title: Changing trends in incidence and aetiology of childhood acute non-traumatic coma over a period of changing malaria transmission in rural coastal Kenya: a retrospective analysis.
abstract: OBJECTIVE
  Recent changes in malaria transmission have likely altered the aetiology and outcome of childhood coma in sub-Saharan Africa. The authors conducted this study to examine change in incidence, aetiology, clinical presentation, mortality and risk factors for death in childhood non-traumatic coma over a 6-year period.
  
  
  METHODS
  Retrospective analysis of prospectively collected data.
  
  
  METHODS
  Secondary level health facility: Kilifi, Coast, Kenya.
  
  
  METHODS
  Children aged 9 months to 13 years admitted with acute non-traumatic coma (Blantyre Coma Score =2) between January 2004 and December 2009 to Kilifi District Hospital, Kenya.
  
  
  METHODS
  delayed development, epilepsy and sickle cell disease.
  
  
  RESULTS
  During the study period, 665 children (median age 32 (IQR 20-46) months; 46% were girls) were admitted in coma. The incidence of childhood coma declined from 93/100 000 children in 2004 to 44/100 000 children in 2009. There was a 64% overall drop in annual malaria-positive coma admissions and a 272% overall increase in annual admissions with encephalopathies of undetermined cause over the study period. There was no change in case death of coma. Vomiting, breathing difficulties, bradycardia, profound coma (Blantyre Coma Score=0), bacteraemia and clinical signs of meningitis were associated with increased risk of death. Seizures within 24 h prior to admission, and malaria parasitaemia, were independently associated with survival, unchanging during the study period.
  
  
  CONCLUSIONS
  The decline in the incidence and number of admissions of childhood acute non-traumatic coma is due to decreased malaria transmission. The relative and absolute increase in admissions of encephalopathy of undetermined aetiology could represent aetiologies previously masked by malaria or new aetiologies.
authors.affiliation: Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute, Wellcome Trust Research Programme, Kilifi, Kenya.
authors.forename: Samson
authors.initials: S
authors.lastname: Gwer
authors.forename: Nahashon
authors.initials: N
authors.lastname: Thuo
authors.forename: Richard
authors.initials: R
authors.lastname: Idro
authors.forename: Moses
authors.initials: M
authors.lastname: Ndiritu
authors.forename: Mwanamvua
authors.initials: M
authors.lastname: Boga
authors.forename: Charles
authors.initials: C
authors.lastname: Newton
authors.forename: Fenella
authors.initials: F
authors.lastname: Kirkham