Factors Associated with Mortality of Adult Tetanus Patients in A Tertiary Hospital in South Western Nigeria

Abstract

Tetanus is a neurological disease that is associated with high mortality. The aim of this study was to analyze the factors that were  associated with high mortality in tetanus. This was a retrospective study over a ten-year period. Details of demographics, immunization  history, site of entry of organism, incubation period, clinical presentation, management, length of hospital stay, admission pattern,  severity of tetanus and outcome were analyzed.Data analysis was done using SPSS software version 21.0 for windows. One hundred and  forty-seven patients with tetanus were admitted during the study period. Of these 106 met the inclusion criteria. The most common  wound site was lower extremities. The incubation period in all the patients studied ranges between 3 days to 90 days with a mean of  15.595 ± 13.857days. Onset time ranges from 8-90 hours with a mean of 33.24 ± 20.22 hours for all the patients studied . Ten (9.4 %) patients had mild tetanus, 52 (49.1%) moderate, 38(35.8%) severe, and 6(5.6%) had very severe tetanus. Fifty-nine (55.7%) of the 106  patients survived. There were 47 (44.3%) deaths. The mortality was highest among those with severe and very severe tetanus at 76.3%  and 83% respectively. Significant prognostic factors for high mortality are short incubation period, short period of onset, lack of adult  tetanus immunization schedule and severity of disease. A vigorous campaign on scheduled adult tetanus immunization coverage is  required.