Browsing by Author "Asante, D.K."
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Item Adult tetanus in Accra, why the high mortality? An audit of clinical management of tetanus(West African Journal of Medicine, 2005-10) Hesse, I.F.A.; Mensah, A.; Asante, D.K.; Lartey, M.; Neequaye, A.Background: Tetanus is a life threatening infection relatively uncommon in the developed countries but occurs frequently in developing countries with case fatality rates of 40-60%. Recent review of adult tetanus at the Korle-bu Teaching Hospital showed a high case fatality of 50%. In order to determine the factors underlying this high case fatality we conducted a retrospective clinical audit of the clinical management of adult tetanus admitted in 1994 to 2001 to the Korle-bu Teaching Hospital. Methods: Data extracted from the admission and discharge books of the Fevers' Unit of Korle-bu Teaching Hospital, Accra and patient case notes were examined and analysed. Results: Case fatality rate (CFR) varied from 25% in 1999 to 72.7% in 2001. There was no gender difference in the case fatality. There was no significant difference in the mean age of those who died and those who survived, however, the CFR rose with age. The presence of neck and a dirty wound were associated with increased CFR. The CFR correlated with the severity of tetanus and increased when an expected treatment action, wound debridement, administration of antibiotics and/or immunoglobulin, was not performed. The administration of anti-tetanus toxin was associated with an increased CFR. Conclusion: The high case fatality rate in Accra was due to inappropriate management with most of the patients not treated with immunoglobulin and antibiotics and had inadequate wound care.Item Characteristics of adult tetanus in Accra(West African Journal of Medicine, 2004-03) Hesse, I.F.A.; Mensah, A.; Asante, D.K.; Lartey, M.; Neequaye, A.Background: Tetanus is a life threatening infection with an estimated annual global incidence of about 1 million cases and a mortality of 50%. It is very common in developing countries. The prevalence in Ghana is not known, however, cases continue to be admitted in hospitals in the country. This retrospective study was undertaken to define the characteristics of cases of tetanus in adults admitted to the Korle-bu Teaching Hospital, Accra, Ghana, from 1 January 1994 to 31 December, 2001. Methods: Information was extracted from the admission and discharge registers of the Isolation Unit of Korle-bu Teaching Hospital, Accra and case notes were examined and analysed. Results: There were 158 (76.6%) males) cases of tetanus with mean age of 32.7 ± 15.0 years. The peak age was in the 20-29 year group. Admission rate was lowest during the raining season months of June-August. Traumatic injury occurred outdoors (56.9%) and was caused by deep prick (24.3%), or cut (16.2%). The most common site of injury was on the lower (44.6%) limbs. The time interval between injury and admission was 8.3 ± 22.4 weeks (range 1-156 weeks) and the duration of symptoms was 2.9 ± 2.7 days (range 1.0-21.0 days). The most common presenting features were locked jaw (82.4%), general spasm (62.2%), presence of a wound (53.7%) and neck stiffness (50.0%). Hospital admission was 11.4 ± 11.6 (range 0-53) days. The case mortality was 50% (79/158). Conclusion: These results confirm that adult tetanus is still very prevalent in Ghana and is occurring in a younger age group compared to that in the developed countries. The case mortality is still very high.