Acute Bacterial Meningitis in Zambian children: Highlighting the changing pattern in the Aetiology of Bacterial Meningitis in Zambia

Abstract

A hospital based prospective study on Acute Bacterial Meningitis (ABM) in Zambian Children was done in the department of Paediatrics, University Teaching Hospital Lusaka over a period of six months in the hot dry season (1st August to the end of November) of the years 1992 and 1993. The aim and objectives of the study were to determine the prevalence, aetiology, risk factors, poor prognostic signs, clinical profile and outcome of ABM. Nine hundred children were recruited aged one month to 15 years as cohorts, 2 9 were excluded, 871 were followed up.It was found out that almost all age groups were at risk, with ABM being commonest around 5 and half years of age. There was no sexual predilection, male to female ratio was 1.2:1, almost 90% of cases came from high density areas of Lusaka. Clinical manifestations ranged from fever with neck stiffness alone, to associated septic shock with petechial rash. The commonest complaints were fever (99%), anorexia (88.5%), headache (73.8%), vomiting (71.3%), arthralgia (about 60%), the commonest signs were; neck stiffness (96.9%), Kernigs (77.4%), Brudzinski(73%), whilst in infants fever, irritability, refusing to suck and bulging anterior fontanelle were common.The most common pathogens isolated were N.meningitidis (77.9%), S. pneumoniae (15.4%), H. Influenzae (2.7%), others (2.6%). Young age, HIV sero positivity, S. Pneumoniae as pathogen , altered level of consciousness and seizures on admission were associated with a poor outcome. Case fatality rate was 10.7%. The highest mortality was seen in children with meningitis caused by S. Pneumoniae (38.75%), compared to influenzal meningitis (14.2%) and Meningococcal meningitis (6.6%) . Follow up was very difficult because more than 50% of the study group defaulted.