Tetanus in a rural setting of South-Western Nigeria: a ten-year retrospective study

We review the records of 79 tetanus patients in two hospitals (one tertiary and one secondary level) in Owo, Ondo state, Nigeria from 1997 to 2006. The male: female ratio was 3:1. Ages were 14-70 years (mean 33.25 years, SD ±16.76). The overall case fatality rate (CFR), 32.91%, did was not significantly different in the two hospitals. CFR for men was 32.10% and for women 35.29%. The main factor indicative of bad prognosis was a short hospitalization period. It was observed that 30.38% of our patients were discharged against medical advice (DAMA), that financial constraint was the underlying problem in 50% of cases, and that the trend of DAMA occurred at the two study sites. This DAMA phenomenon could pose a great danger to the eradication of this vaccine preventable disease in rural areas.