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.