TETANUS SITUATION IN PAKISTAN

COMPARISON OF MEDICAL VERSUS SURGICAL MANAGEMENT

Abstract

Objectives: To determine demographic and clinical profile of Tetanus patients
and to highlight various management strategies as well as the outcome of the tetanus patients.
Background: Tetanus, a preventable disease still found in high frequency in developing world.
Globally one million cases are recorded annually. This disease found more frequently in patients
who are either non vaccinated or partially immunized. Diagnosis of Tetanus is solely made on
clinical grounds with no definitive investigation available to confirm the diagnosis. Mortality of
Tetanus is directly related to the grade of tetanus at presentation. Study Design: Descriptive
observational study. Setting: Public and private sector hospitals of Hyderabad, Pakistan. Period:
1st Nov 2008 to 31st Oct 2015. Materials & methods: It includes patients of either sex above
the age of 13 years who were clinically diagnosed as case of Tetanus. Data was collected for
variables related to demography, incubation period, site of injury, history of tetanus vaccination,
co morbidity, stage of presentation, management & outcome of treatment, complications &
mortality. Results: Total 131 patients of Tetanus were finally analyzed. It includes 124 (94.65%)
male and 07 (5.34%) female patients with mean age of 34.06 years. 69 (52.67%) were farmers by
occupation. History of injury was present in 109(83.20%) patients & incubation period was < 10
days in 39(29.77%) patients. Lower limb was the commonest site of injury noted in 86(65.64%)
patients. Tetanus immunization history was positive in 63 (48.09 %) patients. Among the clinical
findings, generalized bodyache or stiffness with backache was noted in 107(81.67%) patients,
restricted mouth opening in 101 (70.09%) patients. Grade I Tetanus was noted in 63(48.09%)
patients. Complications of tetanus were noted in 43(32.82%) patients. Mortality rate was noted
in 33 (25.19%) patients. Mean hospital stay was 12.3±9.0 days. Conclusion: Tetanus is found
in significant frequency in our setup which carries substantial morbidity and mortality.