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Risk factors for death and severe sequelae in Malawian children with bacterial meningitis, 1997-2010

David W McCormick1, Mark L Wilson, Limangeni Mankhambo

  • 1Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA. dmccorm4@uthsc.edu

The Pediatric Infectious Disease Journal
|August 24, 2012
PubMed
Abstract

Insights

Impaired consciousness and HIV infection significantly increase the risk of death in children with acute bacterial meningitis (ABM). These factors, along with specific bacterial causes, are critical for understanding pediatric ABM outcomes.

Area of Science:

  • Pediatric infectious diseases
  • Epidemiology
  • Global health

Background:

  • Acute bacterial meningitis (ABM) is a major cause of childhood death and disability globally.
  • While HIV is a known risk factor, other significant risk factors for pediatric ABM outcomes remain unclear.

Purpose of the Study:

  • To identify major risk factors for death and severe sequelae in children with acute bacterial meningitis (ABM).
  • To analyze the impact of HIV seropositivity, impaired consciousness, and causative organisms on pediatric ABM outcomes in Malawi.

Main Methods:

  • Retrospective analysis of 1784 pediatric cases (<15 years) of ABM from 1997-2010 at Queen Elizabeth Central Hospital, Blantyre, Malawi.
  • Univariate and multivariate logistic regression models were employed to assess associations between risk factors and outcomes.

Main Results:

  • Impaired consciousness or coma at admission strongly predicted death (OR=14.4) and severe sequelae (OR=3.27).
  • HIV seropositivity was associated with increased odds of death (OR=1.65) but not severe sequelae (OR=0.88).
  • Salmonella spp. infection increased death odds (OR=2.11), while pneumococcal meningitis increased severe sequelae odds (OR=1.84).

Conclusions:

  • Impaired consciousness and HIV infection are significant risk factors for death in Malawian children with ABM.
  • Pneumococcal conjugate vaccine introduction could substantially decrease the burden of ABM in the region.

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