Tetanus in School Age Children Seen at the University of Port Harcourt Teaching Hospital: A Need for Booster Doses of Tetanus Vaccine

Main Article Content

B. A. Alex-Hart
D. LongJohn


Background: Tetanus still causes significant morbidity and mortality amongst children in Nigeria despite decades of immunisation with tetanus vaccine.

Objectives: To determine the prevalence, case fatality rate and predictors of fatality amongst school age children treated for tetanus at the University of Port Harcourt Teaching Hospital.

Materials and Methods:  This was a retrospective study of all children aged 4 to 17 years treated for tetanus at the University of Port Harcourt Teaching Hospital between January 1, 2009 and December 31, 2019. Data was obtained from the case notes and ward registers. Socio-demographic characteristics, presenting complaints, incubation period, onset interval, number of Diphtheria, Pertussis and Tetanus (DPT) vaccine received at infancy, treatment outcome, duration and cost of hospital stay were obtained, entered into a spread sheet and analysed with SPSS version 20. Results are presented in tables and percentages. The level of significance was set at P value <0.05.

Results:  During the period under review, there were 53 children aged 4 to 17 years treated for tetanus, accounting for 0.3% of the total admission. The mean age was 10.79±3.35 years. There were 33 (62.26%) males and 20 (37.74%) females. Majority 26 (49.06%) of the children were of low socioeconomic class. The commonest 28(52.8%) route of infection was broomstick injury. Majority 32(60.3%) of the children were not immunised in infancy. The mean incubation period was 7.34±4.21 days and the mean onset interval was 8.87±10.44 hours. The two most common symptoms were generalized spasms 49 (21.03%) and trismus 47 (20.17%). Short incubation period (≤4 days) and short onset interval (≤4 hours) were significantly associated with higher death rates (p=0.0002; p=0.012).  Patients with short incubation period of ≤4 days and short onset interval of≤ 4 hours are more likely to die (p=0.0002; p=0.012).

Conclusion: There was a high tetanus case fatality rate amongst school age children at University of Port Harcourt. Short incubation period and onset interval were associated with higher mortality. Booster doses of TT containing vaccines should be administered to primary and secondary school children in Port Harcourt to curb the menace.

Tetanus, school age, children, tetanus toxoid, vaccine.

Article Details

How to Cite
Alex-Hart, B. A., & LongJohn, D. (2020). Tetanus in School Age Children Seen at the University of Port Harcourt Teaching Hospital: A Need for Booster Doses of Tetanus Vaccine. Archives of Current Research International, 20(2), 1-9. https://doi.org/10.9734/acri/2020/v20i230172
Original Research Article


World Health Organisation (WHO). Tetanus.
(Accessed 17th January 2020)

Centre for Disease Control and Prevention (CDC). Tetanus.
(Accessed 31st January 2020)

Hinfey PB. Tetanus.
(Accessed 12th February 2020)

World Health Organization (WHO). Tetanus vaccine: WHO position paper. Wkly Epidemiol Rec. 2006;20:198–208.

Scobie HM, Patel M, Martin D, Mkocha H, Njenga SM, Odiere MR, et al. Tetanus immunity gaps in children 5-14 years and men ≥ 15 years of age revealed by integrated disease serosurveillance in Kenya, Tanzania and Mozambique. Am J Trop Med Hyg. 2017;96(2):415-420.

Kyu HH, Mumford JE, Stanaway JD, Barber RM, Hancock JR, Vos T, et al. Mortality from tetanus between 1990 and 2015: findings from the global burden of diseases study 2015. BMC Public Health. 2017;17:170.

Yaguo Ide LE, Nte AR. Neonatal tetanus: A continuing menace. The Nigerian Health Journal 2009;9(1-4):21-25.

Yaguo Ide LE, Uchenwa-Onyenegecha TA. Post neonatal tetanus: 20 years’ experience as seen at the University of Port Harcourt Teaching Hospital. British Journal of Medicine and Medical Research. 2016;12(2):1-5.

World Health Organisation (WHO). WHO recommendations for routine immunisation-summary tables.
(Accessed 31st January 2020)

Ophori EA, Tula MY, Azih AV, Okojie R, Ikpo PE. Current trends of immunisation in Nigeria: Prospects and challenges. Trop Med Health. 2014;42(2): 67-75.

