Acute bacterial meningitis in children presenting to the Royal Liverpool Children's Hospital, Liverpool, UK and the Queen Elizabeth Central Hospital in Blantyre, Malawi: a world of difference
- 1 March 2006
- journal article
- research article
- Published by Taylor & Francis Ltd in Paediatrics and International Child Health
- Vol. 26 (1), 29-37
- https://doi.org/10.1179/146532806x90583
Abstract
Bacterial meningitis is a serious childhood illness worldwide. Children can now be immunised against meningitis with conjugate vaccines. The outcome of bacterial meningitis in British and Malawian children before the introduction of these vaccines was compared. All children with culture-positive bacterial meningitis treated in the Royal Liverpool Children's Hospital (RLCH), UK during 1984-1991 (n=197) and in the Children's Unit, Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi during 1996-1997 (n=175) were studied. Children at QECH presented later and were more often comatose and malnourished. Mortality was 7% in RLCH compared with 41% in QECH. Three organisms caused most cases of meningitis: N. meningitidis 56% vs 4%, H. influenzae b 27% vs 25%, and S. pneumoniae 11% vs 35% in RLCH and QECH, respectively. Mortality was lower in RLCH for each organism: N. meningitidis 10% vs 28%, H. influenzae b 6% vs 43%, S. pneumoniae 0% vs 46%. Mortality from bacterial meningitis in Malawian children is much higher than in British children, even when infected with the same organisms. This might be owing to delay in presentation, malnutrition and HIV infection. Immunisation of Malawian children with conjugate vaccines should continue to develop since their risk of dying from meningitis is five times greater than that of British children.Keywords
This publication has 21 references indexed in Scilit:
- Poor Potential Coverage for 7-Valent Pneumococcal Conjugate Vaccine, MalawiEmerging Infectious Diseases, 2003
- Chloramphenicol or ceftriaxone, or both, as treatment for meningitis in developing countries?Archives of Disease in Childhood, 2003
- Dexamethasone treatment in childhood bacterial meningitis in Malawi: a randomised controlled trialThe Lancet, 2002
- Acute bacterial meningitis in children admitted to the Queen Elizabeth Central Hospital, Blantyre, Malawi in 1996–97Tropical Medicine & International Health, 1998
- Dexamethasone and bacterial meningitis in Pakistan.Archives of Disease in Childhood, 1996
- Changing patterns of invasive Haemophilus influenzae disease in England and Wales after introduction of the Hib vaccination programmeBMJ, 1996
- Urgent full blood count in children over 3 months of age with bacterial meningitis.Emergency Medicine Journal, 1995
- Outcomes of bacterial meningitis in childrenThe Pediatric Infectious Disease Journal, 1993
- Rapid disappearance of Haemophilus influenzae type b meningitis after routine childhood immunisation with conjugate vaccinesThe Lancet, 1992
- Failure of chloramphenicol therapy in penicillin-resistant pneumococcal meningitisThe Lancet, 1992