Acute bacterial meningitis in children admitted to the Queen Elizabeth Central Hospital Blantyre, Malawi in 1996-97.

Abstract

In order to design appropriate interventioos, we collected clinical and demographic data prospectively on all children aged one day to 14 years admitted with a diagnosis of bacterial meningitis (BM) from April 1st 1996 to March 31st 1997 to the Queen Elizabeth Central Hospital (QECH), Blantyre Malawi. During the study period 267 children (2.7% of all paediatric admissions) were found to have BM; 83% were under 5 years of age, 61 % under one year and 23% under one month. The most common causative organisms in the post neonatal period (n = 206) were Streptococcus pneumoniae (27%), Haemophilus influenzae type b (Hib) 21 %, and Salmonella typhimurium (6%). In the neonatal group «I month, n = 61) the most common causes were Streptococcus agalactiae (23%), S. typhimurium (15%), S. pneumoniae (11. 5%) and other gram negative rods (11.5%). Nineteen of 21 salmonella infections were in children under one year of age and all S. agalactiae were in infants under three months. There was delay on presentation: the average length of fever was 4.6 days, 39.5% had convulsed prior to arrival and 57% had an altered level of consciousness. An initial diagnosis of malaria had probably contributed to the delay in 22.5% , (42 of 186 tested). Forty eight percent were < 80% weight for age, with 18% < 60 % weight for age. The overall mortality was 40%. The outcome was worst in salmonella infections, particularly neonatal salmonella BM with a case fatality rate (CFR) of 89% (8 of 9 cases). Coma on presentation worsened prognosis (mortality 64% if Blantyre Coma Score <3, 26% if > 3). Fifteen percent of survivors had sequelae on discharge. Twenty percent of Hib isolates were resistant to chloramphenicol, but all salmonellae were sensitive. Five percent of S. pneumoniae were resistant to penicillin and 8% to chloramphenicol. Earlier access to adequate health care and awareness of BM in a malaria endemic area would reduce mortality and morbidity. Vaccination against Hib infection would have reduced death by 18 (17%) and prevented sequelae in 7.