A review of neonatal tetanus in University of Maiduguri Teaching Hospital, North-eastern Nigeria.

BACKGROUND: Neonatal tetanus is a vaccine preventable disease and is a leading cause of neonatal mortality in developing countries. The effectiveness of immunization and hygienic umbilical cord care practices in the prevention of the disease has been established. OBJECTIVE: The objective of this study was to audit the scourge of neonatal tetanus in a tertiary health facility in a resource-limited setting. MATERIALS AND METHODS: The study was a retrospective study. Case notes of neonates admitted with clinical diagnosis of tetanus into the Special Care Baby Unit (SCBU) between January 2009 and December 2010 were retrieved and evaluated to identify socio-demographic and clinical characteristics, mode of acquisition and severity of the disease, presence of co-morbidities, duration of hospital stay and outcome. RESULTS: Most of the mothers had no tetanus immunization (66.7%) and the main social class of the children was class V (45.1%) and IV (41.2%), respectively. Only 29.4% of the mothers attended ante-natal care (ANC) while majority of the patients were delivered at home (94.1%). Half of the neonates presented with the severe form of the disease (51.0%). Sepsis is a prominent co-morbidity (59.2%). Morality was high with case fatality of 66.7%. CONCLUSION: This high prevalence of neonatal tetanus with high mortality is not only disappointing but unacceptable in the 21(st) century. Therefore, all efforts must be re-focused on current preventive strategies while pursuing new areas such as slow-release mono-dose tetanus vaccine and school health programme as well as advocacy on political will for the sustainability of immunization programmes of women of child-bearing age.

Cephalic tetanus: a case report.

A case report of cephalic tetanus in a 2-year-old girl who was not immunized against tetanus following suppurative otitis media (SOM) is presented. This case is reported because of the rarity of cephalic tetanus associated with high mortality, to highlight the risk of cephalic tetanus as sequelae of SOM and the need for proper aural care and prompt treatment of SOM. Primary immunization of all eligible children as well as booster vaccination at appropriate time as an effective management strategy for tetanus is emphasized.