Survival and long-term neurodevelopmental outcome of children admitted to a Kenyan district hospital with pneumo, coccal meningitis

Abstract

Objective: To determine the frequency and risk factors of long-term neurodevelopmental sequelae associated with pneumococcal meningitis in children admitted to Kilifi District Hospital (KDH). Design: A retrospective study consisting of a historical cohort of cases identified from the database of admissions that was compared to two control groups (Hospital and Community children). Setting: A well demarcated area within Kilifi District, Kenya. Evaluation of study participants was performed at assessment centre within KDH. Methods: Children treated for pneumococcal meningitis (defined as a cerebrospinal fluid culture, Gram stain or latex test positive for Streptococcus pneumoniae) during the period 1994-2004 (Cases) at KDH were identified from the admission database, and those that lived in the area undergoing demographic surveillance were sought in the community. The cases found alive were assessed for neurodevelopmental deficits and compared to age and sex matched controls from the study area. Verbal autopsy was used to determine the cause of death in those children that died following dischar ge. Results: 26.3% of children admitted with pneumococcal meningitis at KDH died in hospital before discharge. We followed up 92 cases that had been discharged alive and who lived in the demographic surveillance area, 5(5.4%) had died after discharge, 9(9.2%) had emigrated from the study area and 3(3.3%) refused consent. A total of203 children were assessed, 75 cases and 128 controls. Median age in years at evaluation was 8.0 for both cases and controls. The disorders observed among cases were speech deficits (13%), hearing loss (40%), vision defects (8%), epilepsy (14%), motor disorders (10%) and behavioural problems (15%). Rates ofneurosequelae in the three groups assessed differed with the highest figure (53%) being observed among children exposed to pneumococcal meningitis. The risk of developing neurological deficits for cases was R.R 1.7; 95%C.I (1.1 to 2.7) in comparison to hospital cohort and R.R 2.5; (C.I 95% 1.5 to 4.2) in relation to community cohort. Predictors of poor neurological outcome in the cases were young age «1 year) and convulsions while prostration and fever (>37.50C) at admission were protective. The Disability Adjusted Life Years associated with the disease was 14.1 years per child affected. Conclusion: Pneumococcal meningitis in children is associated with a high rate of neurodevelopmental disorders and fatality. Children with pneumococcal meningitis are at an increased risk of developing neurological complications which persist 1-10 years from the time of infection. Recommendation: Neurological evaluation is recommended at discharge in all children treated for pneumococcal meningitis. The children should also be subjected to close neurological monitoring after discharge to ensure early diagnosis and timely management of complications to avert severe disabilities and preventable mortality.