Indicators of Acute Bacterial Meningitis in Children at a Rural Kenyan District Hospital

Predictors of Acute Bacterial Meningitis in Children from a Malaria-Endemic Area of Papua New Guinea

“…9 Although, by contrast, a positive blood film in children in Kenya was independently associated with the absence of ABM, a negative malaria slide added little to a predictive model of ABM. 15 In the present study, no child with proven ABM and only one with probable ABM had malaria identified by microscopy. Malarial parasitemia, regardless of the infecting species, was independently associated with the absence of ABM and, more importantly, the addition of presence of malaria parasites to the logistic regression model influenced the utility of clinical signs.…”

“…In studies from the highlands of Papua New Guinea, where there is no malaria transmission 8 and from countries in Africa with holo-endemic Plasmodium falciparum malaria, 9,15 neck stiffness and a bulging fontanel were independently associated with ABM. Other features such as refusal to eat, staring eyes, and convulsions were inconsistent associates.…”

“…Microscopy is often available in facilities treating febrile children in malaria-endemic areas, but the presence of malaria parasites on a blood film did not add significantly to clinical variables in studies of predictors of ABM in children in Africa with severe febrile illness. 9,15 A recent systematic review of the clinical features of pediatric ABM in which 8 of 10 included studies were from tropical countries 16 concluded that many individual predictive variables and especially their combinations warranted further evaluation. In addition, available data from malaria-endemic versus non-malaria-endemic areas 8,9,15 emphasize that clinical prediction algorithms for ABM will depend on local epidemiology.…”

“…9,15 A recent systematic review of the clinical features of pediatric ABM in which 8 of 10 included studies were from tropical countries 16 concluded that many individual predictive variables and especially their combinations warranted further evaluation. In addition, available data from malaria-endemic versus non-malaria-endemic areas 8,9,15 emphasize that clinical prediction algorithms for ABM will depend on local epidemiology. Because low-lying areas of Papua New Guinea and other countries in the Oceania region are epidemiologically distinct from the highlands of Papua New Guinea and sub-Saharan Africa in that there is transmission of P. vivax as well as P. falciparum, the aim of the present study was to prospectively identify clinical and basic laboratory predictors of ABM in well-characterized severely ill children who came to the provincial referral hospital in Madang Province on the northern coast of mainland Papua New Guinea.…”

Adult and paediatric mortality patterns in a referral hospital in Liberia 1 year after the end of the war

“…15,26,29,30 The proportion of admissions for meningitis was similar in Mamba Point and in a Kenyan hospital: 3% and 2% respectively. 35 The main difference was the higher proportion of diarrhoea in other hospitals: 21% of the admissions with an associated CFR of 11% in Zimbabwe 28 and 20% of the admissions in Mali 29 In Mamba Point Hospital, diarrhoea was common, but it was associated with other major diseases and only the main diagnosis was considered in the analysis. It is remarkable that, as in other hospitals in Monrovia, no paediatric cases of AIDS were diagnosed.…”