Project Description

Author: Khan et al.


Background: Tetanus, a preventable vaccine disease, is common in low-income and middle-income countries. A lack of prospective evaluation of risk factors for this fatal disease is evident in the literature. The objective of the study was to elucidate the factors associated with in-hospital mortality of tetanus in Bangladesh.

Methods: This prospective observational study was conducted in two specialized infectious disease hospitals. Adult tetanus patients (≥18 years) were conveniently selected for inclusion and were followed up until discharge from or death in the hospital. Informed written consent was obtained from patients or their guardians wherever necessary. Data were collected through a preformed structured questionnaire. All procedures were conducted in accordance with the Declaration of Helsinki. Kaplan-Meier survival analysis and univariate and multivariable Cox regression analysis were carried out to assess factors associated with in-hospital mortality among patients. All analyses were performed using Stata (version 16) and SPSS (version 26).

Results: a total of 61 confirmed tetanus cases were included and overall mortality rate was 34.4% (n=21). Patients had an average age of 46.49 ±15.65 years (SD), and the majority were male (96.7%), illiterate (46.7%), and farmer (57.4%) and came from rural areas (93.4%). The median duration of development of clinical sign-symptoms was 3 days (interquartile range [IQR]: 2 – 7 days), and the median incubation time was 14 days (IQR: 8 – 15 days). Trismus (98.3%), dysphagia (89.3%), and spasticity (75.4%) were frequent symptoms. Total 42.6% patient developed at least one complication. Patient aged less than 40 years, or had , incubation period of ≤12 days, or develop clinical symptoms rapidly (≤ 4 days) are more prone to develop at least one of the complications. However, age (adjusted hazard ratio [aHR] 4.03, 95% confidence interval [CI] 1.07 – 15.17, p=0.039) and onset time (≤4 days) (aHR 3.33; 95% CI 1.05 – 10.57, p=0.041) were found significant predictors of in-hospital mortality.

Conclusion: Elderly Older age and rapid onset of symptoms are the two important factors for in-hopspital mortality of the tetanus patients. These patietns required more emphasis and should be treated with special care.

Keywords: Tetanus; In-hospital mortality; Fatality; Risk factors

Status: Ongoing

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