title: The incidence, aetiology and outcome of acute seizures in children admitted to a rural Kenyan district hospital.
abstract: BACKGROUND
  Acute seizures are a common cause of paediatric admissions to hospitals in resource poor countries and a risk factor for neurological and cognitive impairment and epilepsy. We determined the incidence, aetiological factors and the immediate outcome of seizures in a rural malaria endemic area in coastal Kenya.
  
  
  METHODS
  We recruited all children with and without seizures, aged 0-13 years and admitted to Kilifi District hospital over 2 years from 1st December 2004 to 30th November 2006. Only incident admissions from a defined area were included. Patients with epilepsy were excluded. The population denominator, the number of children in the community on 30th November 2005 (study midpoint), was modelled from a census data.
  
  
  RESULTS
  Seizures were reported in 900/4,921(18.3%) incident admissions and at least 98 had status epilepticus. The incidence of acute seizures in children 0-13 years was 425 (95%CI 386, 466) per 100,000/year and was 879 (95%CI 795, 968) per 100,000/year in children <5 years. This incidence data may however be an underestimate of the true incidence in the community. Over 80% of the seizures were associated with infections. Neonatal infections (28/43 [65.1%]) and falciparum malaria (476/821 [58.0%]) were the main diseases associated with seizures in neonates and in children six months or older respectively. Falciparum malaria was also the main illness (56/98 [57.1%]) associated with status epilepticus. Other illnesses associated with seizures included pyogenic meningitis, respiratory tract infections and gastroenteritis. Twenty-eight children (3.1%) with seizures died and 11 surviving children (1.3%) had gross neurological deficits on discharge. Status epilepticus, focal seizures, coma, metabolic acidosis, bacteraemia, and pyogenic meningitis were independently associated with mortality; while status epilepticus, hypoxic ischaemic encephalopathy and pyogenic meningitis were independently associated with neurological deficits on discharge.
  
  
  CONCLUSIONS
  There is a high incidence of acute seizures in children living in this malaria endemic area of Kenya. The most important causes are diseases that are preventable with available public health programs.
authors.affiliation: Centre for Geographic Medicine Research - Coast, Kenya Medical Research Institute, Kilifi, Kenya. ridro@kilifi.kemri-wellcome.org
authors.forename: Richard
authors.initials: R
authors.lastname: Idro
authors.forename: Samson
authors.initials: S
authors.lastname: Gwer
authors.forename: Michael
authors.initials: M
authors.lastname: Kahindi
authors.forename: Hellen
authors.initials: H
authors.lastname: Gatakaa
authors.forename: Tony
authors.initials: T
authors.lastname: Kazungu
authors.forename: Moses
authors.initials: M
authors.lastname: Ndiritu
authors.forename: Kathryn
authors.initials: K
authors.lastname: Maitland
authors.forename: Brian Gr
authors.initials: BG
authors.lastname: Neville
authors.forename: Piet A
authors.initials: PA
authors.lastname: Kager
authors.forename: Charles Rjc
authors.initials: CR
authors.lastname: Newton
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006767:Hospitals, District; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007239:Infections / Q000150:complications*; D007630:Kenya / Q000453:epidemiology; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data*; D011379:Prognosis; D012189:Retrospective Studies; D012424:Rural Population; D012640:Seizures / Q000453:epidemiology* / Q000209:etiology