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Aetiology and outcome of non-traumatic coma in African children: protocol for a systematic review and meta-analysis
Stephen T J Ray1,2,3, Charlotte Fuller2,3,4, Alexandra Boubour3,5
1Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK.
Insights
Non-traumatic coma in African children is a significant health issue with high mortality. This review synthesizes evidence to identify causes and outcomes, crucial for improving diagnosis and treatment in resource-limited settings.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Public Health in Africa
Background:
- Non-traumatic coma is a frequent pediatric emergency in Africa, historically linked to cerebral malaria (CM).
- Declining malaria rates shift the diagnostic challenge to identifying non-malarial causes of coma.
- Accurate etiological diagnosis is critical in resource-limited settings due to high morbidity and mortality.
Purpose of the Study:
- To systematically evaluate the causes (etiology) of non-traumatic coma in children across Africa.
- To assess the prognosis, including morbidity and mortality, associated with non-traumatic coma in this population.
Main Methods:
- Comprehensive literature search of MEDLINE, Embase, and Scopus for relevant studies (all designs) on pediatric non-traumatic coma in Africa.
- Inclusion criteria: children aged 1 month to 16 years with coma (Blantyre Coma Score ≤ 2).
- Primary outcome: pooled prevalence of coma etiologies; Secondary outcomes: morbidity and mortality rates. Random effects meta-analysis will be employed.
Main Results:
- This section is to be populated upon study completion.
Conclusions:
- This systematic review will consolidate current evidence on the diverse causes and outcomes of non-traumatic coma in African children.
- Findings will inform diagnostic strategies and clinical management guidelines in regions facing diagnostic challenges.
Background:
Non-traumatic coma is a common acute childhood presentation to healthcare facilities in Africa and is associated with high morbidity and mortality. Historically, the majority of cases were attributed to cerebral malaria (CM). With the recent drastic reduction in malaria incidence, non-malarial coma is becoming a larger proportion of cases and determining the aetiology is diagnostically challenging, particularly in resource-limited settings. The purpose of this study will be to evaluate the aetiology and prognosis of non-traumatic coma in African children.
Methods:
With no date restrictions, systematic searches of MEDLINE, Embase, and Scopus will identify prospective and retrospective studies (including randomised controlled trials, cluster randomised trials, cohort studies, cross-sectional, and case-control studies) recruiting children (1 month-16 years) with non-traumatic coma (defined by Blantyre Coma Score ≤ 2 or comparable alternative) from any African country. Disease-specific studies will be included if coma is associated and reported. The primary outcome is to determine the aetiology (infectious and non-infectious) of non-traumatic coma in African children, with pooled prevalence estimates of causes (e.g., malaria). Secondary outcomes are to determine overall estimates of morbidity and mortality of all-cause non-traumatic coma and disease-specific states of non-traumatic coma, where available. Random effects meta-analysis will summarise aetiology data and in-hospital and post-discharge mortality. Heterogeneity will be quantified with τ2, I2, and Cochran's Q test.
Discussion:
This systematic review will provide a summary of the best available evidence on the aetiology and outcome of non-traumatic coma in African children.
Systematic Review Registration:
PROSPERO CRD42020141937.
