Date of Completion

2024

Document Type

Thesis

Degree Name

Master in Public Health

Keywords

Tetanus; magnesium sulfate; mortality; mechanical ventilation; length of hospital stay

Abstract

Introduction The consistently high mortality risk of tetanus prompts critical inquiries regarding the efficacy of current therapeutic interventions. This research delves into the demographic and clinical profiles of individuals afflicted with tetanus, and evaluated the utilization of magnesium sulfate as a treatment strategy, aiming to elucidate its potential impact on reducing mortality rates, the requirement for ventilatory support, and length of hospitalization. Methodology A retrospective cohort study which focused on adult patients hospitalized for tetanus from 1 January 2012 until 31 December 2021. It involved review of patient’s chart to analyze demographics, clinical data and treatment outcome. Results The study included 946 records; majority were males (87.6%), with a median age of 49. Most cases were moderate (72.6%) at admission. More severe to very severe cases received magnesium sulfate. Likewise, they needed more advanced airway support. Complications was encountered in a third of patients overall, however, more in magnesium sulfate group (51.9% vs 27.0%, p< 0.001).Among the complications, pneumonia was the most common (86.9%), with ventilatory support often needed, more in magnesium sulfate group (83.9% vs 61.9%, p=0.001). The median hospital stay was 9 days (IQR, 4-15), shorter for those given magnesium sulfate (6 vs 9 days, p=0.013). The range of hospital stay in days for both groups does not significantly differ ( 1.0 to 102.0,1,0 to 106.0) Most stayed 14 days or less (72.2%), but more in magnesium sulfate group needed prolonged stay (36.1% vs 26.7%, p=0.040). Approximately 31% died, higher in the magnesium sulfate group (63.0% vs 26.6%, p< 0.001). Autonomic dysfunction (57.7%) was the most common cause of death. Magnesium sulfate was given for autonomic dysfunction ( 41%) and spasm control( 37%). 75% received loading dose, 82% maintenance doses. The median duration for maintenance dose administration was 1 day ( IQR 1- 2). Cox regression analysis showed that the use of magnesium sulfate was associated with increased risk for need for mechanical ventilation ( 2.58, 1.43 to 4.27). In contrast , it did not demonstrate a reduction in the hazard ratio or risk of death ( 1.08, 0.78 to 1.50) even after adjusting for multiple factors known to influence mortality risk. Additionally, there was not enough evidence to show that there is association between the use of magnesium sulfate and length of hospitalization ( 0.87, 0.56 to 1.33) Conclusion Despite holist care, the case fatality remains high, with autonomic dysfunction as the most common cause of death in both cohorts. This underscore the need to optimize magnesium sulfate administration, early recognition and intervention. Further research is needed to establish evidence based management strategies on autonomic instability. Healthcare worker training can facilitate early diagnosis and prompt treatment. Public health efforts should prioritize catch up vaccination on middle age males. Improving access to timely care via local facilities or efficient transfer system is vital.

First Advisor

Greco Mark B. Malijan, MD, MSc

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