Reduction of mortality due to tetanus by immunisation and proper wound management of the patients in Sengerema Designated District Hospital, Tanzania.

Tetanus is a life-threatening, preventable infection with a high mortality. Our aim was to determine the changes in incidence and case fatality rate at Sengerema Designated District Hospital in a retrospective review of patients who had been hospitalised with tetanus between 1962 and 2012. In the 1970s and 1980s a vaccination campaign was organised in order to cover the whole district and to provide immunity for tetanus. Data are based on 476 cases with a fatal outcome in 305 cases. The case fatality rate has declined from 74% between 1982 and 1991 to 11.1% currently. Improved facilities are required in order to significantly reduce adverse outcome from tetanus.

TETANUS NEARLY ELIMINATED AFTER 40 YEARS OF VACCINATION IN RURAL SENGEREMA DISTRICT, TANZANIA.

OBJECTIVE: To study the incidence of tetanus during the last 50 years in Sengerema, Tanzania. DESIGN: Analysing the annual reports in the only district hospital, focusing on the number of admissions and mortality for tetanus and malaria. SETTING: Sengerema Hospital, Sengerema district, Tanzania. SUBJECT: Number of admissions and mortality in Sengerema Hospital due to tetanus. INTERVENTIONS: In the seventies and eighties a vaccination campaign was started end organised in order to cover the whole district and to provide immunity for tetanus. MAIN OUTCOME MEASURES: From 1962 to 2012, we analysed the incidence and fatality rate of tetanus. RESULT: One hundred and fifteen admissions in the sixties, increasing to 183 in the seventies, dropping to 30 in the nineties. For the last ten years 18 patients with tetanus were seen in the only district hospital. Then last year no admissions for tetanus were registered. The number of deaths due to tetanus decreased simultaneously, during the last decade a single fatality case was reported. CONCLUSION: During the last decades, we have witnessed the disappearing of tetanus in Sengerema Hospital. The incidence of tetanus can be reduced significantly or eliminated by an effective immunisation programme, even in rural Tanzania.

RELAPSING FEVER, A DISAPPEARING CAUSE OF FEVER AND MATERNAL DEATH IN SENGEREMA, TANZANIA, EAST AFRICA.

OBJECTIVE: To study the incidence of tick borne relapsing fever (TBRF) during the last 50 years, once like malaria an endemic disease in Sengerema, Tanzania. DESIGN: By analyzing the annual reports, focusing on the number of admissions, maternal deaths, blood smears of patients with fever for Borrelia. SETTING: Sengerema district, Tanzania. SUBJECT: Admissions in Sengerema Hospital due to TBRF. MAIN OUTCOME MEASURES: From 1960 to 2010, we analyzed the incidence of TBRF. RESULT: Forty annual admissions in the sixties/seventies, 200 in the eighties (range from 37 in 1964 to 455 in 1988), dropping to 30 in the nineties. For the last nine years no Borrelia spirochetes were found in blood smears at the laboratory anymore and no admissions for TBRF were registered. The number of maternal deaths due to relapsing fever decreased simultaneously; the last one recordedwas in 2002. CONCLUSION: During the last century, we have witnessed the disappearing of tick borne relapsing fever in Sengerema. Increase of gold mining, improved local economy, housing and standards of living after the nineties resulted in an almost complete eradication of the incidence of TBRF.