Open AccessFactors associated with in-hospital mortality of adult tetanus patients–a multicenter study from Bangladesh
Author(s) -
Abdullah Khan,
Mohammad Jahid Hasan,
Md. Utba Rashid,
Soumik Kha Sagar,
Shahed Khan,
Susmita Zaman,
S M Sumon,
Ariful Basher,
Mohammad Delwer Hossain Hawlader,
Mohammad Hayatun Nabi,
Nadira Sultana Kakoly
Publication year - 2022
Publication title -
plos neglected tropical diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.99
H-Index - 135
eISSN - 1935-2735
pISSN - 1935-2727
DOI - 10.1371/journal.pntd.0010235
Subject(s) - medicine , case fatality rate , proportional hazards model , hazard ratio , tetanus , confidence interval , univariate analysis , pediatrics , population , observational study , incubation period , mortality rate , epidemiology , demography , multivariate analysis , vaccination , immunology , environmental health , biochemistry , chemistry , sociology , incubation
Background Tetanus, a vaccine-preventable disease, is still occurring in the elderly population of low- and middle-income countries with a high case-fatality rate. The objective of the study was to elucidate the factors associated with in-hospital mortality of tetanus in Bangladesh. Methods This prospective observational study, conducted in two specialized infectious disease hospitals, conveniently selected adult tetanus patients (≥18 years) for inclusion. Data were collected through a preformed structured questionnaire. Kaplan Meier survival analysis and univariate and multivariable Cox regression analysis were carried out to assess factors associated with in-hospital mortality among patients. All analysis was done using Stata (version 16) and SPSS (version 26). Results A total of 61 tetanus cases were included, and the overall in-hospital mortality rate was 34.4% (n = 21). Patients had an average age of 46.49 ±15.65 years (SD), and the majority were male (96.7%), farmers (57.4%), and came from rural areas (93.4%). Survival analysis revealed that the probability of death was significantly higher among patients having an age of ≥ 40 years, incubation time of ≤12 days, onset time of ≤ 4 days, and having complication(s). However, on multivariable Cox regression analysis, age (adjusted hazard ratio [aHR] 4.03, 95% Confidence Interval [CI] 1.07–15.17, p = 0.039) and onset time (≤4 days) (aHR 3.33; 95% CI 1.05–10.57, p = 0.041) came as significant predictors of in-hospital mortality after adjusting for incubation period and complications. Conclusion Older age and short onset time are the two most important determinants of in-hospital mortality of tetanus patients. Hence, these patients require enhanced emphasis and care.