Analysis of the indications and results of cerebrospinal fluid examination in children admitted to the paediatric wards of two hospitals in east Africa

Abstract

Objectives: To compare indications for lumbar puncture and ndings of cerebrospinal uid examination in children admitted at Muhimbili National Hospital (MNH) in Dar-es-salaam, Tanzania and Kili District Hospital (KDH) in Kenya Study design: A descriptive, cross-sectional hospital based study. Setting: Paediatric wards of Muhimbili National Hospital (MNH) in Dar es Salaam and Kili District Hospital (KDH) in Kenya. Results: Overall, 8,741 paediatric admissions were recorded in the two hospitals; (Muhimbili = 6,228; Kili = 2,513). Of these, 607 (6.9%) had an LP performed; 154 out 6,228 (2.5%) from MNH and 453 out of 2,513 (18.0%) at KDH. The most common indications for lumbar puncture at MNH were convulsions (61.4%), neck sti ness (14.3%) and prostration (17%), whereas at KDH were convulsions (56.3%), neck sti ness (7.3%) and prostration (22.1%). The bacterial isolates were rarely (2.3%) obtained on culture at both hospitals. Streptococcus pneumonae and Salmonella species were the commonest causes of pyogenic meningitis. Conclusion & recommendations: Lumbar punctures are performed less frequently at Muhimbili than Kili Hospital. Pneumoccocus and Salmonella species are the commonest causes of pyogenic meningitis. Strategies should be put in place to improve the rates of lumbar puncture at MNH and the isolation of bacterial pathogens from cerebrospinal fluid cultures in both hospitals. Other possible causes for meningitis such as viruses need to be investigated.