• Alhaji Aliyu Dept of Community Medicine Ahmadu Bello University Zaria-Nigeria
  • Tukur Dahiru
  • Reginald O Obiako
  • Lawal Amadu
  • Ephraim I Akase


Background: Tetanus, a disease that is largely preventable, is still a major public health problem in the developing world and is associated with high morbidity and mortality. There is a paucity of published literature on adult (non-neonatal) tetanus in this study area in Nigeria.

Methods: This was a study describing the clinical characteristics of patients who were clinically diagnosed with tetanus in Ahmadu Bello University Teaching Hospital (ABUTH) Zaria, northwest of Nigeria between January 2001 and December 2014.

Results: A total of 91 cases were reviewed. The mean patient age was 20 years, and male to female ratio 2.9:1. The majority (88%) of patients were < 40 years old. The mean onset period was 19 days, nearly all patients (96.7%) had generalized tetanus, and the commonest presenting signs were spasm (93.4%) and trimus (78.0%). The most common site of injury was lower limbs (64.8% of cases). The complication rate was 71.4% and case fatality was 48.4%.

Conclusion: Tetanus is still a major public health problem in our setting and affects the younger age group with a high case fatality rate. The incidence of tetanus can be reduced drastically by an effective and sustained immunization program.

Key words: adult tetanus, clinical characteristics, case fatality, outcome, North West Nigeria


Author Biography

Alhaji Aliyu, Dept of Community Medicine Ahmadu Bello University Zaria-Nigeria

Consultant Public Health Physician & Senior Lecturer

Dept of Community Medicine

ABU, Zaria-Nigeria



Cvjetanović, B. Grab, K. Uemura. Dynamics of acute bacterial diseases. Epidemiological models and their application in public health. Part II. Epidemiological models of acute bacterial diseases. Bull World Health Organ. 1978; 56 (Suppl 1):25–143.

Thwaites CL, Farrar JJ. Preventing and treating tetanus: The Challenge continues in the face of neglect and lack of research. BMJ 2003; 326:117-18

Cook TM, Protheroe RT and Handel JM. Tetanus: a review of the literature. Brit Journ Anaethesia 2001; 87: 3:477-87

Ruben FL, Smith EA and Foster SO et al. Simultaneous administration of smallpox, measles, yellow fever and diphtheria-pertussis-tetanus antigens to Nigerian children. Bull WHO 1973; 48:175-81

Myers MG, Beckman CW, Vosdingh RH, Hankins WA. Primary immunization with tetanus and diphtheria toxoids: reaction rates and immunogenicity in older children and adults. JAMA 1982; 248: 2478-80

De Moraes-Pinto MI, Almeida ACM, Keij G et al. Placental transfer and natural acquired neonatal IgG immunity in human immunodeficiency virus infection. J Inf Dis 1996; 173:1077-84

World Health Organization (WHO) tetanus vaccination. Weekly Epidemiol Review. 2006; 81(20):198-208.

Stanford JP. Tetanus-Forgotten but not gone. N Eng J Med 1995; 322:812-13.

Younas NJ, Abro AH, Das K, Abdou AMS, Ustadi AM, Afzal S. Tetanus: Presentation and outcome in Adults. Pak J Med Sci. 2009; 25(5):760-65

Morbidity and Mortality Weekly Report. CDC 1985;34-43

Chalya PL, Mabula JB, Dass RM, Mbelenge N, Mshana SE and Gilyoma JM. Ten year experiences with Tetanusat a Tertiary Hospital in Northwestern Tanzania: A retrospective review of 102 cases. World Journ Emergency Surgery. 2011; 6:20.

Anuradha S. Tetanus in Adults-A continuing problem: An analysis of 217 patients over 3 years from Delhi, India. Med J Malaysia. 2006; 61(1):7-14.

Oladiran I, Meier DE, Ojelade AA, Olaolorun DA, Adeniran A, Tarpley JL. Tetanus continuing problem in developing world. World J Surg. 2002; 26(10):1282-85.

Ibrahim MTO. Tetanus: A ten year review of cases in a Teaching Hospital in North Western Nigeria. Sahel Med Journ. 2007; 10(1):1-5.

Ojiri FI and Danesi M A. Mortality of tetanus at the Lagos University Teaching Hospital, Nigeria. Trop Doct 2005; 35(3):178-81.

Mchembe MD, Mwafongo V. Tetanus and it’s treatment outcome in Daar Es Salaam: East African Journ Public Health 2005; 2:22-23.

Dietz V, Millstein JB, van Loon F, Cochi S, Bennett J. Performance and potency of tetanus toxoid: implications for eliminating neonatal tetanus. Bull WHO 1996; 746:19-28.

Adekanle O, Ayodeji OO, Olatunde LO. Tetanus in a rural Setting of South Western Nigeria: a Ten year Retrospective Study. Libyan J Med 2009; 4:100-4.

Komolafe MA, Komolafe EO and Ogundare AO. Pattern and outcome of Adult tetanus in Ile-Ife, Nigeria. Nigerian J Clinical Practice 2007; 10(4):300-03.

Chukwubike OA, Godspower AE. A 10 year review of outcome of management of tetanus in Adults at a Nigerian teaching hospital. Ann Afr Med 2009; 8(3):68-72.

Feroz AHM, Rahman MH. A Ten year Retrospective Study of Tetanus at a Teaching Hospital in Bangladesh. J Bangladesh Coll Phys Surg. 2007; 25:62-9.

Lau LG, Kong KO, Chew PH. A ten year Retrospective study of Tetanus at a general hospital in Malaysia. Singapore Med J. 2007; 42(8):346-50.

Frrar JJ, Yen LM, Cook T, Fair weather N, Bin N, Parry J. Tetanus. J Neurol Psychiatry 2002: 50: 398-407

Hodes RM, Teferedeges B, Tetanus in Ethiopia: An analysis of 55 cases from Addis Ababa. East Afr Med J. 1990; 67:887-893.

Reis E, Freire E, Alexandrino S. Tetanus in an ICU in Portugal, Epidemiology, incubation and complications. Int J Intensive Care.1994; 1:120-21

Einterz EM, Bates ME. Caring for neonatal tetanus patients in rural primary care setting in Nigeria: a review of 237 cases. J Trop Paediatrics 1991; 37:178-81

Hesse IFA, Mensah DK, Lartey AM and Neequaye A. Characteristics of Adult tetanus in Accra. WAJM 2003; 22(4):291-4.

Bardenheier B, Prevots DR, Khetsuriani N, Wharton M. Tetanus Surveillance- US, 1995-97. In CDC Morbidity and Mortality Weekly Report. 1998; 47:1-13.

Joshi S, Agarwal B, Malla G and Karmacharya B. Complete elimination of tetanus is still elusive in developing countries. A review of Adult tetanus cases from referral hospital in Eastern Nepal. Kathmandu University Med Journ. 2007; 5(3:19):378-81.

Henderson SO, Mody T, Groth DE, Moore JJ and Newton E. The presentation of tetanus in emergency department. J Emerg Med 1998; 16:705-8.

Peetermans WE, Schepens D. Tetanus- still a topic of present interest: a report of 27 cases from Belgian referral hospital. J International Med. 1996; 239:249-52.

Zziwa GB. Review of tetanus admission to a rural Uganda hospital UMU press. 2009; 7(3):199-202.

Ogunrin OA, Unuigbe EI. Tetanus: an analysis of the prognosticating factors of cases admitted into the medical wards of a tertiary hospital in a developing African country between 1990 and 2000. Niger Postgrad Med J, 2004 Jun; 11(11:2):97-102.






Original Article