Pre-post effects of a tetanus care protocol implementation in a sub-Saharan African intensive care unit (Record no. 19943)
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| 000 -LEADER | |
|---|---|
| fixed length control field | 04444nam a22003737a 4500 |
| 003 - CONTROL NUMBER IDENTIFIER | |
| control field | OSt |
| 005 - DATE AND TIME OF LATEST TRANSACTION | |
| control field | 20240305193746.0 |
| 008 - FIXED-LENGTH DATA ELEMENTS--GENERAL INFORMATION | |
| fixed length control field | 221206b |||||||| |||| 00| 0 eng d |
| 028 ## - PUBLISHER OR DISTRIBUTOR NUMBER | |
| Source | Phone: +255 28 298 3384 |
| Source | Fax: +255 28 298 3386 |
| Source | Email: vc@bugando.ac.tz |
| Source | Website: www.bugando.ac.tz |
| 040 ## - CATALOGING SOURCE | |
| Language of cataloging | English |
| Transcribing agency | DLC |
| 041 ## - LANGUAGE CODE | |
| Language code of text/sound track or separate title | English |
| 100 ## - MAIN ENTRY--PERSONAL NAME | |
| Personal name | Riaz Aziz |
| 9 (RLIN) | 20186 |
| 245 ## - TITLE STATEMENT | |
| Title | Pre-post effects of a tetanus care protocol implementation in a sub-Saharan African intensive care unit |
| 260 ## - PUBLICATION, DISTRIBUTION, ETC. | |
| Place of publication, distribution, etc. | Mwanza, Tanzania: |
| Name of publisher, distributor, etc. | Public Library of Science & |
| -- | Catholic University of Health and Allied Sciences [CUHAS – Bugando] |
| Date of publication, distribution, etc. | August 30, 2018 |
| 300 ## - PHYSICAL DESCRIPTION | |
| Extent | Pages e0006667 |
| 490 ## - SERIES STATEMENT | |
| Series statement | Aziz R, Colombe S, Mwakisambwe G, Ndezi S, Todd J, Kalluvya S, et al. (2018) Pre-post effects of a tetanus care protocol implementation in a sub-Saharan African intensive care unit. PLoS Negl Trop Dis 12(8): e0006667. https://doi.org/10.1371/journal.pntd.0006667 |
| 520 ## - SUMMARY, ETC. | |
| Summary, etc. | Abstract:<br/><br/>Background: Tetanus is a vaccine-preventable, neglected disease that is life threatening if acquired and occurs most frequently in regions where vaccination coverage is incomplete. Challenges in vaccination coverage contribute to the occurrence of non-neonatal tetanus in sub-Saharan countries, with high case fatality rates. The current WHO recommendations for the management of tetanus include close patient monitoring, administration of immune globulin, sedation, analgesia, wound hygiene and airway support [1]. In response to these recommendations, our tertiary referral hospital in Tanzania implemented a standardized clinical protocol for care of patients with tetanus in 2006 and a subsequent modification in 2012. In this study we aimed to assess the impact of the protocol on clinical care of tetanus patients and their outcomes.<br/><br/>Methods and findings: We examined provision of care and outcomes among all patients admitted with non-neonatal tetanus to the ICU at Bugando Medical Centre between 2001 and 2016 in this retrospective cohort study. We compared three groups: the pre-protocol group (2001–2005), the Early protocol group (2006–2011), and the Late protocol group (2012–2016) and determined associations with mortality by univariable logistic regression.<br/><br/>We observed a significant increase in provision of care as per protocol between the Early and Late groups. Patients in the Late group had a significantly higher utilization of mechanical ventilation (69.9% vs 22.0%, p< 0.0001), provision of surgical wound care (39.8% vs 20.3%, p = 0.011), and performance of tracheostomies (36.8% vs 6.7%, <0.0001) than patients in the Early group. Despite the increased provision of care, we found no significant decrease in overall mortality in the Early versus the Late groups (55.4% versus 40.3%, p = 0.069), or between the pre-protocol and post-protocol groups (60.7% versus 50.0%, p = 0.28). There was also no difference in 7-day ICU mortality (30.1% versus 27.8%, p = 0.70). Analysis of the causes of death revealed a decrease in deaths related to airway compromise (30.0% to 1.8%, p<0.001) but an increase in deaths due to presumed sepsis (15.0% to 44.6%, p = 0.018).<br/><br/>Conclusion: The overall mortality in patients suffering non-neonatal tetanus is high (>40%). Institution of a standardized tetanus management protocol, in accordance with WHO recommendations, decreased immediate mortality related to primary causes of death after tetanus. However, this was offset by an increase in death due to later ICU complications such as sepsis. Our results illustrate the complexity in achieving mortality reduction even in illnesses thought to require few critical care interventions. Improving basic ICU care and strengthening vaccination programs to prevent tetanus altogether are essential components of efforts to decrease the mortality caused by this lethal, neglected disease.<br/> |
| 700 ## - ADDED ENTRY--PERSONAL NAME | |
| 9 (RLIN) | 23034 |
| 9 (RLIN) | 22982 |
| 9 (RLIN) | 46781 |
| 9 (RLIN) | 46782 |
| 9 (RLIN) | 46783 |
| 9 (RLIN) | 46678 |
| 9 (RLIN) | 22760 |
| 9 (RLIN) | 45114 |
| 9 (RLIN) | 46784 |
| 9 (RLIN) | 46785 |
| 9 (RLIN) | 45967 |
| 856 ## - ELECTRONIC LOCATION AND ACCESS | |
| Uniform Resource Identifier | <a href=" https://doi.org/10.1371/journal.pntd.0006667 "> https://doi.org/10.1371/journal.pntd.0006667 </a> |
| 942 ## - ADDED ENTRY ELEMENTS (KOHA) | |
| Source of classification or shelving scheme | ddc |
| Koha item type | RESEARCH ARTICLES |
| Withdrawn status | Lost status | Source of classification or shelving scheme | Damaged status | Not for loan | Collection | Home library | Current library | Shelving location | Date acquired | Total checkouts | Barcode | Date last seen | Copy number | Price effective from | Koha item type |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MWALIMU NYERERE LEARNING RESOURCES CENTRE-CUHAS BUGANDO | MWALIMU NYERERE LEARNING RESOURCES CENTRE-CUHAS BUGANDO | 12/06/2022 | RA1151 | 12/06/2022 | RA1151 | 12/06/2022 | RESEARCH ARTICLES |