Severe tetanus in Malawi: where are the female patients?

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.