Prospective cohort study of disabling sequelae and quality of life in children with bacterial meningitis in urban Senegal.
BACKGROUND
No studies have prospectively examined disabling sequelae and quality of life in children with bacterial meningitis in Sub-Saharan Africa.


METHODS
Objectives were to (i) follow-up pediatric bacterial meningitis surveillance system children from urban Dakar, Senegal; (ii) use standardized tools to classify disabling sequelae (Global Burden of Disease classification system) and quality of life (Pediatric Quality of Life Inventory tool); and (iii) compare these sequelae with an age- and community-matched control group.


RESULTS
Sixty-six cases and 66 controls had follow-up examinations. The odds of a major sequelae was 3 times greater in the cases (65.1%, 43/66) than the age- and community-matched control group (40.9%, 27/66) (adjusted odds ratio, 3.24; 95% confidence interval, 1.25-8.38). Hearing loss was the most common major sequelae in the cases (51.8%, 29/56) followed by cognitive deficit (40.0%, 26/65), seizures (21.2%, 14/66), and motor deficit (21.2%, 14/66). Of these cases, 34.9% (23/66) had multiple impairments. The risk of major sequelae was 79.2% (17/22) in children with previous pneumococcal meningitis, 59.1% (14/24) in Haemophilus influenzae type b meningitis, and 54.6% (6/11) in meningococcal meningitis. Total quality of life scores were significantly lower in cases (mean, 69.7; standard deviation, 25.6) than controls (mean, 84.0; standard deviation,: 14.4) (weighted mean difference, 12.98; 95% confidence interval, 6.15-19.82).


CONCLUSIONS
Children with bacterial meningitis are at high risk of complex multiple impairments and impaired quality of life. Many of these disabilities could have been averted with use of the new conjugate vaccines against Haemophilus influenzae type b, pneumococcus, and meningococcus.
Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom. karen.edmond@lshtm.ac.uk
Karen
K
Edmond
Yakou
Y
Dieye
Ulla K
UK
Griffiths
Jessica
J
Fleming
Ousseynou
O
Ba
Ndiouga
N
Diallo
Kim
K
Mulholland
D002675:Child, Preschool; D034381:Hearing Loss; D006801:Humans; D007223:Infant; D016920:Meningitis, Bacterial / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology; D016017:Odds Ratio; D011446:Prospective Studies; D011782:Quadriplegia / Q000453:epidemiology / Q000382:microbiology; D011788:Quality of Life; D012675:Senegal / Q000453:epidemiology; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data