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2016 ; 5
(1
): 705
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The burden of tetanus in Uganda
#MMPMID27350934
Nanteza B
; Galukande M
; Aceng J
; Musinguzi J
; Opio A
; Mbonye AK
; Mukooyo E
; Behumize P
; Makumbi F
Springerplus
2016[]; 5
(1
): 705
PMID27350934
show ga
BACKGROUND: The successful scale-up of safe male circumcision (SMC) in Uganda has
been hinged on client's safety and quality of services. However, after the recent
three tetanus deaths after circumcision a review of all tetanus cases in one of
the hospitals where the cases occurred was initiated. This was to ascertain the
potential for an association between tetanus infection and circumcision.
Routinely collected national data were also reviewed to determine the burden of
tetanus in Uganda and contextualize these incidents. METHODS: A review of medical
charts of tetanus cases identified from the inpatients registry at Masafu
hospital, Busia district for the period 2009/2010-2013/2014. Data were abstracted
from the inpatients registries, charts and HMIS annual reports, and a key
informant interview conducted with the in-charge of the ward that treats tetanus
patients. All quantitative data were captured in an electronic database. Routine
facility data from the National District health Information Software-2 (DHIS-2)
for all the 112 districts were also used. Descriptive analysis and Poisson
regression models were used for statistical analysis using STATA version 13.0.
RESULTS: Data from the routine DHIS-2 showed a high and increasing burden of
tetanus from the emergency/out-patient department records over the 4 year period,
highest among females aged 5+ years in all the regions. At the Masafa hospital,
the chart review revealed a total of 25 tetanus cases and all were males. Nearly
a third (32 %) was aged 7-15 years, with no evidence of circumcision apart from
only one case. The rate of tetanus infection among male inpatients over the
review period was 2-6 per 1000. The case fatality rate was nearly a half (47.4 %)
with deaths occurring within 2 days after admission, and rates of patients'
self-discharge against medical advice were high, 36.8 %. The most common tetanus
entry wounds were due to road traffic accidents, followed by diabetic foot.
Anti-tetanus serum was only not readily available. CONCLUSION: The burden of
tetanus is increasing, especially among females aged 5+ years. Tetanus entry
wounds among the inpatients in Masafa hospital were mostly due to road traffic
accidents, and young males. The tetanus case fatality was very high (47.4 %) and
so was patient requested discharge. There is a need to do more to protect the
population against tetanus infection, especially among females, and males who
need either initial or booster tetanus immunization as SMC is scaled up.
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