Tetanus Cases in Mogadishu-Somalia: A Tragic Disease Despite the Existence of a Century-Old Safe and Efficient Tetanus Vaccine

Kaz&inodot;m K&inodot;ratl&inodot;,1 Ibrahim Mohamed Hirsi,2 Burak Çelik,3 Murat Aysin,4 Ahmed Mohamed Ali,1 Selim Turfan,5 Hakan Zeybek6 1Mogadishu Somalia Turkey Recep Tayyip Erdo&gbreve;an Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Mogadishu, Somalia; 2Mogadishu Somalia Turkey Recep Tayyip Erdo&gbreve;an Training and Research Hospital, Department of Pediatrics, Mogadishu, Somalia; 3Health Sciences University, Fatih Sultan Mehmet Training and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey; 4Balikesir University Faculty of Medicine, Department of Public Health, Balikesir, Turkey; 5Giresun Training and Research Hospital, Department of Emergency Medicine, Giresun, Turkey; 6Mogadishu Somalia Turkey Recep Tayyip Erdo&gbreve;an Training and Research Hospital, Department of Orthopedics and Traumatology, Mogadishu, SomaliaCorrespondence: Kaz&inodot;m K&inodot;ratl&inodot;, Mogadishu Somalia Turkey Recep Tayyip Erdo&gbreve;an Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Mogadishu, Somalia, Tel +252 611 522 947, Email [email protected]: Despite the efforts and support of the World Health Organization and other international organizations to reduce the incidence of the disease, tetanus is still an acute condition with serious consequences, including death. The purpose of this study was to assess the tetanus patients we have been monitoring over the past two years in Somalia, a country with a protracted civil conflict, extreme poverty, and restricted access to hospital, social security, and public health facilities.Methods: This study includes tetanus patients who were admitted to the Recep Tayyip Erdo&gbreve;an Training and Research Hospital in Mogadishu, Somalia, Turkey between January 1, 2022, and November 1, 2023. Hospitalization, diagnosis, treatment, complications, death, and test results were all looked at in addition to the patients’ sociodemographic details.Results: The average age of the 196 patients was 10 years, with males making up 67.9% of the total (min-max: 7 days-71 years). Acute injury was the cause of 53.1% of tetanus cases, with the legs being the most frequently injured body area (28.8%). A mean duration of stay of 11 days was observed for 82.1% of the patients who were monitored in the hospital (min-max: 1– 38 days). The total fatality rate was 14.3%, and 85.7% of patients had never had a tetanus vaccination. The group with severe tetanus had higher rates of intensive care admission (p< 0.001), generalized/neonatal tetanus (p< 0.001), high non-vaccination rate (p:0.011), antibiotic usage (p< 0.001), and a positive blood culture (p< 0.001). Almost all of the complications (p< 0.001) and all of the deaths (p< 0.001) were in the severe group.Conclusion: In sub-Saharan Africa, immunization rates are regrettably still insufficient despite the tetanus vaccine’s low cost and great effectiveness. Public education and encouragement on anti-vaccination must continue alongside the enhancement of vaccination programs. Otherwise, low- and middle-income countries will still be plagued by this illness, which has been overlooked in high-income nations.Keywords: immunization, Somalia, Sub-Saharan Africa, tetanus, vaccination