Abstract

A Four Years Record Review of Tetanus Cases Admitted to Jimma University Specialized Hospital (JUSH), Southwest Ethiopia: A Slip of Tetanus Case Management?

Background: Establishment of Intensive care unit (ICU) at JUSH did not improve mortality of tetanus cases due to infrequent tracheostomy and mechanical ventilation. Objective: To assess the morbidity, management and mortality of tetanus cases admitted to JUSH between Jan. 2008 and Dec. 2011.

Methods: Retrospective review of tetanus cases was conducted from Jan. to June 2012. A total of 45 patients were reviewed. Data collection format was used for each individual case to collect information that was recorded about each patient. Data was collected by senior medical students (year V) for 15 days. Training was given for 1 day for data collectors on data collection. Data was summarized and summary statistics were calculated using scientific calculator.

Result: A total of 45 cases were obtained. Males accounted for 34(75.6%), 2(4.4%) were neonates and 22(48.9%) of all cases were aged between 11 and 30 years of age. None of the cases had prior immunization history for tetanus and 37(82.2%) had accessible wound. For all cases there was no evidence as to whether they sought health care for primal wound. The overall mortality was 18(40.0%). The Commonest portal of entry was traumatic wound 24(53.5%). The commonest site was lower limb, accounting for 26(57.8%). Twenty four (53.5%) had period of onset of less than 24 hours prior to admission. Twenty seven (60.0%) had incubation period of < 14 days. At admission, generalized spasm was found in 36(80.0%) of patients and it accounted for 17(94.4%) of all deaths. Eleven (61.1%) of all deaths occurred within the first three days of admission. Quality of care at ICU was unsatisfactory and management of fever and wound were neglected.

Conclusion: Delayed health care seeking by patients was sacrosanct for management of tetanus. Quality of care at ICU was suboptimal. Management of fever and wound got less attention.

Recommendations: Prevention of tetanus through immunization, improvement of early health care seeking, organization of service at ICU, and integration of fever and wound management in tetanus case management are recommended.


Author(s):

Assegid Sahilu, Ismael Kedir, Yemane Ayele



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