Non-Neonatal Tetanus in Mogadishu, Somalia: Clinical Characteristics, Management, and Outcomes—First Report from a Tetanus Referral Centre

Abstract

Background: Tetanus remains a life-threatening yet preventable disease, with a disproportionate burden in low- and middle-income countries. Data on non-neonatal tetanus in Somalia, particularly from referral centres managing severe cases, are limited. This study aimed to describe the clinical characteristics, management, and outcomes of patients with non-neonatal tetanus in Mogadishu, Somalia. Methods: This retrospective observational study was conducted at Madina Hospital between July 2024 and January 2026. All patients with clinically diagnosed non-neonatal tetanus presenting to the Emergency Department were included. Data on demographics, clinical features, management, complications, and outcomes were extracted from medical records. Continuous variables were summarized as mean ± standard deviation or median (interquartile range), while categorical variables were presented as frequencies and percentages. Associations were assessed using Fisher’s exact test, with p < 0.05 considered statistically significant. Results: A total of 50 patients were included (mean age 22.24 ± 15.49 years; 84.0% male). Most patients were unvaccinated (80.0%), and severe or very severe disease was present in 64.0% of cases. Generalized muscle spasm was the most common presentation (50.0%). Dysautonomia (42.0%) and respiratory failure (18.0%) were the most frequent complications. The overall in-hospital mortality rate was 26.0%, with respiratory failure accounting for 69.2% of deaths. Mortality was significantly associated with disease severity (p < 0.001), complications (p = 0.006), antibiotic category (p = 0.043), and vaccination status (p = 0.0265). Conclusions: Non-neonatal tetanus in this referral-based setting is associated with high mortality, predominantly affecting young, unvaccinated individuals presenting with advanced disease. Disease severity and complications, particularly respiratory failure, are the main drivers of outcomes. Strengthening adult immunization, improving early recognition and referral, and expanding access to critical care are essential to reduce tetanus-related mortality.