Acute bacterial meningitis among children, in Manhiça, a rural area in Southern Mozambique.
BACKGROUND
Acute bacterial meningitis (ABM) is one of the most severe diseases in Sub-Saharan Africa. Although data for the continent is very limited, more than one million cases are estimated per year, with mortality and life-long sequelae occurring in 50% of these cases.


METHODS
As part of the clinical management of children admitted to the Manhiça District Hospital, information on cases of ABM was recorded. We analysed data from June 1998 to November 2003.


RESULTS
During the study period, 475 cerebrospinal-fluid (CSF) samples were collected from 20,173 children <15 years of age admitted to hospital. Culture results confirmed 71 (15%) cases of ABM. The most prevalent bacterial aetiologies were Streptotoccus pneumoniae (pneumococcus, n=31), Haemophilus influenzae (n=13) and Neisseria meningitis (n=8). Other important bacteria were Streptococcus sp. (n=7), Salmonella sp. (n=4) and Staphylococcus aureus (n=3). Crude incidence rates of ABM and pneumococcal meningitis were 20/100,000 and 10/100,000 children-year-at-risk, respectively. Incidences were more than three times higher in the <1 year age group. Overall case fatality rate was 36%, and was highest for H. influenzae and pneumococcal meningitis (55% and 45%, respectively, p=0.044). Pneumococcal susceptibility was 81% for oxacillin and 93% for chloramphenicol. For H. influenzae isolates, susceptibility was 54% for ampicillin and 62% for chloramphenicol.


CONCLUSIONS
S. pneumoniae and H. influenzae are the main aetiologies responsible for the high burden of morbidity and mortality associated with ABM in rural Mozambique. These findings are important to evaluate treatment guidelines and potential impact of control measures.
Sigaúque
B
B
Centro de Investigação em Saúde da Manhiça, Ministerio de Saúde, Road No. 12, CP1929 Maputo, Mozambique.
Roca
A
A
Sanz
S
S
Oliveiras
I
I
Martínez
M
M
Mandomando
I
I
Vallès
X
X
Espasa
M
M
Abacassamo
F
F
Sacarlal
J
J
Macete
E
E
Nhacolo
A
A
Aponte
J
J
Levine
M M
MM
Alonso
P L
PL
D000293:Adolescent; D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D002555:Cerebrospinal Fluid / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016920:Meningitis, Bacterial / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D008826:Microbial Sensitivity Tests; D009073:Mozambique / Q000453:epidemiology; D012424:Rural Population
D000900:Anti-Bacterial Agents