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Open Access 01-12-2009 | Research article

Sequelae due to bacterial meningitis among African children: a systematic literature review

Authors: Meenakshi Ramakrishnan, Aaron J Ulland, Laura C Steinhardt, Jennifer C Moïsi, Fred Were, Orin S Levine

Published in: BMC Medicine | Issue 1/2009

Abstract

Background

African children have some of the highest rates of bacterial meningitis in the world. Bacterial meningitis in Africa is associated with high case fatality and frequent neuropsychological sequelae. The objective of this study is to present a comprehensive review of data on bacterial meningitis sequelae in children from the African continent.

Methods

We conducted a systematic literature search to identify studies from Africa focusing on children aged between 1 month to 15 years with laboratory-confirmed bacterial meningitis. We extracted data on neuropsychological sequelae (hearing loss, vision loss, cognitive delay, speech/language disorder, behavioural problems, motor delay/impairment, and seizures) and mortality, by pathogen.

Results

A total of 37 articles were included in the final analysis representing 21 African countries and 6,029 children with confirmed meningitis. In these studies, nearly one fifth of bacterial meningitis survivors experienced in-hospital sequelae (median = 18%, interquartile range (IQR) = 13% to 27%). About a quarter of children surviving pneumococcal meningitis and Haemophilus influenzae type b (Hib) meningitis had neuropsychological sequelae by the time of hospital discharge, a risk higher than in meningococcal meningitis cases (median = 7%). The highest in-hospital case fatality ratios observed were for pneumococcal meningitis (median = 35%) and Hib meningitis (median = 25%) compared to meningococcal meningitis (median = 4%). The 10 post-discharge studies of children surviving bacterial meningitis were of varying quality. In these studies, 10% of children followed-up post discharge died (range = 0% to 18%) and a quarter of survivors had neuropsychological sequelae (range = 3% to 47%) during an average follow-up period of 3 to 60 months.

Conclusion

Bacterial meningitis in Africa is associated with high mortality and risk of neuropsychological sequelae. Pneumococcal and Hib meningitis kill approximately one third of affected children and cause clinically evident sequelae in a quarter of survivors prior to hospital discharge. The three leading causes of bacterial meningitis are vaccine preventable, and routine use of conjugate vaccines could provide substantial health and economic benefits through the prevention of childhood meningitis cases, deaths and disability.

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The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1741-7015/7/47/prepub

Title: Sequelae due to bacterial meningitis among African children: a systematic literature review
Authors: Meenakshi Ramakrishnan
Aaron J Ulland
Laura C Steinhardt
Jennifer C Moïsi
Fred Were
Orin S Levine
Publication date: 01-12-2009
Publisher: BioMed Central
Published in: BMC Medicine / Issue 1/2009
Electronic ISSN: 1741-7015
DOI: https://doi.org/10.1186/1741-7015-7-47

At a glance: The STEP trials

Springer Medicine

Sequelae due to bacterial meningitis among African children: a systematic literature review

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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