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[Post-circumcision] Tetanus in adult males, Bugando Medical Centre, United Republic of Tanzania

Thursday, 11th of January 2018 Print

Abstract below; full text is at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5677607/

 

Bull World Health Organ. 2017 Nov 1;95(11):779-783. doi: 10.2471/BLT.16.185546. Epub 2017 Oct 3.

Tetanus in adult males, Bugando Medical Centre, United Republic of Tanzania

Aziz R1Peck RN2Kalluvya S1Kenemo B1Chandika A1Downs JA2.

Author information

1

Intensive Care Department, Bugando Medical Centre, PO Box 3750, Mwanza, United Republic of Tanzania.

2

Department of Medicine, Weill Cornell Medicine, New York, United States of America.

Abstract

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PROBLEM:

In the United Republic of Tanzania, the incidence of non-neonatal circumcision-related tetanus is probably underreported.

APPROACH:

We analysed charts and extracted information on outcome and wound location for non-neonatal cases of tetanus admitted to the intensive care unit of Bugando Medical Centre between 2001 and 2016.

LOCAL SETTING:

Bugando Medical Centre, which is one of four teaching referral hospitals in the United Republic of Tanzania, has a 13-bed intensive care unit that manages all admitted patients with tetanus. Within the United Republic of Tanzania, formal programmes of tetanus immunization are targeted at infants or women.

RELEVANT CHANGES:

From our inpatient logs, we identified six patients with non-neonatal tetanus among male patients with a recent history of circumcision. Only one of these patients had been circumcised within a subnational programme of voluntary medical male circumcision. The other five had been circumcised outside of the programme - e.g. at small rural dispensaries or by a traditional provider with no formal medical training. The six patients were aged 11-55 years and five (83%) of them died in hospital - all of overwhelming sepsis.

LESSONS LEARNT:

Within the Tanzanian programme of voluntary medical male circumcision, education on wound hygiene probably helps to reduce the incidence of non-neonatal circumcision-related tetanus. The corresponding incidence among the boys and men who are circumcised beyond this subnational programme is probably higher. The training of all circumcision providers in wound care and a vaccination programme to ensure that male Tanzanians receive tetanus immunization post-infancy are recommended.

 

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