PLoS Neglected Tropical Diseases (Mar 2022)

Factors associated with in-hospital mortality of adult tetanus patients-a multicenter study from Bangladesh.

  • Md Abdullah Saeed Khan,
  • Mohammad Jahid Hasan,
  • Md Utba Rashid,
  • Soumik Kha Sagar,
  • Sanzida Khan,
  • Susmita Zaman,
  • Sultan Mahamud Sumon,
  • Ariful Basher,
  • Mohammad Delwer Hossain Hawlader,
  • Mohammad Hayatun Nabi,
  • Nadira Sultana Kakoly

DOI
https://doi.org/10.1371/journal.pntd.0010235
Journal volume & issue
Vol. 16, no. 3
p. e0010235

Abstract

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BackgroundTetanus, a vaccine-preventable disease, is still occurring in the elderly population of low- and middle-income countries with a high case-fatality rate. The objective of the study was to elucidate the factors associated with in-hospital mortality of tetanus in Bangladesh.MethodsThis prospective observational study, conducted in two specialized infectious disease hospitals, conveniently selected adult tetanus patients (≥18 years) for inclusion. Data were collected through a preformed structured questionnaire. 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 analysis was done using Stata (version 16) and SPSS (version 26).ResultsA total of 61 tetanus cases were included, and the overall in-hospital 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%), farmers (57.4%), and came from rural areas (93.4%). Survival analysis revealed that the probability of death was significantly higher among patients having an age of ≥ 40 years, incubation time of ≤12 days, onset time of ≤ 4 days, and having complication(s). However, on multivariable Cox regression analysis, 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) came as significant predictors of in-hospital mortality after adjusting for incubation period and complications.ConclusionOlder age and short onset time are the two most important determinants of in-hospital mortality of tetanus patients. Hence, these patients require enhanced emphasis and care.