Tetanus Deaths are Preventable

Jude Thaddeus Ssensamba

Quality Improvement Officer, Uganda, USAID ASSIST Project/URC

This post originally appeared as an editorial on the New Vision newspaper in Uganda on Friday, March 21.

In just one week, two people close to me succumbed to tetanus, not counting the New Vision newspaper photographer. These are a few of the notable rising number of people dying from an immunizable disease that can be prevented by simple, affordable health interventions. With rising mortality, it’s time that we acted to improve the quality of health care given to accident, trauma and violence victims.

Tetanus is caused by a “stubborn” organism clostridium tetani which can survive the harshest conditions in the world. Every day, each one of us interfaces with dormant forms of tetanus (spores) and shares an equal and demonstrable risk of acquiring the disease; from a farmer deep in the village to someone living in an air conditioned apartment, suite or office in a town irrespective of age or education.

The roll-out of routine immunisations has been instrumental in greatly reducing the burden of tetanus however; this effort is undermined by the quality of health care offered to accident, trauma and violence victims in both public and private health care settings.

Tetanus Deaths Are Preventable

For the cases I have investigated, all clients affected were able to reach a health facility less than an hour after the accident and their deaths raise questions on the quality of care accorded at those facilities.

Other than immunisation, it is continuously preached across all health training institutions that; a simple thorough wound cleaning (surgical toilet) would highly reduce the risk of tetanus based on simple science that these organisms cannot grow or multiply in oxygenated (exposed) conditions.

It is also standard operating procedure that a client with a deep cut or puncture wound must get anti tetanus serum or at least, tetanus toxoid. It’s a pity that none of my friends got any of these interventions. The New Vision employee had to keep the organisms in his body for more than a month until it brought him down yet if only tetanus toxoid had been given there and then, probably he would have been saved.

I will not be tempted to think so, but health settings are also known hubs of tetanus whereby poor sterilisation of instruments used on tetanus cases can act as an inoculant to clients with wounds. This said, it’s common that the affected person will most likely visit a lower level private health facility before continuing to a public facility and unfortunately it’s here where the biggest injustice is done.

It is such quality gaps in the health system that need to be addressed.

What can we do?

For all of us, whenever you get a deep wound or cut, rush to a health facility as soon as possible. It is your right to tell the health worker to clean your wound thoroughly and also to ask for a shot of anti-tetanus serum or tetanus toxoid in addition to antibiotics. It is also advisable for everyone to periodically have booster doses of tetanus toxoid at least every 10 years.

The quality improvement model should also be taken to surgery and patient care. This would see; health workers capacity built, surgery guidelines and operating quality standards and indicators developed, rolled out, monitored and evaluated in both public and private health settings. Government should extend the quality of health care approach to private health practitioners through policy and legislation. Even with funding constraints a lot can be done to avert tetanus which kills in a very painful way.

 

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