Factors associated with mortality in patients with tetanus in Cameroon

BACKGROUND: Tetanus constitutes a significant cause of death in sub-Saharan Africa, with case fatality rates as high as 64%, 47%, and 43.1% reported in Nigeria, Uganda, and Tanzania, respectively. However, the knowledge gap on factors that influence tetanus mortality still exists in Cameroon. OBJECTIVE: To identify the factors that influence the mortality of tetanus patients in three regional hospitals in the North West and South West Regions of Cameroon. METHODOLOGY: This was a 7-year retrospective case-series study. Socio-demographic and clinical data of tetanus cases admitted in Bamenda, Buea, and Limbe Regional Hospitals from January 2010 to March 2017 were collected and analysed. RESULTS: This study recorded 38 cases, but excluded five due to missing inpatient files. Of the 33 cases considered in this study, 27 (81.8%) were males. The mean age of the patients was 32 years. A tetanus mortality rate of 48.5% was recorded – thus, 16 tetanus-related deaths. Mortality was higher amongst patients with incubation periods less than 7 days; the onset of trismus and generalized spasms less than 8 days after exposure; the presence of autonomic dysfunction; the presence of respiratory dysfunction; application or introduction of local regimens, soil or animal waste at the portal of entry; delayed debridement greater than 2 days after onset of tetanus; and a severe clinical disease state. CONCLUSION: This study, therefore, highlights the need to ensure universal vaccination coverage for high-risk populations; males, active population (20–40 years), and farmers. More still, this study emphasizes the need to improve access and utilisation of mechanical ventilation in severe tetanus cases.