Predictors of Bacterial Meningitis Among Paediatric Patients Aged 0-5 Years Hospitalized at Kenyatta National Hospital

Abstract

Background: Meningitis remains a common and serious problem in children worldwide. One million instances of meningitis are assessed to happen in children worldwide each year. In Africa, where outbreaks are common 70% of meningitis cases are diagnosed in children under the age of five (5) years. Though in most cases, doctors diagnose early and adequate treatment started, 5% to 10% of patients still succumb during the 24-48 hours after onset of clinical features. In 2009, the mortality rate in Africa was four thousand deaths. Study Objective: This study describes the predictors of bacterial meningitis among children aged 0-5years admitted at Kenyatta National Hospital (K.N.H) paediatric wards. Methodology: The study adopted a descriptive cross-sectional design. It was carried out in K.N.H paediatric wards. Data was obtained from consenting parent or guardian and healthcare workers (nurses and registrars). Study participants were selected by convenient sampling method. A total of 104 study participants were included in the study sample. In-depth interviews of key informants were conducted on 7 health workers; 5 nurses from the paediatric wards and paediatric emergency unit and 2 paediatric registrars. Ethical consideration included full disclosure to participants, confidentiality, security of health records and informed consent. Data was collected by use of researcher administered semi-structured questionnaire and desk reviews of patients files were also used. Qualitative data from the interviews was audio-taped. Logistic regression analysis was used for data analysis. Quantitative data was cleaned, entered and analysed using Statistical Package for Social Sciences (SPSS) version 23. Results were displayed by utilization of tables, pie charts. Qualitative data was transcribed, grouped in themes and analysed manually. Study Results: The majority of the children (55.8%) were female. The highest percentage of the children (53.8%) were aged less than one year. The highest proportion of the parents (39.4%) were within the age group of 26-30 years. Neonatal sepsis (37.5%), neonatal jaundice (25.0%) and for observation (25.0%) were the common reasons for admission to NBU. Children admitted and managed in the nursery unit were significantly 2.7 times more likely to have bacterial meningitis compared to those children never admitted to the nursery [OR=2.75; 95%CI=1.08-7.00; P=0.031]. Streptococcus pneumonia was the main (51.2%) causative agent of bacterial meningitis among the children. Children who were taken to hospital in delay after illness were 1.740 times more likely to exhibit meningitis than those taken to hospital immediately. Children whose parents had higher levels of income were two times less likely to exhibit meningitis than those with lower. Majority (62.5%) resided in mid urban and slum areas. Most lived in a one (1) bed-roomed house and most houses (60.6%) had more than five people living in it. The main co-existing illnesses among the children were pneumonia (53.8%) and heart disease (22.9%). Conclusions: Streptococcus pneumoniae was the common causative agent of meningitis among the study population. The enviromnetal factors such as living in overcrowded areas, inadequate exposure to health education contributed to contracting and developing meningitis. Financial contraints among caregivers posed a hindrance to the participants in seeking medical attention early. A previous upper respiratory tract infection more often led to contracting meningitis. The study duration was four (4) months at an estimated cost of Kshs.102,580.00.