# Neonatal tetanus in South Sudan: a case series

## TL;DR

This paper reports three neonatal tetanus cases in South Sudan, highlighting the lack of resources and high mortality despite treatment.

## Contribution

The study provides a case series of neonatal tetanus in a low-resource setting, emphasizing the need for prevention and better treatment access.

## Key findings

- All three neonates with tetanus died within 24 hours of admission due to lack of essential treatments.
- Phenobarbitone was used instead of unavailable diazepam, and no tetanus immune globulin or serum was available.
- The study underscores the importance of prevention through antenatal care and vaccination in reducing neonatal tetanus mortality.

## Abstract

Neonatal tetanus is a life-threatening disease of public health importance; it is yet to be eliminated and is still occurring in South Sudan. It is caused by a neurotoxin from a bacterium Clostridium tetani whose spores exist in the environment. Compared to high-income countries, most low-income countries lack intensive care units, and magnesium sulfate shown to improve neonatal tetanus outcomes.

We aimed to determine the outcome of neonatal tetanus in Al Sabah Children's Hospital, Juba, South Sudan.

We conducted a case series study in Al Sabah Children's Hospital in Juba, South Sudan. It described three neonates who presented within the first seven days of life with a history of excessive crying, inability to breastfeed, and tetanic muscle spasms when stimulated. They had signs of respiratory distress, fever, and labile heart rates. We made a diagnosis of neonatal tetanus with autonomic dysfunction, and started them on phenobarbitone because diazepam was not available, oxygen, and antibiotics. However, tetanus immune globulin and anti-tetanus serum were not available.

Unfortunately, all three neonates died within 24 hours of admission.

Our primary focus as a nation is to improve access to quality health services and the prevention of neonatal tetanus through encouraging appropriate antenatal care, facility delivery, clean delivery and healthy umblical cord care practices, and tetanus vaccinations in teenage girls and young adults. When prevention fails, there is a need for neonatal intensive care with recommended medicines to significantly decrease mortality in this preventable tragic illness.