Farooq Ahmed, Farooq Ahmed, Muhammad Javed Afridi, Hamza Khan.
Demographic and prognostic factors in Tetanus patients.
Pak J Med Res Jan ;45(3):82-6.

Objectives: To evaluate the demographic and prognostic factors in adult patients suffering from Tetanus. Study Design: It was a retrospective analysis. Place and Duration of Study: Medical units and Intensive care unit of Khyber Teaching Hospital Peshawar over 2 years ( June 2001 to July 2003). Patients and Methods: A total of 113 patients were studied during the above mentioned period who presented to the medical units and the ICU of Khyber teaching hospital Peshawar with the diagnosis of Tetanus. All the relevant data were collected on a proforma which included baseline characteristics, immunization status, inquiry about the probable entry site, duration of illness, clinical features and outcome of the patients. Results: Of 113 patients with Tetanus, 77 were males and 36 females. Most of the males were farmers and laborers, while most females were housewives. All females and 96.6% males were not immunized. Majority of the patients were from the rural areas (64 males, and 31 females). The presentation in descending order of frequency was locked jaw (89.4%), muscle stiffness (86.7), backache (83.2%), and Dysphagia (72.6%). Eighteen patients (15.9%) presented with fits. Overall 76 patients (67.2%) survived, and 37 patients (32.8%) died. The survival and death figures showed no association with gender. The entry site of organisms was a lacerated wound in 32.7% patients, injections in the previous 3 months in 19.5%, surgery in the last 3 months in 10.6%, and post natal in 7.2% patients. Nine patients (8.1%) had other causes like firearm injuries, snake bites, burns and open fractures. In 26 patients (23%), no obvious cause was found for the entry of organism. Conclusion: The above data clearly indicate that most of the patients suffering from Tetanus are males, and of low socioeconomic class. Most of the patients had no history of vaccination against the disease. In a large proportion of patients, the site of entry of organism is not obvious. Age is considered to be an important factor in the outcome of the illness. But in this study, it is obvious that the percentage of death is high between the ages of 11 to 30 years in males, while in females, it is at its highest in patients between the ages of 31 to 50 years. Overall, more deaths have occurred in females. The outcome of the disease depends upon the early institution of proper management especially in the ICU setting. Tetanus is entirely preventable worldwide. The priorities must be in prevention, universal vaccination, and the development of simpler immunization schedules with longer protection.

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