Determinants of Mortality of Acute Bacterial Meningitis among Yemeni Children in a Tertiary Referral Hospital in Sana’a
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- Category: Vol. 85, June 2017
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Determinants of Mortality of Acute Bacterial Meningitis among Yemeni Children in a Tertiary Referral Hospital in Sana’a, NAJLA AL-SONBOLI, ARWA AL-HARAZI, ABDULLA M. BIN ALZOA, ALI AL-ERYANI, NASHER AL-AGHBARI, ZEKRA AL-SHAEKH and BASHEER ABO ASBA
Abstract
Background: Acute bacterial meningitis (ABM) causes significant case fatality rate and disability in children world-wide. However, the major risk factors for death in pediatric ABM remain unclear and it is very important to be identified to decrease the case fatality rate and its adverse sequelae.
Aim: To determine the risk factors of mortality among children with acute bacterial meningitis.
Methods: A prospective cross sectional study conducted during the period from January 2009 up to March 2015 in Al-Sabeen Hospital for Maternity and Children, a tertiary hospital in Sana'a, Yemen. It is one of the participating hospitals in the national surveillance system for acute bacterial meningitis. The World Health Organization (WHO) clinical case definitions and standard laboratory operations procedures were used. Lumbar puncture (LP) was done for all the study population. Data collected using standardized case report and analyzed using Epi Info software version 3.5.1 (2008). Univariate analysis and multivariate logistic regression models were used to estimate the effects of the clinical, laboratory findings and causative organism on death.
Results: A total of 2096 suspected cases were enrolled, out of them, 822 (3 9%) children were diagnosed as ABM according to the used standard case definition that were approved for this study. The mean age (SD) of children with ABM was 21.2 (33.6) months.
The most common presenting symptoms were fever (96%) and seizers (78%). CSF culture was performed in 705 (86%) samples and found positive in 25 (3%) of the samples. The outcome was complete cure in 712 (87%) of the children, 27 (3.3%) died, 13 (1.6%) were transferred to other health facilities and 70 (8.5) discharged against medical advice (DAMA). Fifty four (7%) children developed complications during the course of hospitalization. In comparison to children who were completely cured [712 (87%)] and those who died [27 (3.3%)] using multivariate logistic regression models, altered mental status and coma were found statistically sig nificantly associated with death [altered mental status: AOR = 3.3, 95% CI (1.3-8.3)]; [Coma: AOR = 5, 95% CI (1.5-16)]. Similarly, the presence of complications during the course of hospitalization [AOR=9.5, 95% CI (3.5-26)]. Regarding the laboratory results we found that, positive cerebrospinal fluid culture (CSF) [AOR = 12.3, 95% CI (4-37.6)] was strongly associated with increased odds of death. However, in univariate analysis low cerebrospinal fluid sugar (<45mg/dl) (OR = 2.9, 95% CI (1.3-6.6)] and Streptococcus pneumoniae (S pnuemo-niae) (OR = 23, 95% CI (6-79)] were statistically significant risks for mortality although multivariate logistic regression analysis showed that they were not independent risk factors for death.
Conclusions: Altered mental status, coma, presence of complication during hospitalization, culture positivity, low CSF glucose and S pneumoniae increased the odds of death from ABM among Yemeni children. Improving the health service in clinical care, increasing the coverage rate of the pneumococcal conjugate vaccine could greatly reduce the burden of ABM in Yemen and its case fatality rate.