The Scourge of Generalized Post-neonatal Tetanus in Children in Lagos: A Review of the Prevalence and Case Fatality Rate

Abstract

Background: While global efforts are focused on eradicating neonatal tetanus, reports from various regions in Nigeria suggest that post-neonatal tetanus remains ab major health problem in children.
Objective: In this study the cases and outcome of postneonatal tetanus in a tertiary hospital in Lagos, Nigeria were reported.
Methods: The clinical records of children older than one month with generalized tetanus admitted between July 2010 and June 2013 were reviewed. Further analysis
included determination of factors associated with inhospital mortality.
Results: Of 6898 children older than one month admitted during the period, 46 (0.67%) had generalized tetanus equalling 6.7 cases per 1000 children. The records of three children could not be retrieved and were excluded. The mean (SD) age of the children with tetanus was 8.9 (3.3) years; 6 (14%) were =5 years while 21 (48.8%) children were aged 8-10 years. Females made up 51.2% of the cohort. The portal of entry was the lower limb and ear in 24 and 5 children respectively. At least one dose of diphtheriapertussis-tetanus (DPT) vaccine was received in infancy by 23 (53.5%) children. Twenty-three (53.5%) children had severe tetanus. Thirteen (30.2%) children died. The children who survived spent 15 (7.8-20.0) days in hospital. Factors associated with death were onset interval =24 hours, temperature =38⁰C and severe tetanus.
Conclusion: Post-neonatal tetanus remains a common childhood problem in Nigeria. A third of children with tetanus die. Severe tetanus, fever or a short onset interval increases the likelihood of death. There is a need to scale up routine childhood immunization in Nigeria as well as revise DPT vaccine schedule to include booster doses in older children.Key words: booster doses of DPT vaccine, routine childhood immunization, DPT vaccine, post-neonatal tetanus