Pediatric and neonatal tetanus: a hospital based study at eastern Nepal

Area of Science:

• Pediatrics
• Infectious Diseases
• Public Health

Background:

• Tetanus, a serious bacterial infection, poses a significant public health challenge, especially in regions with suboptimal vaccination coverage.
• Neonatal tetanus, often linked to umbilical cord care practices, remains a preventable cause of infant mortality.

Purpose of the Study:

• To investigate the demographic characteristics, clinical presentations, and outcomes of childhood and neonatal tetanus cases.
• To identify risk factors and complications associated with tetanus in pediatric populations.
• To evaluate the effectiveness of current management strategies and identify areas for improvement.

Main Methods:

• A prospective hospital-based study was conducted at BPKIHS from July 2004 to May 2006.
• Data collected included patient demographics, vaccination history, clinical features, incubation and onset times, complications, and outcomes.
• Statistical analysis was performed to identify predictors of favorable outcomes.

Main Results:

• Twenty-four cases of tetanus were admitted, including 5 neonatal tetanus cases. A significant proportion of childhood tetanus cases had received incomplete or no tetanus prophylaxis (DPT/TT).
• Otitis media and umbilical sepsis were identified as preceding conditions in some cases. Short onset time was a significant predictor of a favorable outcome (p=0.005).
• Common complications included respiratory failure, pneumonia, rhabdomyolysis, and seizures. Survival rates were 21.1% for childhood tetanus and 40.0% for neonatal tetanus, with respiratory failure being the leading cause of death.

Conclusions:

• Tetanus continues to be an important cause of morbidity and mortality in eastern Nepal, disproportionately affecting unvaccinated or inadequately vaccinated individuals.
• Despite resource limitations, effective management of tetanus cases is achievable, yielding outcomes comparable to those reported in international literature.
• Strengthening tetanus vaccination programs, particularly for pregnant mothers and infants, is crucial for reducing the burden of this preventable disease.