Tetanus in a children's hospital in Addis Ababa: review of 113 cases

At Ethio-Swedish Children's Hospital Addis Ababa, Ethiopia, children admitted with a diagnosis of tetanus during January 1989- December 1998 were studied. During the 10 year study period there were 113 patients admitted with a diagnosis of tetanus. Sixty two (54.9%) of them were newborns and the rest 51 (45.1%) were children between the age of 1 and 12 years. Fifty six (90.3%) of the newborns were born at home and 43 (69.4%) of the mothers didn't have antenatal care. The median age on admission was 7 days. The umbilicus was assumed to be the portal of entry for all the cases with neonatal tetanus. Forty six (74.2%) of those with neonatal tetanus died in the hospital. Significantly high case fatality rate was seen in neonates with incubation period less than 7 days, onset time 48 hours or less, high pulse rate >140/minute and in those having fever. In non-neonates, the median age at admission was 9 years and the commonest site of entry was lesion on the lower extremities. Sixteen (31.4%) died in the hospital. The outcome was poor in those with onset time of 48 hours or less and in those presenting within 72 hours after the onset of illness. The overall mortality is high. Due attention needs to be given to children with tetanus having poor prognostic factors, particularly among newborns. Antenatal care needs to be promoted. A community based study is recommended to determine the true magnitude of the problem.