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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


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


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


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


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.


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.


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.


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.