J Pediatr Infect Dis 2020; 15(06): 293-298
DOI: 10.1055/s-0040-1716832
Original Article

Mortality Rate and Prognostic Factors in Neonatal Tetanus: A 3-Year Analysis of Cases Presented to Turkey-Somalia Mogadishu Training and Research Hospital

1   Dr. Behçet Uz Pediatric Diseases and Surgery Education and Research Hospital, Izmir, Turkey
3   Turkey-Somalia Mogadishu Training and Research Hospital, Mogadishu, Somalia
,
2   Department of Emergency, Medical School of Düzce University, Merkez/Düzce, Turkey
3   Turkey-Somalia Mogadishu Training and Research Hospital, Mogadishu, Somalia
› Institutsangaben
Funding None.

Abstract

Objective The aim of this study was to evaluate mortality rate and prognostic factors in neonatal tetanus cases presented to Turkey-Somalia Mogadishu Training and Research Hospital.

Methods A total of 35 neonatal tetanus cases presented to Turkey-Somalia Mogadishu Training and Research Hospital between 2014 and 2017 were included in this prospective observational study. Data on demographic, clinical and maternal obstetric characteristics, and laboratory findings including complete blood count and blood biochemistry were recorded in each patient. Study parameters were evaluated with respect to survivorship status, while multiple logistic regression analysis was performed to determine independent predictors of increased mortality risk.

Results Overall, mortality occurred in 22 (62.9%) of 35 neonates diagnosed with neonatal tetanus. Tetanus prophylaxis was absent in the majority of neonates, regardless of survivorship status (100.0% in nonsurvivors vs. 84.6% in survivors, p = 0.131). In nonsurvivor versus survivor groups, significantly higher likelihood of constipation (50.0 vs. 7.7%, p = 0.002), contracture (81.8 vs. 46.2%, p = 0.035), and ventilator support (95.4 vs. 53.8%, p = 0.006) as well as significantly lower hemoglobin (14.45 ± 2.06 vs. 17.15 ± 1.77, p = 0.003) and potassium (3.50 ± 0.86 vs. 4.14 ± 0.93, p = 0.003) levels and neutrophil (3.34 ± 1.75 vs. 4.47 ± 1.08, p = 0.047, white blood cell (WBC) (5.54 ± 2.30 vs. 7.78 ± 1.70, p = 0.003) and platelet (median [min-max] 133.5 [68–332] vs. 196 [123–550], p = 0.006) counts were noted. Presence of contracture (odds ratio [OR]: 14.525, 95% confidence interval [CI]: 1.398–150.870, p = 0.025) and ventilator support (OR: 22.282, 95% CI: 1.269–391.131, p = 0.034) was the independent determinants of increased risk of mortality.

Conclusion Our findings emphasize high mortality in neonatal tetanus cases in Somalia along with lack of maternal tetanus prophylaxis in majority of cases. Presence of contractures and ventilator support were significant determinants of poor survival, while factors such as constipation, lower hemoglobin, and potassium levels and lower neutrophil, WBC and platelet counts were also more common among nonsurvivors, albeit not found to be associated with mortality risk in the multivariate analysis.