National Population Commission. Nigeria Demographic and Health Survey. Abuja, National Population Commission; 2018.
(Accessed 31st January 2020)

National Population Commission. Nigeria Demographic and Health Survey. Abuja, National Population Commission; 2013.
(Accessed 2nd February 2020)

Orimadegun AE, Adepoju AA, Akinyinka OO. Prevalence and socio-demographic factors associated with non-protective immunity against tetanus among high school adolescent girls in Nigeria. Ital J of Pediatr. 2014;40:29.

Ajite AB, Ogundare EO, Oluwayemi IO, Olatunya OS, Babatola A, Taiwo A et al. Demographic survey and management outcome of post-neonatal tetanus at the Ekiti State University Teaching Hospital, Ado Ekiti. J Child Adult Vaccines Immunol. 2019;3:1-7.

Komomo E, Chimaeze T, Emmanuel E, Asindi A. Non-acidental sticks injury as a cause of post-neonatal tetanus. Pan Afr Med J. 2019;34:143.

Fatunde OJ, Familusi JB. Post neonatal tetanus in Nigeria: A need for booster doses of tetanus toxoid. Nig J Paediatr. 2001;28:35.

Oyedeji GA. Socio-economic and cultural background of hospitalized children in Ilesa. Niger J Paediatr. 1985;12(14):111-117.

Bankole IA, Danesi MA, Ojo OO, Okubadejo NU, Ojini FI. Characteristics and outcome of tetanus in adolescent and adult patients admitted to the Lagos University Teaching Hospital between 2000 and 2009. J Neurol Sci. 2012;323(1-2):201-204.

Animasahun A, Gbelee OH, Ogunlana T, Njokanma OF, Odusanya O. Profile and outcome of patients with post-neonatal tetanus in a tertiary centre in South west Nigeria: Any remarkable reduction in the scourge? The Pan Afr Med J. 2015;21:254.

Angurana SK, Jayashree M, Bansal A, Singhi S, Nallasamy K. Post-neonatal tetanus in a PICU of a developing economy: Intensive care needs, outcome and predictors of mortality. J Trop Pediatr. 2018;64:15-23.

Okike CO, Muoneke UV, Uwaezuoke SN, Mbagwu EN, Onyeka-Okite E. The prevalence and case-fatality rates of post –neonatal tetanus in a population of hospitalized Nigerian children: An 8-year retrospective review. J Trop Pediatr. 2019;1-9.

Also U, Gwarzo GD. How common is post neonatal tetanus in Rasheed Shekoni Specialist Hospital, Jigawa, North Western Nigeria? Niger J Basic Clin Sci. 2018;15:105-108.

Anah MU, Etuk IS, Ikpeme OE, Ntia HU, Ineji EO, Archibong RB. Post neonatal tetanus in Calabar, Nigeria: A 10 year review. Nig Med Pract. 2008;54(2):45-47.

Marulappa VA, Manjunath R, Mahesh N, Maligegowda L. A ten year retrospective study on adult tetanus at the Epidemic Disease (ED) Hospital, Mysore in Southern India: A review of 512 cases. J Clin and Diag Res. 2012;6(8):1377-1380.

Mahmoud AO, Ayanniyi AA, Salman MF. Observations of teachers in llorin, Nigeria on their practices of corporal punishment that are potentially injurious to their pupils' eyes. Annals Afr Med. 2011;10(2):150-154.

Nte AR, Mayuku A, Oruamobo RS. Neonatal and post neonatal tetanus: The time to act is now. Nig J Paediatr. 2002;29: 85.

Brook I. Current concepts in the management of Clostridium tetani infection. Expert Rev Anti Infect Ther. 2008;6:327-336.

Ijezie E, Megbelayin F. Post-neonatal tetanus from broomstick injuries: A word of caution for caregivers. Int J Med Res Rev. 2017;5(7):644-648.

Amalu MN, Abang KB. School absenteeism among primary school pupils in Cross Rivers State: Psychological implication for national development. Global J Edu. 2016;15:49-56.

World Economic Forum. Three things Nigeria must do to end extreme poverty.
(Accessed 18th February 2020)

Onoka CA, Onwujekwe OE, Uzochukwu BS, Ezumah NN. Promoting universal financial protection: Constraint and enabling factors in scaling-up coverage with social health insurance in Nigeria. Health Res Policy Syst. 2013;11:20.

Aregbeshola BS, Khan SM. Out-of-pocket payment, catastrophic expenditure and poverty among households in Nigeria 2010. Int J Health Policy Manag. 2018;7(9):798-806.

Sexton DJ. Tetanus.
(Accessed 19th February 2020)

Bhatia R, Prabhakar S, Grover VK. Tetanus. Neurol India. 2002;50:398-407.