 years or less. Overall, 48.8% (224/459) participants died, of whom 85.3% (191/224) were males (85.3%, n = 191), though females had a higher mortality rate (50.8%, 33/65; vs 48.5%, 191/394). Those aged 31–40 years accounted for 23.7% (53/224) of the deaths; and 88.7% (197/224) of the deaths occurred within the first 7 days of admission. The total number of tetanus admissions declined (TauA = -0.6444, p = 0.0116). However, mortality rates remained stable (TauA = 0.0222, p >0.999). The average length of hospital stay was 8.1 days (SD – 7.5, Range: 1–46). Conclusions While tetanus admissions declined, mortality rate remained high. Males were disproportionately affected. We recommend quality of care audits for inpatient care improvement; and more research on the determinants of infection and mortality to inform vaccination for at-risk men.

Management and outcome of adult generalized tetanus in a Chinese tertiary hospital

“…The overall median duration of hospitalization of patients with tetanus in this study was 29.5 days, which was similar to a recent report of low mortality (2.8%) from Vietnam (30). The median hospital stay of the latter was 25 days, which was much longer than the hospitals reported in some areas with high mortality (10,18). Severe tetanus, in particular, requires longer ICU time, more mechanical ventilation requirements and longer hospital stay, remains a significant burden on healthcare services.…”

“…However, there is no uniform guideline for wound debridement in patients with tetanus. Some published studies on the prognosis of tetanus have not reported the rate of implementation of debridement ( 10 , 29 , 30 ). We believe that debridement is essential to control the symptoms of tetanus and improve the prognosis, especially for severe tetanus.…”

“…The mortality rate of adult tetanus in developing countries varies greatly, ranging from 10 to 50%. The lack of health resources and appropriately trained staff means that the mortality rate of tetanus is still high in some developing countries ( 8 , 9 ), with an estimated 48.8% deaths in African countries ( 10 ). Due to incomplete mortality data for many countries, the actual number of tetanus-related deaths may be larger than current.…”