Publikationsverlauf

Eingereicht: 05. April 2020

Angenommen: 12. August 2020

Artikel online veröffentlicht:
21. September 2020

Georg Thieme Verlag KG
Stuttgart · New York

 
  • References

  • 1 World Health Organization. Maternal and Neonatal Tetanus Elimination by 2005. Strategies for achieving and maintaining elimination. Geneva: WHO; 2000
  • 2 UNICEF newsletter. 2014 Elimination of Maternal and Neonatal Tetanus. . Available at: https://www.unicef.org/health/index_43509.htm (PMID: . Accessed Aug 24, 2020)
  • 3 UNICEF. Achieving and sustaining Maternal and Neonatal Tetanus Elimination: Strategic Plan 2012–2015. Available at: www.who.int/immunization/diseases/MNTEStrategicPlan_E.pdf (PMID: . Accessed August 24, 2020)
  • 4 Hinfey PB, Ripper J, Engell CA. et al Tetanus. Medscape Mar, 2014. Available at: http://emedicine.Medscape.com/article/229594-overview (PMID: . Accessed August 24, 2020)
  • 5 World Health Organization. Progress towards the global elimination of neonatal tetanus, 1990-1998. Wkly Epidemiol Rec 1999; 74 (10) 73-80
  • 6 Ibrahim MM, Omar HM, Persson LA, Wall S. Child mortality in a collapsing African society. Bull World Health Organ 1996; 74 (05) 547-552
  • 7 Moore PS, Marfin AA, Quenemoen LE. et al Mortality rates in displaced and resident populations of central Somalia during 1992 famine. Lancet 1993; 341 (8850): 935-938
  • 8 Ymele Fouelifack F, Kenfack B, Lekelem Nguefack S. et al Determinants of noncompletion of the third dose of tetanus toxoid vaccine in pregnant women in Dschang Health District, Cameroon. Adv Prev Med 2020; 2020: 1603518
  • 9 Ridpath AD, Scobie HM, Shibeshi ME. et al Progress towards achieving and maintaining maternal and neonatal tetanus elimination in the African region. Pan Afr Med J 2017; 27 (Suppl. 03) 24
  • 10 World Health Organization. WHO vaccine-preventable diseases: monitoring system. 2016 global summary. 2016 (PMID: . Updated July 15, 2016)
  • 11 Lam PK, Trieu HT, Lubis IN. et al Prognosis of neonatal tetanus in the modern management era: an observational study in 107 Vietnamese infants. Int J Infect Dis 2015; 33: 7-11
  • 12 Basu S, Paul DK, Ganguly S, Chandra PK. Risk factors for mortality from neonatal tetanus: 7 years experience in North Bengal, India. Ann Trop Paediatr 2006; 26 (03) 233-239
  • 13 Onalo R, Ishiaku HM, Ogala WN. Prevalence and outcome of neonatal tetanus in Zaria, Northwestern Nigeria. J Infect Dev Ctries 2011; 5 (04) 255-259
  • 14 World Health Organization. Report of the SAGE Working Group on Maternal and Neonatal Tetanus Elimination and Broader Tetanus Prevention. 2016
  • 15 Lambo JA, Anokye EA. Prognostic factors for mortality in neonatal tetanus: a systematic review and meta-analysis. Int J Infect Dis 2013; 17 (12) e1100-e1110
  • 16 Asekun-Olarinmoye EO, Lawoyin TO, Onadeko MO. Risk factors for neonatal tetanus in Ibadan, Nigeria. Eur J Pediatr 2003; 162 (7-8): 526-527
  • 17 Blencowe H, Lawn J, Vandelaer J, Roper M, Cousens S. Tetanus toxoid immunization to reduce mortality from neonatal tetanus. Int J Epidemiol 2010; 39 (Suppl. 01) i102-i109
  • 18 Dikici B, Uzun H, Yilmaz-Keskin E. et al Neonatal tetanus in Turkey; what has changed in the last decade?. BMC Infect Dis 2008; 8: 112
  • 19 Uleanya ND. Achieving neonatal tetanus elimination in Nigeria: undisclosed challenges and prospects. Trop Doct 2018; 48 (01) 25-30
  • 20 Kc A, Jha AK, Shrestha MP. et al Trends for neonatal deaths in Nepal (2001-2016) to project progress towards the SDG target in 2030, and risk factor analyses to focus action. Matern Child Health J 2020; 24 (Suppl. 01) 5-14
  • 21 Leroy O, Garenne M. Risk factors of neonatal tetanus in Senegal. Int J Epidemiol 1991; 20 (02) 521-526
  • 22 Davies-Adetugbo AA, Torimiro SE, Ako-Nai KA. Prognostic factors in neonatal tetanus. Trop Med Int Health 1998; 3 (01) 9-13
  • 23 Galazka A, Cook R. Neonatal Tetanus Today and Tomorrow. High Risk Mothers and Newborns: Detection, Management and Prevention. . Edited by: Thun P. Switzerland: Ott Publishers; 1987: 109-122
  • 24 World Health Organization. Prevention of neonatal tetanus: WHO meeting. World Health Forum 1982; 3: 432-433