Bacterial meningitis in Swaziland: an 18 month prospective study of its impact.
OBJECTIVE
To describe the epidemiology, clinical features, and outcome of bacterial meningitis in Swaziland.


METHODS
Prospective study of patients diagnosed as having meningitis of nonviral aetiology during an 18 month period from February 1991 to July 1992.


METHODS
Four regional hospitals covering the population of the four districts in Swaziland.


METHODS
All patients with non-viral meningitis admitted to hospital within the study period.


RESULTS
Altogether 85 patients were reported to have bacterial meningitis: 48.3% were aged under 1 year. Causative organisms were identified in 60% of cases, and Streptococcus pneumoniae was found to be the commonest (49% of cases). Overall, case fatality was 38.8% for all age groups, and 62.5% (15 of 25) for adults. Neurological sequelae occurred in 22.4%. Three of the adult cases were HIV seropositive. Seizures, but not duration of symptoms before admission, were associated with a poor prognosis. There was a significant rise in incidence related to a period of drought. Fifteen patients were reported with tuberculous meningitis, of whom five were known to be HIV seropositive; the case fatality was 73.3%.


CONCLUSIONS
The aetiology and age distribution of cases of meningitis differs greatly from that in developed countries. Rising HIV infection may have an important impact on the future incidence of meningitis. The high case mortality found should encourage efforts towards earlier diagnosis and treatment, and strengthens the need to develop appropriate vaccines.
Ford
H
H
Good Shepherd Hospital, Siteki, Swaziland.
Wright
J
J
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D013541:Eswatini / Q000453:epidemiology; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016920:Meningitis, Bacterial / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology; D009422:Nervous System Diseases / Q000382:microbiology; D011446:Prospective Studies; D014390:Tuberculosis, Meningeal / Q000453:epidemiology