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Severe tetanus in Malawi: where are the female patients?

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Abstract

Aim

The treatment of severe tetanus is a challenge for the resource-poor countries in Africa. In the critical care unit at the University of Malawi’s largest teaching hospital (Queen Elizabeth Central Hospital), we have seen more male than female adult patients suffering from severe tetanus. Here we tried to determine, whether it is true or not, that what we are seeing is a developing “gender-shift” in Malawian adult patients with severe tetanus.

Method

We retrospectively reviewed medical records of patients treated at the critical care unit of the Queen Elizabeth Central Hospital during 2006–2015 and interviewed senior staff in the four central hospitals and in 20 hospitals in the districts.

Results

From 2006 to 2015 we treated 21 adult patients (≥18 years) suffering from severe tetanus in our intensive care unit (ICU). There were 19 male patients (90.4 %), 1 female patient (4.8 %) and one patient with missing data on gender (4.8 %). Staff interviewed countrywide identified eight cases of severe tetanus in the other three central hospitals (all male) and two male patients in the 20 hospitals in the districts since 2013. Countrywide we found 31 cases of severe tetanus of which 29 (93.9 %) were male and only 1 female (3.05 %). We have not been able to identify any female adult patients suffering from severe tetanus in Malawi since 2012.

Conclusion

Adult generalized tetanus is no longer very common in Malawi. Severe tetanus nowadays seems to be a predominantly male disease in Malawi. Post-exposure immunization and co-immunization for the male partner during antenatal care should be intensified.

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Acknowledgements

Our thanks goes to Sydney, our ICU administrator, for his tireless work.

Contributions

Gregor Pollach: Concept, writing, interviews, data collection, anaesthesia consultant for the tetanus patients in Blantyre; Cyril Goddia: Data collection, interviews; Felix Namboya: Discussions, interviews, anaesthesia consultant for the tetanus patients in Blantyre; Thomas Luiz: Guidance on financial relevance, preparation of the first draft, result review; Camilla Rothe: Initial discussion of the idea, writing, infectious diseases consultant for the tetanus patients in Blantyre.

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Authors and Affiliations

  1. Department of Anaesthesia and Intensive Care, College of Medicine, University of Malawi, Chichiri, Blantyre 3, BP 360, Malawi

    Gregor Pollach & Felix Namboya

  2. Department of Anaesthesia and Intensive Care, Queen Elizabeth Central Hospital, Chipatala Road 1, Blantyre, Malawi

    Gregor Pollach & Cyrill Goddia

  3. Westpfalz-Klinikum, Helmut-Hartert-Street 1, Kaiserslautern, Germany

    Gregor Pollach & Thomas Luiz

  4. Department of Internal Medicine, College of Medicine, University of Malawi, Chichiri, Blantyre 3, BP 360, Malawi

    Camilla Rothe

Authors
  1. Gregor Pollach
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  2. Cyrill Goddia
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  3. Felix Namboya
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  4. Thomas Luiz
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  5. Camilla Rothe
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Corresponding author

Correspondence to Gregor Pollach.

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Conflict of interest

The authors declare that they have no conflict of interest. This study did not receive any funding. No patient can be identified, no picture of a patient was used and no procedure was carried out on a patient, thus no informed consent or approval of an ethics committee was necessary.

Disclaimer

This study did not receive any funding. None of the participants has a conflict of interest.

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Pollach, G., Goddia, C., Namboya, F. et al. Severe tetanus in Malawi: where are the female patients?. J Public Health 24, 401–408 (2016). https://doi.org/10.1007/s10389-016-0735-6

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  • DOI: https://doi.org/10.1007/s10389-016-0735-6

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