Pilot study on short term complications of acute bacterial meningitis in children beyond the neonatal period at Kenyatta National Hospital
Abstract
To describe the short-term complications associated with bacterial
meningitis in children 2-60 months of age.
Cohort study.
Paediatric filter clinic (PFC) and paediatric general wards at the Kenyatta
National Hospital (KN H).
Sample size of 200 was used based on an estimated prevalence of
complication of bacterial meningitis in Kenya ranges between 27-40%. Eligibility
jar inclusion required being within the age 2-60 months, constitutional features of
temperature or hypothermia in combination with anyone of 9 pre-defined clinical
findings (inclusion criteria) and an informed consent. As high as 76% of the cases
with bacteriologically unconfirmed meningitis had prior antibiotic treatment In
other health facilities before attending KNH.
Bacterial meningitis was diagnosed on basis of a positive CSF culture. gram stain or
latex test. The dialogic agents. associated mortality and complications were
documented against various exposure variables. Step-wise logistic regression v\ as
used to define independent predictors of sequelae and mortality.
Twentv-sevcn (14%) of (he study population was bacteriological I:
confirmed to have meningitis. Seventy percent of the children with confirmed
bacterial meningitis had prior antibiotic treatment in peripheral health facilities
before admission at KNH.
Overall mortality rate was 59% and 37% of the survivors sustained neurological
sequelae. S. pneumoniae and H. influenzae were the most common isolates
comprising 22/27 (81 %) of all the isolates and the two were associated 'with a high
mortality and morbidity. Out of 7 children with H. intluenzae b meningitis. six died
while one developed aphasia. Coma, aphasia, hydrocephalus, hemiparesis, seizures
and ataxic gait were observed in 9.1 % each of survivors Dr S. pneumoniac
meningitis, while deafness was in 45.5% and impaired vision in 18.2%.
The best predictors of death in children < 12 months of age were seizures (OR 5.83
[95% Cl 1.95-17.68] P-value < 0.001), coma (OR 6,44 [95% CI 2.22-19.0~J p.
value < 0.001) and nuchal rigidity (OR 8.05 [95% CI 2.92-22.19] P-value < 0.001)
for children aged 12 months to 5 years. Bulging anterior fontanel was associated
with recovery with sequelae (OR 5.26 195% IC 1.76-15.6] P-value (0.00I) in
children younger than One year.
S. pneumoniae H. influenzae b were the most common pathogens
causing meningitis in children. Hearing loss was the commonest neurologica
sequelae observed in children with ABM. The best predictors of outcome were age
<12 months, coma, nuchal rigidity and seizures.
The result or this stud) suggested that children with
meningitis should be assessed for hearing .and ophthalmic complications up to at
least 6 weeks after completion of treatment. Those with deficits should be provided
with hearing aids, in the case of hearing impairment to improve hearing.
Citation
Masters of Medicine (Paediatrics)Publisher
University of Nairobi School of Medicine